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– Spinal injury in diving: your only seasonal injury?
– In the hot season, there are more accidents that affect motorcyclists. However, the main and most brutal trauma in the summer are injuries to the cervical spine caused by soaking in water. Every year, several dozen young people are injured or killed as a result. Such jumps into the water are very dangerous because not only the nerve fiber but also the spinal cord, which is responsible for the mobility of the lower body, passes through the neck. For example, if the fifth cervical vertebra fractures, a person can no longer control the legs or arms, the function of the pelvic organs is impaired (urination, defecation). This is a great disability. In the summer, this trauma occurs quite frequently. Unfortunately, deaths are often inevitable.
– Would you advise not to dive from the catwalk in a lake or river, or to do it only after a good examination of the bottom?
– I would advise against jumping into the water in all outdoor pools or in places not specially equipped for that. After all, the water is active, the currents, the waves happen where you dive many times and you know that diving here is safe. But now perhaps the current or the waves carried some stump or stone. Even if you’re not here ten times and everything ended well, for the eleventh time, diving can hit an obstacle, and that’s it. People don’t appreciate that the depth of the water is changing. Also, sometimes adults forget to watch children dive. And when you ask why that man did not dive into such a place, he says: I saw children diving there. But he forgot that his height and weight were much greater than that of a child, and therefore greater in speed and depth of crochet. Often such injuries occur when a person is intoxicated with alcohol or other things, a little bit judgmental. And these are injuries exclusively to young men: During my many years of practice I remember only one girl who had to undergo surgery for the injury.
Even if you’re not here ten times and everything ended well, for the eleventh time, diving can hit an obstacle, and that’s it.
– Who is more likely to have spinal problems: people who are mobile, active or sedentary?
– People of all ages suffer from diseases of the spine and, due to surgical treatment, every year I also have another child or adolescent under 16-17 years old, similarly to people over 90 years old. Therefore, the age range is very wide, and the most common spinal problems are people of working age, 25-60 years. These patients are operated mainly for degenerative spinal diseases. They are generally people who live an active lifestyle. These are people who do both physical and sedentary work and more, it’s hard to say.
Priests, teachers, chargers, and drivers suffer from the disease. A separate occupational group characterized by diseases of the spine are athletes. Many basketball players are my old patients. Interestingly, spinal diseases are more common in tall, thin people.
– Why is that?
– A question worth a million. If we knew why, we could try to remove it. Maybe it’s the weakness of the connective tissue, maybe the construction of the joints is to blame, but if we compare the groups of basketball players and wrestlers, there will be many more people with basketball among basketball players. Perhaps the fighter’s ligament connector is stronger, perhaps for other reasons. And intervertebral disc herniation is more common in tall people.
– Are these hernias considered spinal injuries?
The myth that surgeons operate on everything that falls into their hands. I consult people with spinal problems, but I only prescribe surgery for every eighth or even tenth patient.
– Very often, not by doctors, but also by some doctors, it is associated with trauma. However, trauma is seldom the cause of intervertebral disc herniation, especially if the disc has not degenerated, altered, or is unhealthy. Intervertebral disc disease is often caused by permanent trauma. For example, long-distance drivers sit at least eight hours a day during the day, in addition to swaying all the time. Microcracks appear in the ring that supports the intervertebral disc. Or basketball players. Frequent jumping, heavy exercise. The intervertebral discs suffer, are traumatized, the retaining fibrous ring breaks, no longer retains the disc material, at some point breaks, and therefore an intervertebral disc herniation occurs. So, in principle, it is a disease. We surgeons call trauma when a previously healthy person collapsed or was injured in an accident, the edge of a broken bone, and a hernia jumped. But more often, especially in sports, a hernia is the result of chronic trauma and intense exertion. It develops gradually and at some point as if a drop overflows the glass and therefore a hernia occurs.
– In general, diseases, problems with the spine are on the rise?
– At the beginning of my working career, 30-40 years ago, there were fewer spinal diseases. In terms of injuries, its peak was perhaps 10 to 20 years ago, when statistics on the number of people killed and injured in accidents increased dramatically. About 1 thousand 15 thousand people were said to have died in accidents during the year. – injured Now those numbers tend to drop significantly. The number of people injured during diving remains similar and the number of illnesses is increasing. However, the question is whether they are increasing due to increased life expectancy, or if we are diagnosing more of them because people now simply see doctors more often. Today, people want a better quality of life, so they tend to deal with health problems radically.
Bronius Špakauskas. Photo by A. Aleksandravičius
– If a person complains that due to spinal pain he can hardly move, the only way to help him is by surgery? Maybe physical therapy can help?
– There are some cases where surgery is absolutely necessary. First, when the hernia of the spine is internal and compresses not one nerve, but the entire fiber. This manifests itself as numbness in the perineum, legs, foot weakness, urinary incontinence. Another condition that requires immediate surgery is when paralysis of the foot develops. Then a foot starts to get in the way, the shoe starts not sticking, the shoe on the foot starts, intense pain starts, and treatment doesn’t help. In all other cases, there is no emergency surgery – spinal surgery is not the method of first choice. The myth that surgeons operate on everything that falls into their hands. I consult people with spinal problems, but I only prescribe surgery for every eighth or even tenth patient. I recommend non-surgical treatments for all other patients. Therefore, surgeries are performed on a very small percentage of people who suffer from spinal pain.
In cases of non-surgery, treatment begins with pain relievers and various exercises, other physiotherapy procedures, water treatments, stretching, etc. Physiotherapy results show that various problems can be solved in this way. After all, medications are only for pain relief. The point is physical therapy and exercise. Massage is not that helpful. It is true that massage is more pleasant for a person because he is only lying and someone kneads him. And when you exercise, you have to make an effort yourself, but exercise brings more benefits.
– Older people often have back pain due to wear of the intervertebral disc.
– As a person ages, the vertebrae and intervertebral discs wear out, their elasticity decreases, salts accumulate, the area of the vertebrae expands and, in popular words, growths are formed. They narrow the spinal canal, which contains the main nerve fiber, and put pressure on the nerves and blood vessels. As a result, some older adults move forward over the years, leaning forward, frozen. As soon as they walk, they need to sit down. When you sit down and curl up, they get a little better.
– Why does it improve when it is wrinkled?
– Then the blood circulation improves, the compressed nerves relax. And older people with narrowing of the spinal canal or stenosis (rather than a hernia) caused by regeneration or accumulation of salt may be prescribed for spinal surgery. The spinal canal is then dissected, and the spinal column is often strengthened with staples, screws, or special implants. Surgery for vertebral fractures caused by thinning of the bones is also performed, when a special polymer of bone cement is injected into the damaged spine, strengthening it. Such operations are often carried out even in the 1990s.
In the elderly, pain in the spine can often be caused by cancer diseases. Therefore, if an older person develops back pain, gait changes, posture, he should first be screened for cancer diseases.
– How common are tumors in the spine?
– It is not a very common thing, brain tumors occur ten times more than the spine. Metastatic tumors are more common in the spine.
– Is the removal of spinal tumors probably very difficult?
– It is particularly difficult to remove tumors that are not in the spinal column but in the spinal cord, growing infiltratively, destroying the nerve pathways that pass through the spinal cord. Radical removal of such tumors is often impossible, so treatment results are not always good. As a result, certain neurological defects can persist after such operations: leg weakness, numbness, impaired gait. And treating bone tumors of the spine is a bit easier, of course, if it’s not a common cancer disease.
– Probably since the Soviet era, the belief that spinal surgery is very dangerous, after which a person can not only stop walking, but also can not get out of bed. How much truth is there in such a saying?
– The truth is almost non-existent, except that these operations are really complex. During the time that separates us from the Soviet era, the surgical technique has greatly improved, the qualification and competence of surgeons has increased, and various spinal strengthening devices have been used during surgeries. All this improves the performance of operations. Also, we now use surgical microscopes that allow us to see better, deal with bleeding more efficiently, perform operations more subtly, and avoid various injuries. Medications used for anesthesia have also improved, and awakening from anesthesia, postoperative care, and breastfeeding have improved. As a result, we are now treating more complex diseases, performing more complex surgeries, and obtaining better results. A few decades ago, computed tomography, nuclear magnetic resonance tomography, intraoperative diagnosis, and microscopes appeared during operations. Around 1980 After spinal surgery it was necessary to spend 3-4 weeks in bed and only then, with a good result, was it possible to get out of bed, the season. And now, after many spinal surgeries, we allow her to start walking the next day, and later active rehab is waiting.
– People probably remember failures more …
– Of course, there is still a certain percentage of unavoidable things. There are unforeseen cases due to the circumstances, the peculiarities of the human anatomy, its reaction, the surgeon’s actions, everything. It is true, sometimes people say: lo and behold, Peter made it work well, he was running again and John was wrong, he stayed in bed. But people don’t know what the real situation was: maybe John stayed in bed due to an oncological disease that was so advanced that it was no longer possible to help with the surgery, and perhaps Peter’s simplest case was.
Often the deterioration after surgery is not due to the surgeon doing something wrong, but to the progression of the disease. Sometimes it is only during surgery that you find out, for example, that a tumor has grown so large that moving it is life-threatening, not just health.
– Due to the COVID-19 threat, not all services are currently available. Are they provided to a person suffering from spinal pain?
– I cannot say how public medical institutions work now. I currently work, consult and operate in the private clinic Agatas. Our clinic resumed operations as soon as it was allowed to do so, and we currently provide all services, of course, in strict compliance with applicable law, ensuring maximum safety for patients and staff. I also consult patients at the Basic Orthopedic Service.
– What is the sequence: who should a person turn to first if they have constant back pain?
– The person should first see their family doctor, who should prescribe a referral to a neurologist. This specialist doctor may prescribe an MRI test. And with the responses to this study, if the treatment applied is not effective, a neurosurgeon should be consulted. It is better to go to someone who specializes in treating diseases of the spine and discuss the convenience of the operation with him. It is always better to consult more and decide on the effectiveness of the treatment to be applied.
– Your advice to keep your spine healthy?
– The spine is damaged by static positions, i.e. long-term sitting at the computer in a bent position, long-distance traveling by car where chronic spinal cord injury occurs, lifting heavy objects without preparation, without stretching the column accordingly. We can learn how to gain weight properly from pregnant women: they recover and then get up. Weight should be lifted by warming up, exercising, and possibly wearing a wide belt similar to that used by weightlifters.
Therefore, a useful exercise is not a sport, but a physical culture. I would advise exercising daily to have strong back muscles, sitting properly instead of contractions. There is a whole complex of exercises to strengthen the muscles of the back. The flexibility of the spine is improved both in swimming and in fast walking, Nordic walking. Because many people’s way of life is that we sit a lot at the computer, we drive for a long time; breaks are necessary, during which we must get up, stretch, turn and visit.
Genetics must also be considered. If many people in the family and relatives complain of spinal diseases, more exercise is needed for prevention. Being overweight in the spine is also wrong.
Optimism, a positive attitude towards the environment are also important. It is important to think about what is best for me today, rather than what is likely to hurt me today. If a person comes and asks if they will have a disability group after surgery in the hope that it belongs, I don’t know how to cure that person. Such a person expects in advance that after the operation he will receive the benefit for the rest of his life and will not have to work. And the other person burns voluntarily to return to normal life, activities after the operation. He recovers faster. I will say an old saying: when a patient goes against a disease with a doctor, it is much easier to win, and if only the doctor goes against the disease and the patient with it, it becomes extremely difficult to win this fight. It is good to treat athletes because they are willing, disciplined, patient. If you tell them you need to exercise eight times a day, they will do it many times. Therefore, a lot depends on the mood, the motivation of a person.
In conclusion, I can say that to keep the spine healthy, a healthy lifestyle is very important, it is necessary to exercise, avoid being overweight, exercise, be physically active.
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