Bridging The Gap Between Pain Management and Spine Surgery
This content was medically reviewed by Baher S. Yanni, MD, on August 17th, 2017.
For anyone who has suffered from low back pain and especially those with chronic pain (persistent for more than 3 months) there are numerous treatment options offered. Many consumer products or some clinicians are boasting a promise to “cure” or offer long-term relief. From Internet gadgets to suggested remedies by friends, and treatments recommended by physical therapists and doctors, there are many means to approach back pain management.
Many patient exhaust hours upon hours searching the Internet and trying these gadgets and remedies and either deal with the pain or lose hope because the pain persists without relief. Because of the pain, their lifestyles are severely interrupted:
- Significant lost days at work
- Missing out on kids sporting events
- Inactive lifestyles
When patients suffer for 3 months or longer (chronic back pain) they often seek out pain management for diagnosis, injections and some interventional procedures. Many of these procedures pinpoint the pain generator and offer significant relief and no further treatment is needed. For example, patients who suffer from chronic back pain and spasms are often suffering from facet joint syndrome. The facets allow patients to bend forward, backwards and turn. As a pain management physician, I often will use a medial branch block injection to identify the facets as the pain generator.
If the injection works and the back pain returns, I will recommend a radiofrequency ablation. This procedure is a least invasive option done under X-ray that places small needles through the skin over the nerves. These needles are then heated causing a lesion on the small nerves, which alleviates back pain. Clinically, in my practice, 80% of patients do very well afterwards for about 6 months to 18 months. In the 20% group that doesn’t respond, further injections or procedures can be used to help relieve their pain. Unfortunately, the nerves regenerate and patients sometimes come back, after the initial pain relief complaining and wanting additional procedures. This is typically true for most pain management practices.
When patients are in pain and fail to get optimal relief, pain management often recommends a consultation with a spine surgeon. Patients don’t want to have spinal surgery and are often scared to move towards a consult with a spine surgeon. They have all heard the worst-case scenarios where a friend had spine surgery and the results were less than desirable. Spine surgery is not the end of the world, and for the right patient indication, it is a great option. In my practice, I searched for better solutions that could bridge the gap between pain management and spinal surgery. I have attended many courses over the last 10 years educating and training myself on a new surgical procedure called endoscopic spine surgery. The techniques and surgical instrumentation were developed and mastered by Anthony Yeung, MD of Desert Institute For Spine Care. Dr. Yeung saw that many pain management procedures and injections once exhausted, still left a great deal of patients in pain or not optimal relief. These patients then moved onto invasive spine surgery with large incisions, lengthy recovery time, not returning to work and in some cases no additional relief.
Endoscopic spine surgery is a least invasive option that avoids in many cases, minimally invasive spine surgery. In my practice for example, I offer an endoscopic rhizotomy similar to the above mentioned radiofrequency ablation of the facet nerves. The significant difference is that endoscopically I make a ¼ inch incision with the patient under local sedation, and place a ¼ inch metal cannula, endoscope and an HD camera in the patient’s back on the painful nerves. I use a radiofrequency probe visually ablating and severing these nerves. The results are outstanding, about 90% of patient get relief and the relief lasts about 3 to 5 years. Patients leave after the procedure within 2 hours with a Band-Aid. Often, patients return to administrative work within a week. This procedure can literally delay or save a patient from spine surgery or spinal fusion. Because of my success and dedication to endoscopic spine surgery, I am routinely invited to lecture and instruct these techniques at spine seminars and international conferences.
In my humble opinion, not all pain management or spine procedures are equal, nor are the doctors and surgeons who perform them. In situations where endoscopic spine surgery can be utilized for patients suffering from spine conditions using a least invasive approach, is an option worth exploring! The goal of seeking any treatment for spine conditions should be to exhaust all least invasive options before ever pursuing minimally invasive spinal surgery.
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