Back pain can range from a nagging nuisance to a raging torture. Nerve and muscular problems, degenerative disc disease and arthritis can all trigger pain, and there are wide variety of surgical and non-surgical treatments for various back conditions.
Dr. Stuart Kinsella, who arrived in Vero just last summer, is an orthopaedic surgeon with Vero Orthopaedics. He specializes in injuries and conditions of the back and neck, and has expertise in open and minimally invasive spine surgery as well as robotic and navigation assisted spine surgery. But just because he can do something surgically to relieve the pain, doesn’t mean he pushes a surgical solution.
“My goal is to avoid surgery completely, if possible,” Dr. Kinsella said. “And if I have to do surgery, I do the most specific surgery possible to help their symptoms. Back surgery is not the same for everyone and it’s not the picture I’m treating; it’s the patient. It doesn’t matter what their picture looks like. It could be really bad or really good. If there’s a connection between what they are saying and what I can see, I fix that specific problem and not fix anything that isn’t causing a problem.”
Lower back pain – one of the most common ailments out there – will typically respond to nonsurgical treatment such as inti-inflammatory medications, heat and physical therapy. If you can get the inflammation to go down, you can feel better without physically decompressing that nerve.
If the pain continues, your doctor may advise you to get X-rays to isolate the source of the pain. Short courses of oral steroids as well as epidural steroids (injections of medication on the nerve directly) are other non-surgical methods of treatment.
“The injections to the spine have both numbing medication and steroids in them, and while they work very well, they don’t last that long,” said Dr. Kinsella. “From a diagnostic perspective, what happens during the first 24 hours after an injection can isolate the source of the problem. If you get complete relief from numbing one of the nerves at a certain spot in the spine but it only lasted a day, you have learned exactly where that problem lies and can narrow it down to the specific cause. Knowing that can lead to less invasive surgery if needed.”
Spinal stenosis – the narrowing of the spinal canal, which causes pressure on the nerves – is identified by the source of the pain. Cervical stenosis occurs in the upper/neck part of the spine and can radiate down the arm to the hand or fingers, or cause numbness or tingling in the shoulder or arm.
Lumbar spinal stenosis is a narrowing of the spinal canal in the lower back. It compresses the nerves traveling through the lower back into the legs. While it can occur in younger patients, it more often is a degenerative condition that affects people in their 60s and older. Usually nerve compression is caused by arthritis or disc degeneration. In general, it’s a process that happens over time. Part of the arthritis process is bony overgrowth, and when that happens in a spinal canal, it can push on the nerves. The recommended treatment for this condition usually is surgery.
“When you have lumbar stenosis, the spinal cord usually ends around L-1 so in most of the lower back it’s actually nerve roots floating in a sac,” explained Dr. Kinsella. “It’s kind of like strands of spaghetti floating in a clear fluid in a see-through membrane. You can actually see the nerves floating in there. Some people have stenosis so severe that all those nerves will bunch up. If during surgery you take out the bone or arthritis that is pushing on that sac, you can actually watch it expand giving the nerves room to float when they used to be squished together. By giving them space the pain is diminished or alleviated.”
Herniated discs, also known as pinched nerves or bulging discs, occur when the spinal disc, which acts as a shock absorber between the vertebrae, leaks some of its inner material and aggravates a nerve, causing pain, numbness and weakness. Disc herniation symptoms usually start for no apparent reason. Or they may occur when a person lifts something heavy and/or twists the lower back, motions that put added stress on the discs. Fortunately, 95 percent of herniated discs and the symptoms they cause through nerve compression can get better without surgery.
While Dr. Kinsella is an expert in robotic navigation surgery, he doesn’t generally use it for cervical surgeries. “Most of the straightforward degenerative procedures aren’t significantly aided by robot navigation assistance beyond the free hand techniques,” he said. “But in the setting of complicated revisions and deformities such as scoliosis, the robot in real-time navigation is extremely useful. Robotics and navigation surgery is taking over and there are so many advances in the area. One of the goals I had coming down here was to bring this advanced technology to the Treasure Coast to provide the care that was otherwise unable to be done here. I brought the first Excelsius GPS Robotic Navigation Platform to the east coast of Florida and it’s now housed at Sebastian River Medical Center.
“I fell in love the spine because it has such an impact on our lives and I wanted the opportunity to help people get their health back,” recalled Dr. Kinsella. “During my medical training we had a patient who had a very compressed lumbar spine and by decompressing the spine and sac I could actually see the nerves expanding and their color improving. When I looked back on the MRI and made the connection, it showed how powerful that kind of surgery can be when it’s done correctly.”
Dr. Stuart Kinsella moved to Vero Beach last August after completing his spine surgery fellowship at Beth Israel Deaconess Medical Center/Harvard Medical School in Boston, and is proud to be part of the Vero Orthopaedics team of surgeons. He can be reached at 772-569-2330.