Spine Disorders: Treat the Cause, Not Just the Symptoms

By Carrie Diulus, MD
Wednesday, June 14, 2017

Carrie Diulus, MD

Traditional spine care focuses on medication, physical therapy, surgery, injections, and in some cases, manipulation therapy. However, recent studies have shown that treatment practices continue to move further away from accepted guidelines. Despite these evidence-based guidelines, many patients are subjected to unnecessary imaging scans and narcotics, and are not provided treatments that have been shown to be effective. This has resulted in expensive care with inconsistent outcomes and low patient satisfaction.

Getting to the root cause of a person’s condition, rather than just treating the symptoms, often involves a comprehensive evaluation. Such an in-depth evaluation can dramatically improve a patient’s spine health as well as their overall well-being. For example, obesity places increased stress across the spine, which can lead to increased pain. Other systemic conditions like diabetes and autoimmune diseases can cause nerve conditions that can imitate or complicate disc herniations and lumbar stenosis. Treating the symptoms without addressing the underlying causes may help relieve symptoms temporarily, but may unfortunately not provide lasting relief, which can lead to future flares.

In the spine practice, we see many patients who also have diabetes and/or pre-diabetes and have elevated markers of systemic inflammation. If we are able to effectively help patients reverse these conditions with lifestyle modifications — including diet, exercise, supplements and sometimes medication — we often secondarily improve their spine and nerve conditions as well.

Inactivity alone can be a significant contributing factor to spine-related pain. Prolonged sitting has clearly been shown to increase not only spine pain but also morbidity associated with other chronic health conditions. Sitting too much can quite literally shorten your life and increase your pain. Our spines need to be moved to gain nutrients, stay supple and heal.

Strong core and back muscles provide support for the back and the neck as well. Without this strength, we can have pain even when attempting to maintain normal posture throughout the day. Working with patients, who are on the road to recovery, to plan a long-term fitness program helps not only prevent recurring spine problems but also helps patients improve their overall health.

It is also not uncommon that we see patients suffering from low-back pain and even leg pain, who have failed to improve with other treatments — we sometimes discover they actually have a problem with their sacroiliac joint. Patients with prior lumbar spinal fusions are also at risk for sacroiliac joint dysfunction. Fortunately, using a comprehensive approach, we are able to significantly improve and often resolve the pain associated with this condition.

Expanding the “toolbox” to include all of the treatments that have been shown to be effective in spine care can often more effectively and more quickly help a patient take control of their spine health.

Many times, combining tools results in better outcomes than the individual tools themselves. Examples include combining physical therapy with medication supplement therapy, massage therapy and yoga. Additionally, using tools that treat all of the factors a patient has affecting his or her spine improves outcomes. For example, using tools to improve weight and sleep can positively impact a patient’s spine health.

I am often asked, “Why would a spine surgeon want to use an expanded toolbox and not just discuss surgery as an option when talking talk to patients about surgery?” While surgery can be very effective for some circumstances, it certainly does not address all spine problems. Additionally, when surgery is necessary, if we use additional tools from the spine wellness toolbox, we get better outcomes from surgical procedures with fewer complications.

Using a patient-centered approach, with the expanded spine wellness toolbox, helps to provide patients with a faster, more comprehensive approach to achieving spine wellness and can also improve their overall health.


Dr. Carrie Diulus is a board-certified spine surgeon, fellowship trained at the San Francisco Spine Institute, and practicing with Crystal Clinic in Akron, Medina, Hudson and Cuyahoga Falls OH.