Solutions for Back Problems

with James Stoll, M.D., Spine Surgeon, Columbia St. Mary’s

Posted: May 1, 2005

Backaches can sometime knock you flat on your back and interfere with the normal, everyday activities of daily life. So if you’re coping with the severe pain and discomfort of a significant back problem, seeing a spine specialist is the thing to do. But what can you expect from that initial visit?

Dr. James Stoll, spine surgeon with Columbia St. Mary’s Spine Services and a member of the Milwaukee Institute of Minimally Invasive Surgery, said clear concise, two-way communication between doctor and patient is vital in that initial visit. “The patient must understand what’s happening and not to be afraid of what’s going on,” he said.

“I encourage patients to bring a second set of ears to our meeting – spouse, family member or a friend – to hear and understand my explanations. I also urge them to write a list of questions in advance of our meeting.

James Stoll, M.D., Spine Surgeon, Columbia St. Mary’s "My job as an orthopaedic surgeon is to review a patient’s medical history and prior tests to assure that the medical problem has been accurately identified."

“There are many advanced medical technologies we can apply to solve a patient’s back problem, but the best outcomes come from appropriately identifying that problem before the patient goes into the operating room,” he explained.

According to Dr. Stoll, there are many causes of back problems. “But there are two primary types: nerves in either the neck or lower back that are being squeezed causing acute, severe pain; and mechanical or structural problems,” he said.

“We can usually treat the nerve pain with less invasive or endoscopic surgery that can remove the pressure on the nerve. Mechanical problems, the second type, are more difficult. They require more sophisticated reconstructive surgeries, like spinal fusions. The technology for doing these less invasively is still under development.”

Identifying the problem is key
The step that’s most important in the process is figuring out exactly what’s wrong with the patient and developing a treatment plan that addresses the problem and gets that person back to living a normal, productive life.

“My job as an orthopaedic surgeon is looking at the quality of the data – the medical history and tests – that the patients bring to me and making sure the problem is accurately identified. I spend a lot of time in my office doing diagnostic studies and prescribing non-operative care. That’s very different than what patients usually think when they first walk into my office. They think all we’ll be talking about is surgery. Often I don’t even mention that. I go back over their medical information and make sure it’s completely clear.”

Dr. Stoll said diagnostic tools have become much more sophisticated now than what they were 20 years ago. “For example, we can do a simple test like a MR scan and sometimes replace an invasive test called a myelogram. We also have electrical studies that can look at nerves and tell us about the physiology.”

Non-surgical treatment is almost always tried before surgery, he said. It usually includes anti-inflammatory medication, physical therapy to strengthen the back and abdomen, and cortisone injections to reduce inflammation and pain. If these do not help, surgery becomes an option. In his practice, he considers surgery when a patient can’t walk a block without pain.

Important questions to ask
Dr. Stoll suggested patients ask the following questions when considering back surgery:

What’s wrong with my back?
“The patient needs a clear, concise explanation about the problem. It should be phrased in words and concepts that the patient can understand.”

What are you going to do to resolve my problem?
“There are three alternatives:

1. Non-operative care, such as physiotherapy, exercise and medicines.
2. Intermediate care, such as cortisone shots.
3. Surgical. If surgery is needed, the patient must understand what the doctor is proposing to do. That must be clearly enunciated and understandable. No surgery should be done until the patient understands the procedure and its ramifications. If the patient doesn’t understand, the doctor should delay the surgery or treatment until understanding is achieved.”

Dr. Stoll advises getting a second medical opinion if a patient experiences any doubt or has unanswered questions. “You need a consensus of opinion, an agreement, if you’re going to have any invasive procedure done on you – because you’ve got one really good shot at having your problem fixed. If done correctly, the first operation has a much better success rate than any subsequent operations.”

According to Dr. Stoll, the diagnostic and proposed treatment information given to the patients is not beyond the patient’s comprehension. “It boils down to the importance of good doctor-to-patient and patient-to-doctor communication,” he reiterated, “and the patient should be comfortable with the doctor and what the doctor advises.”

James E. Stoll, MD
Midwest Spinal Center
2015 E. Newport Avenue, #605
Milwaukee, WI 53211
414-962-8600

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