The spine also ages. Over time, discs lose moisture and elasticity, while the joints, ligaments and muscles supporting the spine gradually weaken. The spinal canal, through which nerve bundles pass, narrows much like arteries affected by atherosclerosis. When a disc protrudes toward the spinal canal or the canal narrows and compresses the nerves, patients experience back pain and leg numbness.
What matters most in spinal disease is "symptoms." Dr. Jung Sang-won, director of the Spine Clinic at Barunsesang Hospital and a renowned expert in spinal treatment, said, "How much discomfort the patient feels from pain is the most important criterion for treatment, rather than results from imaging tests such as MRI."
On Seoul Economic Daily TV's "Now, the Master" airing at 9 p.m. on the 18th, Dr. Jung appears to explain in detail the treatment standards for spinal diseases and daily management methods.
◇ Differences Between Herniated Disc and Spinal Stenosis
Herniated disc and spinal stenosis, the representative spinal diseases, both cause back pain accompanied by leg numbness. While the symptoms appear similar, the underlying mechanisms differ. A herniated disc is a condition in which the intervertebral disc protrudes and locally compresses the nerve, whereas spinal stenosis is a condition in which the passageway through which the nerve travels narrows and compresses the nerve.
Generally, herniated disc pain worsens while sitting and often affects one leg, while stenosis tends to worsen the longer the patient walks. Dr. Jung explained, "Many patients have both conditions simultaneously, and symptoms are often atypical, making it difficult to distinguish them based on symptoms alone."
Both herniated disc and spinal stenosis have "warning signs" that require an immediate hospital visit. These include △leg muscle weakness △frequent falls while walking △bowel or bladder dysfunction. Dr. Jung said, "Actual loss of strength means nerve damage is progressing," adding, "Once nerves are damaged, function may not fully recover even with surgery."
Meanwhile, many patients worry about treatment after being told in an MRI exam that "the disc has protruded," but they should remember that the criterion for deciding on treatment is not the imaging but the "symptoms."
◇ Stepwise Treatment: Medication, Injection, Non-Surgical, Surgery
Treatment should be approached in stages as a principle. Since both spinal stenosis and herniated disc cause pain through "nerve compression," the treatments are similar.
The first step is medication and lifestyle correction. Painkillers are combined with posture correction to reduce strain on the back and adjustments in activity levels, and many patients see symptom improvement at this stage.
If pain persists afterward, injection therapy or procedures are considered. A nerve block, commonly known as a "nerve injection," is a method of injecting a local anesthetic and steroid around the nerve to reduce inflammation and relieve pain.
A more active procedure, nerve plasty, involves inserting a thin tube through the tailbone to directly access the lesion site, injecting medication and releasing adhesions. However, because these procedures do not fundamentally resolve structural problems, there is a risk of recurrence.
If symptoms are not controlled even with procedures or nerve compression is severe, surgery is considered. Recently, minimally invasive surgery, which uses smaller incisions to aid faster recovery, has been actively applied. "Biportal endoscopic spine surgery" is a representative example. It involves making two small holes of about 1 cm each around the spine and removing the lesion through them, resulting in less tissue damage and faster recovery. For herniated discs, the protruding portion is removed, while for stenosis, the thickened ligament is removed to widen the nerve passage.
Meanwhile, when the spine is unstable, "spinal fusion," which uses screws to fix the spine, may be necessary, and this surgery is also considered when recurrence happens three or more times.
Dr. Jung emphasized, "Injections and procedures are effective for symptom control, but they are not fundamental treatments that remove the structures compressing the nerves," adding, "Surgery should be considered when injections and procedures are ineffective."
◇ Beware of "Unconditional Exercise"
The key to everyday spinal health is "load management." When sitting for long periods, it is good to stand up and straighten the back every 20 to 30 minutes, and when sitting, it is advisable to keep the back pressed against the backrest and lean back slightly.
Dr. Jung pointed out that people should be wary of "unconditional exercise." In particular, increasing exercise while in pain can worsen symptoms. "You should first control the pain, and begin exercising gradually only after your condition improves," he said.
Recommended exercises include walking, light running and core-strengthening exercises such as planks. However, "appropriate intensity" is important for these as well.
Dr. Jung stressed, "Rather than assuming back pain is due to lack of exercise, it is important to first receive an accurate diagnosis and treatment."
"Please, Do Not Do This" — Postures Warned Against by a Spine Specialist [Dr. Jung Sang-won, Director of Spine Clinic at Barunsesang Hospital]
