Bridging The Gap Between Pain Management and Spine Surgery For Low Back Pain

You have recently injured your low back over the weekend gardening, playing sports or while jogging around the lake.  You may be suffering from an acute injury such as a pulled muscle, strain of a ligament or a spasm in your low back. You have tried several conservative measures such as rest, ice, exercise and maybe even physical therapy with no relief.  The pain is not subsiding after a few weeks, and you’re wondering what I can do to get relief?

Most people will find relief from low back pain with conservative treatment.  However, many of those affected by low back pain may have underlying spinal problems that will linger much longer than a few weeks.   Low back pain significantly consumes many suffering patients who search the Internet endlessly for education and relief. For many people, these efforts may fail, and the pain may continue to the point they lose hope and seek medical attention often from their primary care or a pain management physician.

When low back pain persists for more than three months, it is considered chronic pain and should be evaluated by a qualified physician.  Recent research – Epidemiology of Spine Care: The Back Pain Dilemma, claims that low back pain disorders are one of the most commonly reported problems, and affects up to 80 percent of the population.  According to the study, The Rising Prevalence of Chronic Low Back Pain, low back pain is the second most common cause of disability among adults in the United States and leads to significant lost days of work.  The study also notes that low back pain costs between $100 to 200 billion annually, two-thirds of which are attributed to decreased wages and productivity.

 

Three Most Significant Complaints With Low Back Pain Sufferers:

  1.   Debilitating back pain
  2.   Significant lost days of work
  3.   Can’t live an active lifestyle

 

Most Common Low Back Pain Diagnosis:

  1.  Facet joint syndrome
  2.  Degenerative disc disease
  3.  Herniated or bulging disc

 

When Conservative Care Fails

After conservative care has failed, patients are often referred from their primary care doctor to a pain management physician for diagnostic imaging, therapeutic injections, and interventional procedures.  An MRI and X-rays of the spine are taken along with a physical exam to determine the pain generator. For example, patients that complain of chronic low back pain are typically diagnosed with facet joint syndrome.  These facet joints, which allow our backs to turn and bend, can become arthritic and degenerative or injured and become very painful.

Pain management physicians will use a medial branch nerve block injection, next to the facet joint, to diagnose what is causing the pain you feel in your back. If the injection provides relief for a few hours, and the pain returns, they typically will recommend a radiofrequency ablation (link to related page) of those nerves.  A nonsurgical procedure, done under X-ray, places small needles through the skin, over the nerves and then heats them forming a lesion on the nerves that discontinues the back pain. Clinically, about 80 percent of patients receive relief for about six months to one year. Unfortunately, these nerves will regenerate, and for some patients routinely they will seek additional pain management treatments.

 



The Gap Between Failed Pain Management and Minimally Invasive Spine Surgery

Pain management, which works for many people, can often fail to provide optimal or long-term pain relief.  Patients who fail to get long-term relief are then recommended for a consultation with a spine surgeon. Too often, patients suffering from chronic back pain undergo invasive spine surgery and lengthy recovery time.  After spine surgery, some patients suffering from low back pain, struggle to return to work and in some cases get little to no additional relief.

For these reasons, many patients fear spine surgery.  They have heard stories from friends that have had spinal fusion surgery that resulted in a long, painful recovery and not always ideal results.  Spine surgery is an excellent choice for some well-qualified candidates, however in the case of low back pain due to the facet joints, the only treatment option surgeons have had is to perform a spinal fusion of the facet joint.

In 2005, Dr. Anthony Yeung, an orthopedic spine surgeon from the Desert Institute for Spine Care, invented a new surgical technique called the Endoscopic Dorsal Rhizotomy.  This procedure was truly less invasive than spinal fusion and more effective in providing lasting pain relief for chronic low back pain associated with facet joints. The least invasive technique uses an endoscope and HD camera to locate the small facet nerves that cause low back pain.  Through a ½ inch incision, the scope is guided under X-ray to the painful facet joint. Once the nerves are visualized, they are ablated and severed with a radiofrequency probe. The endoscopic dorsal rhizotomy results have significantly improved on the radiofrequency ablation percutaneous procedure used by pain management.  

 

 

Unlike the short-term results for pain management’s radiofrequency ablation, patients undergoing an endoscopic dorsal rhizotomy have a 90% success rate in alleviating low back pain, and the relief lasts up to 5 years.  The ability of a surgeon to see the actual nerves with their eye dramatically enhances the likelihood of ablating the nerves and increasing the longevity of the pain relief. Also, the procedure can delay additional spinal surgery or the need for a spinal fusion.

 

Advantages of Endoscopic Dorsal Rhizotomy Versus Minimally Invasive Spinal Fusion

First and foremost, the endoscopic dorsal rhizotomy can spare a patient a spinal fusion.  Also, unlike spinal fusions performed under general anesthesia, the endoscopic dorsal rhizotomy can be performed under local anesthesia with oral or Intravenous (IV) medication and numbing of the skin.  The incision is about ½ inch for the endoscopic surgery versus at least 2 to 3 inches with the spinal fusion surgery. The smaller incision is likely a reason for less post-operative pain. Patients go home within a couple of hours of operation with little to no pain and return to work within a couple of weeks.  On the other hand, there is significant post-operative pain after a spinal fusion and patients typically return to work in about 2-3 months.

Less Is So Much More

Dr. Rodriguez saw a significant need in his practice to learn and adopt this endoscopic dorsal rhizotomy surgery.  Where he used to perform 10 to 20 spinal fusions a month, he now does many endoscopic rhizotomies with great results and only one or two spinal fusions per month.  Patients are delighted with the procedure results, and return to an active lifestyle and work sooner than his minimally invasive spine patients.

This new procedure has dramatically enhanced his patient’s outcomes and bridged the gap between pain management and minimally invasive spine surgery.  

At the International Spine Institute, we believe that “Less Is So Much More.”  In Dr. Rodriguez’s practice, endoscopic spine surgery is what he calls the Least Invasive option that alleviates pain, with the least amount of recovery that can avoid in many cases, the need for minimally invasive spine surgery.  He believes that all patients should explore the least invasive options before ever agreeing to minimally invasive spine surgery.

 

Am I a Candidate for Least Invasive Surgery?