“Most people with back pain have completely the wrong idea about where to go for the right help.” That’s coming from someone who really knows what he’s talking about: spinal specialist Dr Urs Iwan Zuberbühler is a consultant in orthopedic surgery and musculoskeletal traumatology – working, among other places, at the Neuro and Spine Center at the Hirslanden Andreasklinik in Cham. He also works as an affiliated doctor at several renowned clinics in Switzerland. In this interview, Dr Zuberbühler, who also enjoys a strong reputation as a pain specialist and scoliosis surgeon, explains what patients with back pain should do.
Leading Medicine Guide: Dear Dr Zuberbühler, in our experience, back pain is often not taken very seriously, even when it has been affecting people for a long time. Many people initially try to manage it with the usual home remedies – is that wrong?
Dr Urs Iwan Zuberbühler: It’s not wrong, at least not initially. Often the pain does indeed go away after a short time. Around sixty to seventy per cent of common back pain is localized in the lower part of the spine. There are a number of remedies available, ranging from hot water bottles and ointments to special plasters from the chemist. If these help, then the goal is achieved. However, if the pain keeps coming back, almost daily, if it’s always the same kind of pain, and you can’t recover from it at all, then you really should take urgent action.
Leading Medicine Guide: And where should someone turn if they are constantly plagued by back pain?
Dr Urs Iwan Zuberbühler: In this case, it certainly makes sense to seek advice at a spinal center. Yet many people worry that this is too specialized for their back pain and that such centers primarily treat and operate on difficult cases. That is simply not true: spinal medicine is the domain of the spinal surgeon. We treat back pain, but also pain and weakness in the legs caused by nerve irritation.
Leading Medicine Guide: So people’s self-diagnosis often prevents them from taking the right action?
Dr Urs Iwan Zuberbühler: Exactly, because the first step in treatment is identifying the cause of the symptoms – this requires the most accurate diagnosis possible. We spinal surgeons treat absolutely every type of back pain. For us, there is no such thing as ‘simple’ back pain; instead, we prioritize precise diagnosis and targeted treatment – primarily conservative, but surgical if necessary.
Leading Medicine Guide: However, with back pain, physiotherapy is often prescribed for a certain period, and most patients simply come to terms with the fact that the pain accompanies them to a greater or lesser extent in their daily lives.
Dr Urs Iwan Zuberbühler: As I said, an accurate diagnosis is crucial for back pain. Once the cause of the back pain is known, treatment can be tailored to the specific issue. Very often, follow-up physiotherapy based on the diagnosis proves successful. The causes of back pain are multifactorial. That is why interdisciplinary care for patients is very important. Back pain belongs in the hands of a specialist who, using their expertise, can determine exactly what is causing the pain. Because there is no single cause for back pain.
Back pain has many causes
Leading Medicine Guide: But?
Dr Urs Iwan Zuberbühler: Degenerative changes in the intervertebral discs or facet joints, or irritation of the nerve roots, can cause pain in the lower back. Similarly, poor posture, muscle weakness, obesity or osteoporosis, a slipped disc, a joint blockage or a previous fall can contribute to back pain. However, there are also causes of pain in the spinal region that are linked to inflammatory reactions in the internal organs and are triggered, for example, by the intestines, the kidney and bladder area, or gynecological causes.
Leading Medicine Guide: Nevertheless, many people will think that a spinal center or a spinal surgeon is not quite the right choice for their relatively simple back pain.
Dr Urs Iwan Zuberbühler: Many patients are afraid that a spinal surgeon would only be interested in performing an operation. However, this preconception is incorrect. Spinal medicine is primarily about assessment, education and counseling the patient. We do not operate on eighty per cent of our patients; instead, we treat them using a range of other options. Those who come to us are not discussing surgery; they come for a detailed diagnosis and targeted therapy, which is primarily non-surgical.
Leading Medicine Guide: What does the diagnostic process look like when it comes to back pain?
Dr Urs Iwan Zuberbühler: The standard procedure is a detailed consultation with the patient. A thorough clinical examination is the next step, followed by an X-ray, MRI or, if necessary, a CT scan. If required, additional neurological and electrophysiological examinations are carried out. Once all the examination data is available, the results are discussed, along with possible treatment options.
MRI
Magnetic resonance imaging (MRI) is an imaging examination. Magnetic waves are used to generate precise, millimeter-accurate cross-sectional images of the body’s interior. This allows even small changes to be visualized. Unlike an X-ray, the body is not exposed to radiation during this procedure.
Leading Medicine Guide: Many cases of back pain have psychological causes. How can you identify this, or perhaps better still, ‘filter it out’?
Comprehensive diagnosis: “I build a relationship with my patients!”
Dr Urs Iwan Zuberbühler: As a spinal surgeon, I build a relationship with my patient. Once a proper assessment has been carried out, I explain the examination results in detail. Only then does targeted, individualized treatment begin, for example with physiotherapy, osteopathy or interventional pain management, i.e. infiltration. Throughout the course of treatment, I see the patient regularly and monitor how successful the targeted interventions are. To identify psychological causes of the symptoms that arise – as a doctor, you have to be very vigilant; this requires a great deal of observation, conversation and listening. During these discussions, I also explain which mechanisms can lead to symptoms. These include poor posture, lack of exercise, and sometimes even incorrectly performed sports, as well as mental states involving stress or overload. Spinal medicine is a very complex field.
What is an infiltration for back pain?
Infiltration involves injecting a mixture consisting of a local anesthetic and an anti-inflammatory drug directly into the source of the pain. This reduces irritation, inhibits inflammation – and relieves the pain. Following an infiltration, temporary sensory disturbances or even muscle weakness may occur. Rest is therefore recommended: it is best to lie down and wait until the effect sets in.
Leading Medicine Guide: That is rather surprising – that a spinal surgeon does not primarily perform surgery.
Dr Urs Iwan Zuberbühler: Of course we operate! However, surgery is always the last resort in pain management. In fact, only around twenty per cent of patients from our clinic require an operation. There are so many conventional ways to reduce lower back pain. However, physiotherapy simply on a hunch is often of little help. Around sixty to seventy per cent of back pain is caused by degenerative changes; in such cases, we proceed step by step, see the patient regularly and monitor how successful the treatment is.
Leading Medicine Guide: When is surgery really necessary – for example, in cases of herniated discs?
Dr Urs Iwan Zuberbühler: Surgery is indicated following unsuccessful conservative treatment of the pain or in the event of neurological deficits such as sensory disturbances or motor weakness in the leg. In such cases, the operation should be carried out promptly to prevent permanent damage.
© bilderzwerg / Fotolia
Eighty per cent of herniated discs can be treated effectively with conservative methods or injection therapy. Surgery is only recommended in cases of neurological deficits, but even then it must be carried out promptly to prevent permanent damage. Bladder emptying problems associated with a herniated disc, for example, are a medical emergency.
“A spinal center focuses on diagnosis, information, advice and precisely tailored treatment”
Leading Medicine Guide: As a patient with back pain, what is the sensible thing to do when choosing a doctor?
Dr Urs Iwan Zuberbühler: There’s nothing wrong with seeing your GP first. However, if the pain does not improve within a reasonable timeframe, you should ask to be referred to a specialist – though this does not mean that surgery will be performed straight away. A spinal center focuses on diagnosis, information, advice and precisely tailored treatment. Simple back pain that isn’t caused by a vertebral fracture is rarely treated with surgery.
Leading Medicine Guide: Dr Zuberbühler – thank you very much for these interesting insights!
You can find out more about this experienced expert here on his profile page.
