Low back pain is a condition we will all likely experience at some point throughout our lives. Fortunately, most back pain will resolve with little to no intervention. When the pain persists despite more conservative measures, we can help achieve durable relief while avoiding traditional spinal surgery. Here, we will provide an overview of some of the minimally invasive therapies available to assist in our endeavor for pain relief.
Minimally Invasive Therapies for Low Back Pain
Radiofrequency Ablation (RFA)
One of the more common procedures performed for low back pain is radiofrequency ablation or neurotomy. With this, radiofrequency energy generates heat around specific nerves to stop their ability to transmit pain signals to the brain. RFA is a short outpatient procedure performed without the need for anesthesia. With proper patient selection, pain relief can be significant, typically within 1-2 weeks of having the procedure performed.
The most common application of RFA is to the nerves sensing pain from the small joints on the back of your spine called facet joints. These joints commonly cause pain in the middle of your low back related to strain or degeneration. Similarly, RFA treatment can be performed on the nerves transmitting pain from the front of your spinal column. Specifically, this therapy is known as basivertebral nerve ablation and can resolve pain emanating from the vertebral bodies, the larger bony structures at the front of your spine.
Treatments for Lumbar Spinal Stenosis
The narrowing of the canal that houses your spinal cord is referred to as spinal stenosis. Common symptoms of lumbar spinal stenosis include worsening back and leg pain with prolonged standing or with walking. Often, this pain will improve with sitting down or leaning forward, which helps open the spinal canal and decrease the degree of narrowing. Traditionally, spinal stenosis required spine surgery with removal of portions of the spine and occasionally the need for spinal fusion. Fortunately, we now have minimally invasive therapies to manage this condition without the need for spine surgery.
One such option is named Minimally Invasive Lumbar Decompression or MILD. This outpatient procedure is performed with the need of only local anesthetic (numbing medicine). MILD is done by removing part of what is called the Ligamentum Flavum. With aging and progressive degeneration this ligament will thicken and contribute to the spinal canal being narrowed. By removing portions of this ligament we can reopen the canal without removing any bone or placing any implants.
Another option are interspinous process spacers. These are implants placed through small surgical incisions that fit between the spinous processes on the back of your spine. They act by helping to keep open the central spinal canal and the areas where nerves exit thus relieving compression and the resultant pain.
Sacroiliac Joint Fusion
The sacroiliac joint (SIJ) is a common source of low back and gluteal region pain. Diagnosis is made through a series of physical examination maneuvers followed by diagnostic injections. Once the SIJ is confirmed to be a culprit for your pain one option for long lasting relief is SIJ fusion. Recent advancements have made this procedure simpler and safer while not compromising its effectiveness. One option is the placement of a small device into the joint which acts to stabilize it and resolve the associated pain. This outpatient procedure is performed through about a 1-inch incision and requires very little if any activity restriction immediately afterwards.
Spinal Cord Stimulation
Spinal Cord Stimulation (SCS) involves the placement of small electrodes along the back of your spinal canal to regulate the pain signals being transmitted to your brain. The electrodes send small electrical impulses that are generally imperceptible and absent of any side effects that are commonly seen with medications. A trial is first performed to gauge how effective the therapy will be for each individual patient. The final implantation is then performed as an outpatient procedure. SCS is effective at treating multiple causes of back and leg pain including persistent pain after prior spine surgery, lumbar radiculopathy, diabetic neuropathy, etc.
Compression fractures of the vertebral bodies commonly result from osteoporosis (loss of bone strength) and trauma. These injuries can be severely painful and debilitating. Using vertebral augmentation procedures, we can significantly and swiftly treat the pain associated with these fractures. Additionally, the treatment decreases the risk for further fracture and often reduces the deformity associated with these fractures. We often perform the procedure without the need for general anesthesia. The procedure involves the installation of cement into the fractured vertebra to stabilize the break. This is often preceded by the inflation of a balloon or implantation of a device to help restore the fractured vertebral body to a more normal height. In conjunction with the procedure, the evaluation and management of osteoporosis is paramount in preventing further fractures.
Dr. William Dreiss is a Board-Certified Anesthesiologist and Fellowship Trained in Interventional Pain Management. Click here to learn more about Dr. Dreiss.
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February 27, 2023