Back to FirstHealth Magazine Home
In This Issue
Message from the CEO
Your Letters
New Providers
Past Issues
Request A Hardcopy
FirstHealth of the Carolinas
The neck and back By Dick Broom

The spine—the neck and backbone—is actually 33 different bones called vertebrae. They are interlocked in such a way that they can move without coming apart.

Wedged between each of the vertebrae are cushions that keep the bones from rubbing against each other and wearing out. The cushions are called discs, which describes their shape.

The make-up of a disc is similar to that of a gel-cap that you might have in your medicine cabinet—a soft, jelly-like substance surrounded by a tough but flexible shell.

The spine starts at the base of the skull and ends with the tailbone. It allows us to sit and stand, and it provides support for all of our major organs. It also serves as a conduit for the nerves that connect the brain to every part of the body below the head.

Each vertebra has a hole in the middle of it. When all of the vertebrae are stacked on top of each other, they form a column with a hollow center. This is the spinal canal, and through it runs the thick cluster of nerves called the spinal cord.

The spine serves two essential functions. It gives the skeleton its structural “backbone,” quite literally, and it protects the spinal cord from injury.

Four out of five people will have a problem with their back sometime in their lives. The most common problem is degenerative disease of one or more of the discs in the lower back.

“Discs sometimes show their wear by having minor tearing or cracking of the outer fibers,” says orthopaedic surgeon James Rice, M.D., of the Sandhills Orthopaedic and Spine Clinic in Southern Pines. “That damage can cause inflammation that causes your back to go into spasm.”

As we age, the discs in our spine tend to dry out. “When they lose some of their water content, they do just what a tire does when it loses air: the sidewalls bulge,” says Dr. Rice. “That narrows the spinal canal and puts more stress on the joints in the back, which can lead to arthritis.

“You can have a disc herniation—a ruptured disc—where some of the disc material pushes out into the spinal canal and presses up against one of the spinal nerves. When it presses against the sciatic nerve, it causes pain down the leg that we call sciatica.”

As the discs lose their plumpness and flatten out, the spinal column becomes more compacted. That causes the soft tissue covering the back of the spinal canal to shorten and thicken, just as a rubber band is thicker when it isn’t being stretched.

“That results in a condition called spinal stenosis, where the opening in the spinal canal is narrowed down and the nerves are pinched,” says Dr. Rice. “We see a lot of that, especially with an older population.”

Genetics and smoking are the two major risk factors for degenerative disc disease. If you have a strong family history of back problems, then you are likely to have back problems.

Smoking is bad for backs—as it is for almost every other part of the body—because discs don’t have a very good blood supply. “Smoking constricts blood vessels and decreases the blood supply to discs even further,” Dr. Rice says. “That makes it more difficult for a disc to repair itself if it is injured, and it can cause an earlier cascade of degeneration of the disc that leads to problems down the road.”

James Rice, M.D.

Being overweight doesn’t do the back any favors, either. Every extra pound you carry around puts a little more stress on your back. “We talk with patients about working on weight reduction, along with having a good exercise program to strengthen the muscles that help support your back,” Dr. Rice says. “Exercises that promote flexibility also can ease the tension and stress on your back.”

Only a small percentage of people with back problems ever require surgery. For those who do, spinal fusion is one of the most common procedures for a ruptured disc or spinal stenosis with debilitating problems. With spinal fusion, two or more vertebrae are fused together to immobilize them.

A pain in the neck can be just as severe and debilitating as a pain in the lower back. But neck problems are less common, probably because the neck doesn’t have to support nearly as much weight. On the other hand, the neck has greater mobility and is less well protected, so it is more vulnerable to traumatic injury.

Pain in the upper back is much less common than in the neck or lower back.

“There’s a very good reason for that,” Dr. Rice says. “It’s called the ribs. They provide additional support to the spine, so there is not as much stress on the discs.”

Like a lot of other people in the Sandhills, Brenda Montjoy says her passion is golf. So she was pretty unhappy when her back started hurting so badly that she couldn’t play

“The pain would start in my back, cross over my backside and go down my right leg to the knee,” she says.

Montjoy went to see James Rice, M.D., of the Sandhills Orthopaedic and Spine Clinic in Southern Pines, who found that she had a pinched nerve in her spine. He said she appeared to be a good candidate for spinal fusion surgery, but he wanted to try more conservative treatments first.

Montjoy had a series of injections to relieve the pain, but they worked only in the beginning. She also had physical therapy and wore a soft back brace, which helped for a while. But over time the pain became progressively worse.

Brenda Montjoy has been able to return to her “passion,” golf, since her successful spinal fusion surgery.

“It got to the point where, if I was walking, I would have to stop and sit down,” Montjoy says. “I couldn’t go another step because of the pain. Eventually, I couldn’t even stand up straight; I would be at an angle sideways.”

Montjoy went back to Dr. Rice, who, after taking more X-rays, recommended spinal fusion surgery. He performs spine and other orthopaedic procedures at FirstHealth Moore Regional Hospital.

Montjoy had her surgery on Halloween 2006. She was out of work for three months and wore a back brace for six months.

“I was very religious with my physical therapy,” she says. “Then I got a personal trainer at the Fitness Center who gave me exercises to do on my own.

“They tell you the recovery period is one year, but I was playing golf about nine months out. Now I’m playing golf and walking three miles a day, and I feel great. It’s totally miraculous.”

Montjoy, 64, lives in Robbins. She works part time in Troy as a pharmacist with FirstHealth Cares, the program that provides certain prescription drugs at no cost to people who don’t have insurance coverage and can’t afford to buy them. She is also a relief pharmacist at Standard Drug in Troy and in the pharmacy at FirstHealth Montgomery Memorial Hospital.

Like Montjoy, Cenda Hoogerland had pain that got progressively worse. “I was bent over like an old person,” she says. “I couldn’t sit up or stand up straight because of the pain in my back.”

Hoogerland’s back pain had troubled her for five or six years. “I tried shots, and I did therapy,” she says. “I’m a student of Pilates, so I did that. I’m a swimmer, and I did that. I also went to a chiropractor. I tried everything, and nothing helped.”

Hoogerland had two slipped discs and spinal stenosis (narrowing of the spinal canal) caused by arthritis. Dr. Rice corrected those problems with spinal fusion surgery in January 2007. Hoogerland says the difference in the way she feels and in what she is able to do is remarkable.

“I don’t have pain like I did before, just a little bit when I first get out of bed in the morning,” she says. “It takes me a little while to get going, but I think that’s just from age.”

Hoogerland, 70, lives in Seven Lakes West and works as a “relationship banker” in the BB&T office there. She was able to go back to work just six weeks after her spinal fusion surgery.

“Dr. Rice was thrilled with my progress,” she says. “He said I was a model patient.”