spine specialist with patient

Dr. Bono (right) and his spine surgeon team strive to ease back pain with the least amount of surgery possible.

Dr. Christopher Bono, Chief of the Department of Orthopedic Surgery’s Spine Service, has a habit of talking patients out of spine surgery. It’s not that he doesn’t want to help you – quite the contrary.

Spine surgeons in Dr. Bono’s practice end up performing surgery on less than 25 percent of the more than 800 patients that they see each year. Dr. Bono is proud of that low rate, as his team’s goal, as ironic as it may seem, is to perform the least amount of surgery possible. His rationales for this objective are that spine surgery, even in the hands of its best surgeons, is a very risky proposition, and the vast majority of patients with back pain can be treated effectively without surgery.

The universal goal of Dr. Bono’s patients is that they want to eliminate, or at least minimize, their back pain. Unfortunately, determining the source of that pain is quite elusive when there are no abnormal findings on an MRI. “We don’t have a very good grasp of where back pain comes from,” explains Bono. “Can it come from disks? Yes. Can it come from the bones and the ligaments and the muscles? Yes. But we can never be sure where it comes from because we don’t have any diagnostic tests for pain. We have diagnostic tests for anatomy.”

In cases where back pain is localized to the central back and doesn’t occur regularly, says Dr. Bono, a patient can be treated by a primary care physician (PCP) with non-narcotic medications and counseling. By taking a short course of medication, gradually returning to non-strenuous physical activity, and getting short periods of bed rest, a patient with this type of condition should get better within a matter of days.

If the pain consistently occurs two or three times a year, or the pain lasts longer than a few days, a non-operative treatment like physical therapy might be warranted. This treatment should be accompanied by counseling aimed at discovering potential causes (e.g., bad body mechanics, poor physical condition) and remedies for that pain.

When back pain becomes chronic – at least two or three episodes per month – your PCP might order an x-ray and an MRI and refer you to a physiatrist, a spine expert who specializes in non-operative treatments. These specialists focus on educating patients about their condition and the benefits of exercise therapy, along with prescribing medications and administering minimally invasive injections to treat pain and restore function.

When an MRI suggests abnormalities that are clearly identified causes of back pain, such as infection, tumor, disk herniation, or spinal stenosis (narrowing of the spinal column), surgery – to either decompress nerves or stabilize the spine – becomes a consideration. A patient with one of these conditions typically has back pain that radiates to other parts of the body, especially the lower extremities. Even then, in most cases, exploring non-operative treatments will be the initial strategy.

If exhaustive non-operative treatments fail to diminish the pain, a patient is still faced with a weighty decision. Spine surgery carries significant risks, including nerve damage, paralysis, and infection. And, as with any surgery, spine surgery doesn’t come with a guarantee.

Yet, despite the risks, Dr. Bono knows from experience that spine surgery can dramatically improve the lives of certain patients. “They can barely get through their day, and they’d rather take the risk on the operation than continue to live the way they are,” says Bono. “And at that point, I think it’s a clear-cut decision for them.”

Watch a video about spinal disorders: Common Spinal Disorders: What Is Appropriate Treatment?

– Chris P

comments (2)