Lower Back Pain Diagnosis & Treatments
How is Low Back Pain Diagnosed?
Accurate and thorough diagnosis is key to selecting the best treatment options. The following is part of a comprehensive diagnostic workup:
- Medical history – Assessment of symptoms, previous treatments and care.
- Physical examination – A careful examination by a spine specialist for limitations of movement, problems with balance, and pain. The examination should also cover loss of reflexes in your extremities, muscle weakness, loss of sensation or signs of spinal cord damage.
- Diagnostic tests – Generally, we start with plain x-ray films, which allow us to rule out other problems such as infections. CT scans and MRIs are often used to give us three-dimensional views of the lumbar spine and can help detect herniated discs. Diagnostic injections can be therapeutic as well as determine the pain generator causing the spinal condition.
What Are The Treatment Options For Low Back Pain
Treatment for low back pain ranges from conservative therapies to surgical intervention. The goals of treatment are to relieve pain, prevent or reduce stress on the discs or spinal nerves and maintain normal function. It is almost always recommended that patient be prescribed non-surgical conservative treatment initially to help relieve symptoms.
- Cold therapy for inflammation/heat for spasm (acute) during the first 24-48 hours
- Medications – anti-inflammatories, muscle relaxers and on rare occasions narcotic medications and neuroleptics.
- Physical therapy – stretching, exercises for strengthening, and massage
- Chiropractic care – re-aligning and improving motion in “locked” joints.
- Transforaminal Epidural Steroid Injections – are used two-fold, first, to relieve inflammation of the affected spinal nerve and secondly, diagnostically to confirm the correct affected level at which the pain originates from.
- Facet Joint Injections/Medial Branch Nerves – can provide immediate short-term relief from painful symptoms and provide a diagnostic result confirming the affected level where the pain originates in the patients low back.
- Discography – a diagnostic injection technique used to determine which discs of a patient’s spine, are a source of pain.
Least Invasive Procedures
Once conservative measures have been exhausted and the patient is still in considerable pain after 6-12 weeks, then minimally invasive procedures may be recommended. The following procedure has shown great results in alleviating pain altogether and returning patients to work and life sooner than traditional spine surgery.
Endoscopic Discectomy – A ¼ inch incision is made and a 7mm operating tube is place on the disc at the site of the annular tear. An endoscope with HD camera is inserted into the operating tube to visualize the annulus and spinal nerves. Then the tear is debrided to make sure no nucleus pulposus is stuck within the annulus and thermally heated with bipolar instrument to reduce and close the tear.
Endoscopic Rhizotomy – is a least invasive procedure done outpatient to help patients suffering from chronic back pain and muscle spasms. Patients who have received some temporary relief from percutaneous medial branch rhizotomy, but the pain came back are good candidates for endoscopic rhizotomy.
Minimally Invasive Surgery
MIS Microdiscectomy/Laminectomy – A minimally invasive approach that involves a small 15-20mm incision and sequential dilating tubes that gently spread the muscles to afford visualization to the spine.
Lumbar Artificial Disc – The specific advantages of the artificial disc replacement is to maintain the motion, maximize function, and minimize the long-term risks to the discs above and below this level.
MIS Transforaminal Lumbar Interbody Fusion (TLIF) – In some cases and as a last resort, a spinal fusion may be necessary to stabilize the spine by stopping motion in the spinal segment affected to reduce or alleviate pain. With a minimally invasive approach to the spine a surgeon takes out what is causing the pain such as a disc or bone spurs that tether a spinal nerve and stabilize the spine in order to reduce and alleviate pain.
How Long Is The Recovery?
Our Least Invasive Procedure patients can begin getting out of bed one hour after surgery and go home shortly afterwards. There will probably be some pain after the procedure and is usually localized to the incision site. Activity is gradually increased and patients are typically able to return to work around a week to two weeks. Keep in mind just because there is less or no pain, always consult your physician before beginning any physical work.
Our Minimally Invasive Spine Surgery patient’s post-operative recovery is much longer and may involve overnight stay in the hospital. Once your pain in under control you can go home. Dr. Rodriguez will give you medication to control your pain while you recover at home.
At home, you will need to continue to rest. You will be instructed on how to gradually increase your activity. You may still need to take the pain medications for a while. However, pain and discomfort should begin to reduce within a couple of weeks after surgery. The doctor will discuss with you other techniques for reducing pain and increasing flexibility before you leave for home. The doctor will also discuss with you a time frame for when you can resume basic activities such as walking, driving and light lifting, and when you can return to more advanced activities such as physical labor, sports and yard work.