H. Chester Boston, Jr. MD, received his medical training at the University of Alabama. After completing an orthopaedic residency at the Mayo Clinic, Dr. Boston established the University Orthopaedic Clinic with Dr. John P. Buckley. Dr. Boston's particular area of interest is the spine. In 1991, he was Senior Spine Fellow at the University of Maryland.

Q: I've recently been experiencing some pain in my back. Should I consider visiting an orthopaedic surgeon for an examination?
A: Be patient if the pain is tolerable. Fortunately most back problems are better in a few weeks without treatment. If the pain is not bearable and persists, first seek help from your family doctor. A spinal surgeon usually becomes involved in the treatment of advanced or serious problems.

Q: What are the typical causes of spinal problems?
A: Many spinal problems are present at birth or result later from developmental growth deformity. For example, scoliosis, or curvature of the spine, is often not discovered or noticed until a child reaches adolescence. Other spinal problems can develop from trauma or accidents.

Q: What are the most common causes of spinal injuries?
A: Motor vehicle crashes account for almost half (45%) of all spinal injuries. Other major causes are falls - 21.7%; acts of violence - 16% (mostly gunshot wounds); and sport injuries - 13%.

Q: When it comes to treatment of a spinal problem involving the back or neck, what is the difference between the work of a neurosurgeon and orthopaedic surgeon?
A: Spinal surgeons, whether neurosurgeons or orthopaedic surgeons, perform many of the same procedures in the same fashion. Ordinarily it should not matter which spinal specialist is consulted. Occasionally the orthopaedist and neurosurgeon work together as a team and have traditionally consulted each other when desirable.

Q: What specifically are the most common problems you treat?
A: Traditionally we take a conservative approach to treating a problem. Only a small percentage of patients with spinal problems require surgery. Rest, physical therapy, medication, back supports, and education about body mechanics, are always fully explored prior to surgery. The most common surgical problems are:

• Ruptured lumbar or lower back discs: These ruptured discs are seen in people of all ages and walks of life. Frequently a recognizable event such as back strain will trigger the pain typically in the leg or buttock area.
• Ruptured cervical or neck discs: These ruptured discs are also seen in all people. They may typically cause arm numbness or pain. Neck pain is common.
• Elderly people may experience arthritic spinal stenosis or spondylolisthesis, resulting in partial closure of the spinal canal and causing back and leg pain commonly made worse by walking.
• Scoliosis (curvature of the spine). In many cases bracing can correct the problem.

Q: What new advances is your field experiencing?
A: The field has changed significantly in recent years with the development of better spinal fixation procedures and techniques for correcting deformities.

Q: What about laser surgery in the spine?
A: For the past several years there has been interest on the part of some surgeons in developing a percutaneous procedure for the removal of herniated lumbar discs. A vacuum procedure has been tried and more recently the use of a laser has gained some popularity. The drawback of both these procedures is that they can only be used within the body of the disc itself. The portion of a herniated disc which actually is causing the problem has already been extruded from the body of the disc and rests within the spinal canal causing direct pressure to a nerve. Vacuum procedures and laser procedures cannot address this area without the threat of injuring or destroying the associated nerve. For this reason most spinal surgeons have either chosen not to use these procedures or have abandoned them since statistically the best results are still obtained from the traditional open lumbar discectomy.