The Latest Advancements in the Treatment of Back and Neck Pain

September 10, 2008

Unless you are one of the lucky few, you have probably experienced back pain at some time in your life. As Neurosurgeon, Michael Doyle, MD, explained, “The biggest source of back pain is damage to disks.”

“Disks are the soft, shock absorbing cushions between the bones, or vertebrae, that make up the spine,” said Dr. Doyle. “With age, injury or disease, they can degenerate and compress, which causes the bones to move closer together, reducing the disk’s shock absorbing properties. This can be very painful, especially when the back is stressed. This condition rarely needs surgery, and is often helped by exercise, lifestyle adjustments, physical therapy and pain management with antiinflammatory medication.”

Dr. Doyle added that occasionally, a disk will become herniated, which means that a piece of the disk has pushed its way into the spinal canal and is compressing the spinal cord or a nerve root.

Minimally Invasive Surgery for Sciatica

When the nerve that branches out from the spine is compressed, it can result in pain, numbness or weakness in the legs, a condition known as sciatica. Sciatica often responds well to non-operative therapies. But, when they don’t help, surgery may be required. According to Dr. Doyle, “We can perform a diskectomy to remove the disk that is pressing on the nerve. In the past, that required a large incision, significant recovery time and considerable postoperative pain. Now, however, because of very strong magnification and powerful light sources, the procedure requires only a small incision and is usually done on an outpatient basis. People bounce back much faster than in the past. The success rate for surgery to treat sciatica is very high.”

When the Spinal Canal Becomes Compressed

Spinal stenosis is the narrowing of the canal through which the spinal cord and nerves run. This can cause compression of the nerves, leading to pain and numbness in the legs. One significant cause is osteoarthritis, which can lead to the formation of bone spurs. “This condition often responds to epidural steroid blocks, physical therapy, antiinflammatories and lifestyle adjustments,” said Dr. Doyle. “There are cases, however, in which a procedure called a laminectomy is the best option. In this surgery, we open up the spinal canal, removing the cause of the pressure on the nerves.”

“About 80 percent of Americans will have a back problem at some point in their lives. Less than two percent will require surgery. However, for those two percent, today’s surgeries are more effective and far less traumatic than in the past.” – Michael Doyle, MD Neurosurgeon

Treating Disk Problems in the Neck

The same problems that occur in the lumbar, or lower spine, can also occur in the cervical spine, which runs through the neck. “Stenosis of the cervical spine can lead to spinal cord dysfunction that affects the arms, hands and legs,” said Dr. Doyle. “It can be present without a lot of neck pain and often goes undiagnosed.”

Disk Removal and Bone Fusion

The cervical spine is also susceptible to disk problems. “A degenerating disk in the neck can cause pain under the shoulder blade and in the arm and is often misdiagnosed as a shoulder problem. This condition may require surgical intervention. The surgery can be approached from the front of the neck and is usually done on an outpatient basis. During the procedure, called an anterior cervical diskectomy with fusion, the damaged disk is removed, and the vertebrae above and below it are fused with a bone graft.”

New Artificial Disk Offers Significant Advantages

While bone fusion after surgery to remove a damaged cervical disk may still be the best option for some patients, a new technology is now available that preserves more flexibility in the neck. According to Dr. Doyle, “It involves the implantation of an artificial disk that has recently been approved by the FDA. Not only does the replacement disk put less stress on the disks above and below it, which may prevent future problems, but it also maintains flexibility in the spine.”

“Floyd Memorial has the state-of-theart technology needed to determine the cause of back and neck pain on even the most difficult diagnoses. Magnetic resonance tomography, nerve conduction testing, electromyography and more are all available. And, if surgery is necessary, the hospital is equipped with everything needed for the most advanced procedures.”

Physical Therapy Plays a Key Role

Physical therapy is almost always part of the plan of action designed to help a patient suffering from back or neck pain. Jim Snyder, PT, the outreach therapy coordinator at Floyd Memorial’s Physical Therapy Center at Highlander Point, explained how it is used.

For the Non-Surgical Patient

Most physicians will initially try conservative treatment for back and neck pain. Snyder explained that when a physician determines that the patient is a candidate for physical therapy, the therapist will perform an evaluation and create a treatment program that may include therapeutic exercise, ultrasound therapy, electrical stimulation or gentle traction for 10 to 20 minutes. “In addition,” he said, “we usually recommend sitting and standing postures that might lessen the effects of the condition.”

For the Post-Surgical Patient

“After the neurosurgeon provides direction, we perform an evaluation to determine how to get the patient back to functional status,” said Snyder. “We provide therapy to help the patient bend, sit for prolonged periods of time, drive and perform other daily activities. Treatment often includes exercise, ultrasound, electrical stimulation and moist hot or cold packs.”

Education for Everyone

As Snyder explained, “Education is very important for patients. We help them understand exactly what their condition is, discuss causes of the problem and what can exacerbate or relieve it. We suggest appropriate sitting and standing postures and tools that might help, such as a lumbar cushion or a more ergonomic chair. And we teach them appropriate lifting and bending techniques, especially if the patient’s job requires heavy lifting.”

Transcutaneous Electrical Nerve Stimulation, or TENS, is a therapy used to treat back and neck pain that is chronic or intense following surgery. The TENS device, which is about the size of a pager, has electrodes that attach to the back or the neck. It works by delivering a painless, intermittent electrical current that relieves pain and improves mobility. A physical therapist can teach the patient how to use it effectively at home.