In these uncertain times, it can be difficult for patients to know when to seek neurosurgical care for spine conditions. Many patients are apprehensive about coming in for an evaluation for fear of being exposed to COVID-19 in a hospital setting. Some people simply put off the issue and deal with pain, while others wait until their symptoms are so bad that they end up in the Emergency Room.
To help with making the right decision, my general approach is to separate patients into emergent, urgent, and non-urgent categories.
- Emergent issues are those which arise suddenly or unexpectedly and include significant arm or leg weakness and bowel or bladder dysfunction. These patients should come to the Emergency Room right away.
- Urgent issues include severe pain, mild arm or leg weakness and trouble with balance. These conditions are best evaluated in a timely manner in an outpatient setting.
- Non-urgent issues include chronic pain and mild to moderate acute pain without weakness – typically, these are best treated by physical therapists and pain physicians.
Some of the most common conditions we treat are herniated discs in the neck and lower back. These typically cause arm or leg pain and sometimes numbness, tingling and weakness. Unless significant weakness is present, the initial course of treatment is usually conservative and directed by the primary care physician. This often includes medications, physical therapy and steroid injections. If there is no improvement after a month or two, a neurosurgeon consultation is warranted to discuss possible surgical treatment.
Another common issue we encounter is spinal stenosis. These patients typically have trouble walking more than a few blocks without developing weakness or numbness in the legs. Sitting down or leaning forward (e.g., on a shopping cart) often relieves these symptoms. If there is no response to conservative treatment, a minimally-invasive laminectomy surgery is very effective in improving the ability to walk and provides a significant increase in quality of life for these patients.
These are a few examples of conditions that should be evaluated by a neurosurgeon. With the recent easing of restrictions on outpatient visits and elective surgeries, our office is once again open for new patient evaluations. To ensure patient and staff safety, we take all necessary precautions to avoid exposure to COVID-19. Both patients and providers are required to have their temperature checked, wear a mask and sanitize their hands or wear gloves. Another option is a virtual visit, where a patient receives a consultation via a video conference through the My Rush app on their phone. And as always, our phone lines are open for any questions and concerns.