1. Why so many veterans experience back pain. Back pain can stem from either a single traumatic event — such as involvement with an improvised explosive device or gunshot wounds— or every day activities such as carrying heavy equipment for several miles. “These guys are coming back from overseas with ongoing neck, leg and back problems,” says Dr. Kaul. “Their MRIs look like they have the spine of a 50-year-old. The stresses can start during their training exercises when they have to carry heavy equipment and operate in cramped conditions.”
2. Minimally invasive surgical intervention. Many veterans who suffer from back pain are unable to hold a job or be productive in society because of the stresses from their service. The spine surgery they are able to receive at VA Hospitals is often done through an open procedure, which disrupts their muscles and can prevent them from returning to regular activities for months. In many cases, Dr. Kaul is able to relieve the pain with a minimally invasive procedure, which keeps the patients’ anatomy intact. “What I’ve been able to do is significantly helping these young guys,” says Dr. Kaul. “The surgical interventions we are able to do now are much more effective than they were five years ago. We are able to address their pain and manage their degenerative conditions through minimally invasive procedures that allow them to return to full function.”
3. Government coverage is often lacking. Most of the pushback against surgical intervention for military veterans has come from the United States government’s insurance provider. The provider doesn’t have guidelines beyond conservative treatment, and even then it can be difficult for physicians to receive approval for pain management treatments. “The government puts up a lot of road blocks and hurtles in front of these guys before they can receive care,” says Dr. Kaul. “The veterans are the ones who need it most. Many of them have been managed medically in the past, which can lead to opioid dependency, when they really need therapy or stronger interventions to address their problems.”
In a few cases, the veterans have been able to obtain insurance coverage through unusual means, such as through a family members’ carrier. In other instances, coverage has been continuously denied and Dr. Kaul treated the patients regardless because they were in such strong need of care. “It just seems such a tragedy that we have these young guys carrying out these duties and when they come back, the government, in terms of healthcare funding, looks the other way,” he says. “I hope there’s a greater recognition of the need for spine care and that things change in a positive direction in the future.”
4. Moving past the psychological roadblocks for good outcomes. Any patient undergoing spine surgery should be mentally stable and in a good frame of mind to achieve the best possible outcomes. Unfortunately, many of the veterans who would benefit from surgery suffer from post-traumatic stress disorder, which can add complications in their treatment path. “Veterans often experience different things that need to be addressed before undergoing surgery,” says Dr. Kaul. “When they come to me, I can try to help them from the spine standpoint, and I also try to help the psychologically as well. I think there needs to be a more coordinated approach to rehabilitating these men when they come back.”
Dr. Kaul often refers his patients with PTSD to psychologists in the community to receive biofeedback on their condition. He has also organized group meetings where past and present patients with PTSD come together and discuss their experiences overseas. “There are a lot of things these guys want to talk about when they come back to civilian life. They all talk about the sense of isolation they feel here because in the military unit they had such a tight sense of camaraderie,” says Dr. Kaul. “The challenge is to create a multidisciplinary forum so that there are different specialists getting together to discuss the cases and help the veterans.”
5. Helping veterans become comfortable with surgical intervention. The meetings between past and present patients also helps the veterans become more at ease with the idea of surgery. In addition to discussing their time on duty, the patients can talk about their back pain and treatment. “If a few patients who has gone through surgical correction, they can communicate with future patients about how it was for them,” he says. “When you have a patient speaking to the patient, you are able to more intimately address some of the concerns people have going through these things.”
Learn more about Project Backbone.
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