Consulting a Spine Specialist
Appointment Preparation and What to Expect
Back and neck pain is the foremost reason why people seek medical attention. For some people, back pain is a one-time inconvenience, while other patients suffer episodic spine problems throughout their life. Approximately 80% of the population in the United States will at some time be affected by back or neck pain. This figure is expected to climb as the population as a whole ages. Often pain is accompanied by other symptoms that include numbness, tingling, and extremity weakness.
Unfortunately there is no 'magic bullet' to halt aging. However, great strides have been made in medicine and the health sciences to increase longevity and expand quality of life. When back or neck pain strikes - it may be wise to seek the opinion of a physician that specializes in spine care. Most patients find a qualified spine specialist through referral from their primary care physician or other treating practitioner.
Orthopaedic spine surgeons and neurosurgeons are physicians who have completed additional years of medical training to diagnose and treat disorders affecting the spine. Often these specialists have received advanced training such as a fellowship in spine care. Spinal disorders include scoliosis (sko-lee-oh-sis), osteoarthritis (os-t-o-arth-rye-tis), osteoporosis (os-t-o-pour-o-sis), herniated disc (her-knee-ate-ed disc), spinal stenosis (spinal sten-oh-sis), trauma, vertebral fracture, deformity, tumor, infection, and congenital abnormalities.
Consulting a spine specialist is similar to a visit with a primary care physician (PCP) - except the focus is on the spine. The consultation includes a physical and neurological examination and review of the patient's medical history and current symptoms. The following suggestions are provided to help patients prepare:
1. Write down your medical history, family history and all medications including over-the-counter drugs, vitamins and herbs. Include allergies and side effects experienced from medications (or other substances) taken in the past.
2. List all symptoms. Describe the type of pain, location, when it started and activities that aggravate or alleviate symptoms.
3. Bring a copy of reported results from diagnostic tests or studies (e.g. x-ray, blood work). If possible, bring the actual x-ray, MRI, CT Scan, or other imaging study/film.
4. List the names and contact information of other medical professionals or practitioners who are currently treating or who have treated the condition.
5. Write down questions and concerns.
6. Bring an extra set of 'ears' such as a family member or friend to the consultation.
What to Expect
New patients complete forms to provide information about their medical and family history, previous surgery/ies, allergies, and current medications. A universal pain diagram is provided to help the patient illustrate the location and characteristics of their pain. The diagram is a drawing of the front and back of the body. The patient indicates where pain is felt using symbols, grades the intensity and type of pain, as well as other sensations such as numbness or weakness.
Prior to meeting the spine specialist, the medical assistant or nurse may weigh the patient, measure height, and take the patient's blood pressure and pulse. The spine specialist will review the written information provided by the patient and ask many questions. Questions may include:
•When did the symptoms begin?
•Was the onset of symptoms gradual or sudden?
•Does the pain radiate into the arms or legs (extremities)?
•Was there a specific event such as a car accident that preceded the symptoms or is this a recurring problem?
•How does the condition affect your life? For example, does it prevent you from working, driving a car, walking, or other daily activities?
Prior to the examination, the patient changes into a gown. The physician inspects and feels (called 'palpation', pal-pay-shun) the spine for muscle tenderness and spasm. With the patient standing, the shoulders and hips are checked to determine if they are of equal height bilaterally (left, right sides). Spinal range-of-motion is evaluated as the patient turns their head from side-to-side; bends their head toward the shoulder; twists the shoulders from side-to-side; bends forward at the waist to touch their toes, from side-to-side, and then backward.
While the patient is lying on their back (called 'supine', sue-pine), the physician may raise each of the patient's legs - this test is called straight leg raises. Each straight leg raise may be combined while the patient dorsiflexes (door-see-flexes) the foot (toes pointed toward the head). Further, each leg is measured to determine if the legs are of equal size and length.
The findings from the physical examination determine the extent of the motor and sensory evaluation. Typically, a neurological examination may include:
1. The patient walks back and forth, heel-to-toe, on tip-toe and on the heels. During these exercises, the physician observes the patient's posture, balance, and extremities (arms, legs) during movement.
2. Balance is observed as the patient stands with both feet together without arm support. This test (called the Romberg Test) is repeated with the eyes open and closed.
3. The physician provides resistance against the patient's force. For example, with the patient seated, the patient lifts their left knee and tries to hold it up against the gentle downward force exerted by the physician's hand. Resistance exercises test muscle strength, flexion and extension.
4. A pinwheel instrument is gently moved across the same area of each leg (e.g. calf, thigh) to determine if the patient feels the same sensations in each leg. A tuning fork may be used to determine if the patient perceives vibration.
5. A rubber-tipped reflex hammer is gently tapped against one or more tendons in the arms or legs (e.g. elbow, knee). The reflexes can be tested when the patient is sitting or standing.
6. The physician moves his finger up, down, and from side-to-side to test the patient's ability to follow the movement with their eyes.
Each piece of information obtained from the patient about their condition is used to form the diagnosis and to determine the next step in the patient's care. Sometimes further diagnostic testing is required to confirm the physician's findings or to provide more information about the extent of the patient's spinal disorder.
This article is an excerpt from Dr. Stewart G. Eidelson's book, Advanced Technologies to Treat Neck and Back Pain, A Patient's Guide (March 2005).