Spine Surgery: When Is It Right for You?

James Kang, MD, Chief of the Department of Orthopaedic Surgery at Brigham and Women’s Hospital (BWH), has a habit of talking patients out of spine surgery. It’s not that he doesn’t want to help you – quite the contrary.

Spine surgeons in his practice perform surgery on less than 10 to 20 percent of the more than 800 patients they see each year. Dr. Kang is proud of that low rate, as his team’s goal, as ironic as it may seem, is to perform the least amount of surgery possible.

“Even in the hands of the best surgeons, there are certain risks associated with spine surgery, and the vast majority of patients with back pain can be treated effectively without surgery,” says Dr. Kang.

Most of Dr. Kang’s patients want to eliminate, or at least minimize, their back pain. Unfortunately, determining the source of that pain is elusive when there are no obvious correlating abnormalities on an MRI.

“We don’t always have a very good grasp of where back pain comes from,” explains Dr. Kang. “Can it come from disks? Yes. Can it come from the bones and the ligaments and the muscles? Yes. But we can never be sure where it comes from because we don’t have any diagnostic tests for pain. We have diagnostic tests for anatomy.”

In cases where back pain is localized to the central back and doesn’t occur regularly, says Dr. Kang, a patient can be treated by a primary care physician (PCP) with non-narcotic medications and counseling. By taking a short course of medication, gradually returning to non-strenuous physical activity, and getting short periods of rest, a patient with this type of condition should get better within a matter of days.

If the pain consistently occurs two or three times a year, or the pain lasts longer than a few days, a non-operative treatment like physical therapy might be warranted. This treatment should be accompanied by counseling aimed at discovering potential causes (e.g., poor body mechanics, or poor physical condition) and remedies for that pain.

When back pain becomes chronic – at least two or three episodes per month – your provider might order an X-ray and an MRI and refer you to a physiatrist, a spine expert who specializes in non-operative treatments. A physiatrist focuses on educating patients about their condition and the benefits of exercise therapy. They also prescribe medications and administer minimally invasive injections to treat pain and restore function. Most patients with low back pain alone will not require surgery.

“When patients present with low back pain, which includes pain that radiates down the leg (sciatica), this may signal a more serious condition whereby the nerves in the spine are being compressed,” says Dr. Kang.

The most common conditions that cause such neurologic symptoms (leg pain, numbness or weakness) are herniated discs or spinal stenosis. Less frequently, causes may be infections or tumors.

A physician uses an MRI to diagnose these conditions, and in some instances, surgery may be required so permanent nerve damage does not occur. In fact, spine surgery for these neurologic conditions are very successful in improving these symptoms and restoring the quality of life that patients seek.

Some common surgeries that are performed for these conditions include microdiscectomy, laminectomy, and spinal fusion. However, it must be emphasized that all surgeons will still use conservative measures prior to considering surgery.

If non-operative treatments fail to diminish the pain, a patient is still faced with a weighty decision. Spine surgery carries significant risks, including nerve damage, paralysis and infection. And, as with any surgery, spine surgery doesn’t come with a guarantee.

Yet, despite the risks, Dr. Kang knows from experience that spine surgery can dramatically improve the lives of certain patients.

“Some patients can barely get through their day, and they’d rather take the risk on the operation than continue to live in pain,” says Dr. Kang. “At that point, it’s a clear-cut decision for them.”

Asthma Prevention


Asthama is a chronic condition in which the patient experience shortness of breath due to inflammation and narrowing of the bronchial tubes. With this, patient may hear or feel a whistling or wheezy sound in your chest whenever one breathes.
You may guess that you have an Asthama if you are with the symptoms like cough (especially at night), difficulty in breathing, tightness in chest, shortness of breath and hearing or feeling of wheezing or whistling sound in your chest.
That’s better if you don’t have it but what is you have it then?? Don’t worry, following are the preventive measures that you can perform to control and cure Asthama.

Preventive measures
  • Prevent chronic and troublesome symptoms, such as coughing and shortness of breath.
  • Reduce your need for quick-relief medicines
  • Help you maintain good lung function
  • Let you maintain your normal activity level and sleep through the night
  • Prevent asthma attacks that could result in an emergency room visit or hospital stay

There is a saying that “Prevention is better that cure”. So that its far more better to cure before you get affected by this Asthama. For this, one should better know the causes of it which will make us aware of it before we get affected by it. Here goes the causes of asthama.

  1. Allergies like pollen, animal dander, dust mites etc, air irritants like smoke, fumes, dusts etc and various extreme weather conditions may trigger the symptoms for Asthama.
  2. Heavy exercises during illness or flu will make you more susceptible to cause Asthama.
  3. Deep emotions like shouting, crying or laughing which affects the normal breathing patterns may also act as a trigger for asthama.
  4. For a person with asthama, panic or strong emotions may cause an attack which is probably a dangerous condition.
  5. Asthama symptoms doesn’t wait for a time or condition, it may appear at anytime. The mild episode can last for few minutes and can be resolved back to normal condition with a proper medication. Whereas severe episodes may last hours and days.

Disease of chronic condition itself is a demon. If we do careless, then anything may happen to us even a lost of life. These disease affects the livelihood of the person which may lead to depression. So if you are a patient or you are experiencing difficulty in breathing then be aware. Visit a doctor or see an allergist for diagnosis and treatment.

If you want doctor checkup and counselling at your doorstep then Caring hands Nepal is there with you. Please contact us, we would be happy to help you.