Treating Back Pain
For those individuals with active lifestyles, back pain can be both a physical and mental challenge. Back pain hinders our ability to perform our daily routines as well as enjoy those extracurricular activities that we love. Fortunately though, through the advances of the Las Colinas Spine Program, there are treatment options available to minimize or cure your pain. These back pain treatment options range from physical therapy and exercise treatment planning to extremely delicate surgery. Furthermore, each case is different and therefore treatment must be tailored to each patient.
Treatment methods fall into two distinct categories:
Conservative treatment - Including exercise, medications, physical therapy, pain management procedures and other non-operative therapy.
Surgical treatment - which includes laminectomy, diskectomy, and spinal fusion in selected conditions.
Treatment for any back condition should involve two goals:
- To relieve the immediate problem
- To reduce the risk of re-injury
Exercise / Physical Therapy
Exercise plays an important role in achieving both of these goals. Many studies have shown that people who exercise regularly have far fewer problems with back pain. Exercise stimulates the body's natural pain controlling hormones and actually decreases pain perception. A physical therapist may be contacted to help you with your exercise program. The physical therapist will also teach you about ways to prevent further back injury.
Medication / Pain Management
No medication will cure back pain of degenerative origin. Medications are used to control: pain, inflammation, muscle spasm, and sleep disturbance. Many physicians feel that narcotic medications should not be used on a continuous basis to treat chronic low back pain. There are certain circumstances where pain management specialists are finding that chronic narcotics will actually benefit certain groups of patients with chronic low back pain - but the majority of low back pain will not require this approach.
If simple measures fail to control your back pain, then an epidural steroid injection (ESI) may be suggested. Many different problems can cause inflammation of the nerves in the lumbar spine. The epidural steroid injection involves placing a small amount of cortisone into the bony spinal canal. Cortisone is a very powerful anti-inflammatory drug that may bring the inflammation surrounding the nerves under control and ease your pain. The epidural steroid injection is not always successful. Most centers report a 40%-50% success rate. These injections are reserved for cases where all other conservative measures have failed, or as a last attempt to postpone surgery.
Surgery is only necessary in a small number of patients. There is no one surgical procedure that is appropriate for all spine problems. If surgery is recommended, our fellowship trained spine surgeons will recommend the most appropriate procedure for addressing your pain. While back surgery may seem common, the vast majority of people with back problems are not candidates for surgery and will regain function through conservative forms of treatment. However, if surgery is required, the procedures detailed below may be recommended.
One of the most common surgical procedures is a diskectomy, the removal of a herniated disk to relieve pressure on a nerve root. The first step of this procedure is removing a portion of the lamina of the vertebra. The lamina is the portion of the vertebra that forms the roof over the spinal nerves. Through removal of a portion of the lamina, a small window to the spine is created. Once accessible, the nerves are then pulled to the side so that the herniated disk can be viewed. Small instruments are then used to remove the herniated disk material. Most of the nucleus pulposus is removed to prevent the disk from herniating again. Once the disk material is removed, the nerves are free of pressure and irritation.
For some patients, back pain is caused when the spinal canal is too small, a condition known as spinal stenosis. As a result of this condition, many surgeons will recommend a procedure known as a laminectomy. The term laminectomy means "removal of the lamina". Remember, the lamina is the back portion of the spine forming the roof of the spinal canal. By removing the lamina, this allows more room for the nerves and enables the surgeon to remove bone spurs around the nerves. Once complete, this procedure reduces the irritation and inflammation on the spinal nerves. Additionally, this bone will not grow back. Instead, scar tissue will form replacing the lamina and protecting the spinal nerves.
If your back problem is the result of segmental instability, a spinal fusion may be suggested. A spinal fusion involves placing a bone graft between two or more vertebrae, causing the vertebrae to grow together, or fuse. The bone graft is usually taken from the bones of the pelvis at the time of surgery. There are two general types of spinal fusions:
- Posterior Fusion
- Interbody Fusion
In the posterior fusion, the bone graft is placed on the back side of the vertebrae. During the healing process the vertebrae then fuse, or grow together. This creates a solid block of bone between the vertebrae, and the vertebra that are fused together act like one bone. The interbody fusion differs by placing the bone graft between the vertebrae, where the disk has been removed. Once again, the healing process causes the vertebrae to fuse, creating a solid block of bone between the fused vertebrae. Note, both fusions accomplish the same thing. The goal of a spinal fusion is to limit or stop the motion between two vertebra stemming from segmental instability. Fusing the vertebra together reduces the mechanical back pain and impingement on the nerve root that comes from too much motion between the vertebra.