Gnawing, nagging back pain. It dooms your day and denies you sleep at night. Sometimes it keeps you from standing, other times from sitting and all too often from enjoying life to its fullest. Back pain is so common that an estimated 80 percent of people will experience an episode lasting a week or longer at some point in their life — making it second only to the common cold in causing lost work productivity.
David Slocum, a carpenter from Short Pump, knows all too well how chronic back pain can disrupt one’s life and livelihood. For years he’s battled pain; and though his job requires physical labor, he doesn’t attribute his back ailments solely to his work.
“My back problems were a cumulative effect,” says Slocum, who is 54. “I played a lot of sports in high school and college, and then rugby for the last 12 years plus weightlifting and the gym. Maybe some of it’s congenital, but there’s also my age.”
BACKGROUND ON THE BACK
Throughout the length of the spine is a central tube, the spinal canal, inside which are the spinal cord and spinal nerves. Vertebrae and disks surround and protect the spinal canal. Slocum had developed degenerative disk disease that over time produced spinal stenosis, narrowing of the spinal canal that causes compression of the spinal nerves. As a result, a searing pain traveled down his leg, known as sciatica. Years later another bout of sciatica was related to a herniated disk.
In both cases, symptoms worsened over time, but Slocum delayed surgery as long as he could. Like many back-pain sufferers, he tried various remedies to alleviate the pain — occasional over-the-counter medications, heat, cortisone injections and even a new mattress — but nothing helped.
“What put me over the edge was not getting any sleep,” he says. “At night the pain would wake me up, and then with no sleep I’d be grumpy and irritable the next day.”
TIME FOR SURGERY?
So when does back pain escalate from a common occurrence taken in stride to a condition meriting medical attention and perhaps surgery? Dr. J. Michael Simpson, a board-certified and fellowship-trained spine surgeon with Tuckahoe Orthopaedic Associates, says back pain should be thoroughly evaluated when it becomes significant or debilitating and lasts more than two weeks. “If the patient’s primary complaint is back pain without neurologic symptoms, conservative management … is in order,” says Simpson. That includes exercise, physical therapy and anti-inflammatory medication. “[However,] when the pain is neurologically based (sciatica) and is persistent and limits normal daily function, it raises another level of concern.”
Open decompression surgery, medically referred to as a laminectomy, was Simpson’s recommendation for Slocum because his persistent sciatica was unresponsive to conservative measures. The procedure involved an incision in the lower back (lumbar region) and removal or trimming of the protruding vertebrae’s bony “roof,” known as lamina. The procedure opened up space in the spinal canal, relieving pressure and pain. During Slocum’s second episode, a more limited surgical procedure successfully removed a disk fragment decompressing the nerve.
NINETY PERCENT SHOW IMPROVEMENT
Patients undergoing a laminectomy face a 1 percent risk of spinal fluid leak, nerve damage or infection, but predicted outcomes typically make surgery worth the minimal risks. Simpson, who performs approximately 500-600 spinal procedures per year, estimates that when correctly diagnosed, 90 percent of laminectomy patients report decreased pain and increased function shortly after the procedure.
“Instant relief” is how Slocum describes the aftermath of his surgeries, the first of which was performed at Henrico Doctors’ Hospital and the second at Bon Secours St. Mary’s Hospital. “They really were no big deal. Sure, I was sore, but after the fourth or fifth day [of recovery] I realized I should have done it a long time ago.
“You see, I work with my hands and fix things. When something is broken, I say you need to go get it fixed. So I told Dr. Simpson to just fix it.” And he did.
Lynn Kirk is a Richmond-based freelance writer and public relations consultant. Contact her at
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