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One of the most important facts to remember about treating back problems
is that most people whose primary symptom is back pain improve in several
days with minimal treatment. That’s why noninvasive treatment options
should usually be the first step in treatment.
Non-invasive Treatments
There are many non-surgical options for treating back pain. In fact,
only about five to ten percent of all spine problems are managed with
surgery. Comprehensive rehabilitation and pain management play big roles
in the Spine Institute’s treatment programs. For example, you may find
that rest and special back exercises help relieve your pain, or you may
need a combination of medication and physical therapy. Here are the common
non-invasive treatments for back pain:
Rest
One of the first treatments recommended by physicians for severe back
pain will usually be two to three days of bed rest, with a gradual return
to normal activities. Your physician may recommend special pillows or
devices for extra support for your back or neck. Longer periods of strict
bed rest are generally not indicated.
Heat and Cold
Often hot or cold treatments will help to lessen back pain. Heat generally
serves to relax muscles and soothe painful areas, while cold has a numbing
effect that can also relieve pain. For cold, you might use an ice bag
or a store-bought cold pack, but do not leave it on after your skin becomes
numb. For heat, try hot showers or baths, heating pads or warm compresses.
Cold treatment is often used when there is an acute injury.
Medication
If back pain cannot be relieved by rest or hot and cold treatments, your
physician may recommend a pain-relieving drug. Analgesics or muscle relaxants
can sometimes help relieve back pain, but nonsteroidal anti-inflammatory
drugs to reduce inflammation are the most commonly prescribed. Sometimes
medication will be used in combination with physical therapy.
As with any medication, work with your physician to make an informed
decision about what you will be taking. For example, let your doctor know
if you are taking other medications and ask if the drug being prescribed
is addictive, how long you will have to take it, and if there are any
side effects.
If you want to try over-the-counter drugs, aspirin and ibuprofen are
two common anti-inflammatory drugs. One danger with using medication to
treat back pain is that drugs may be masking symptoms of a more serious
problem with your back. If the back pain doesn’t get better in three days,
call a physician.
Physical and Occupational Therapy
As discussed in a previous section, proper exercise can help you prevent
back problems and is important for a healthy back. Exercise can also be
part of the treatment for back pain.
A physical therapist can work with you to create an individualized exercise
plan to best suit your needs. Continued home therapy is an important part
of any physical therapy program as well. Physical therapists may also
teach relaxation exercises, posture training and lifting techniques.
Occupational therapists can show patients how to adapt their daily routines
in order to place less stress on the back. For example, energy conservation
and back protection strategies can be used to prevent further aggravations
and recurrence of symptoms.
Braces for Scoliosis
In general, braces are an option for children with scoliosis curves in
the 25 to 40 degree range. While braces don’t permanently correct a curve,
they can be used to stop the progression of the curve until bone maturity.
Besides the patient’s age and the degree and location of the curve, another
factor to consider before bracing is the patient’s willingness to wear
the brace. Some children or adolescents may refuse to wear it because
it is unsightly and hinders their daily activities. However, many braces
today can be worn at night or for part of the day and some can be hidden
more easily under clothes. Your physician will work with you and your
children to decide whether part-time or full-time bracing is appropriate
and what kind of brace is best.
Invasive Treatments
Most back problems can be treated successfully with the noninvasive procedures
described previously. When these fail, however, surgery may be required.
Careful evaluation is done before any surgery and the type and timing
of any operation depends on many factors: the severity of the disorder,
if there is any pressure on the spinal cord or nerve, your age, how long
you have had the pain, previous operations, etc. The Spine Institute uses
the most advanced technology and, whenever possible, the most minimally
invasive surgical techniques to perform back surgery.
Injections
For chronic and intense back or neck pain, the physiatrist may inject
a combination of local anesthetic and steroid drugs directly into the
collection of nerves in the back that form part of the nervous system.
A similar injection into the joint spaces of the spine often relieves
back pain. An epidural injection, in which a small amount of cortisone
is placed directly into the spinal canal to ease inflammation surrounding
the nerves, may also produce long-term improvement.
Discectomies
One of the most commonly performed procedures in the country, the discectomy
is probably the most common operation for sciatica. Very simply, discectomy
means to remove part of a herniated disc because it is irritating a nerve
and causing pain.
Generally, the operation is performed on patients who have had back and
leg pain for at least six weeks. When deciding whether or not to have
a discectomy, you should look at your personal surgical risks with your
physician as well as the extent of the pain and how much it is disrupting
your life.
Depending on the location and the severity of the disc damage, the operation
can be performed using open surgery or the less invasive endoscopic or
microscopic surgery with arthroscopic techniques similar to those used
on knee operations. With endoscopic surgery or an open discectomy, you
will usually go home either the day of the procedure or the next day.
Open surgery or microdisectomy usually requires an incision 1 1/2 inches
long.
In the open surgery, the surgeon will first remove a portion of the lamina
(the roof over the spinal nerves) of the vertebra in order to see into
the spinal canal. Gently pulling aside the nerves to protect them, the
surgeon then removes the herniated disc material. After the material is
removed, the nerves are freed from pressure and irritation.
Laminectomy
A laminectomy is often performed to combat spinal stenosis--the narrowing
of the spinal canal. In this operation, the lamina--the bony back portion
of the spine over the spinal canal--is removed at the location where nerves
are being irritated. The surgeon can then remove any bone spurs from around
the nerves, reducing the irritation and inflammation. It may be necessary
to remove part of the facet joints or part of the discs as well. This
surgery is frequently done on patients past the age of 65.
Spinal Fusion
Spinal fusion is used when there is an instability in the spine that
causes pain. Fusion will reduce the motion, and therefore the pain, by
immobilizing the segment of the spine that is causing your back problem.
This operation may be performed because instability has occurred secondary
to arthritis, trauma or prior surgical procedure. Fusion surgery is also
done to correct the progression of a spinal deformity such as scoliosis
(see below).
During a spinal fusion, the surgeon places a bone graft--generally taken
from the patient’s pelvic bone or rib, but sometimes from a bone bank--between
two or more vertebrae. The vertebrae then fuse together and grow into
a single bone, and over a period of about four to nine months, the bone
graft is replaced with living bone produced by your body. Spinal segments
must be held immobile to allow the fusion to complete itself. This may
be done internally with spinal instrumentation (plates, wires, rods, hooks,
or screws) or by external methods such as braces or casts.
Fusions can be done from the front (anterior fusions) or from the back
(posterior fusions) or sometimes from both depending on the type and location
of the problem. In an anterior fusion, the surgeon takes out the discs
of the spine that will be fused in order to create more flexibility, while
in a posterior fusion, the facet joints in the area to be fused are removed.
Since two or more vertebrae are being fused together, many patients are
concerned with a loss of flexibility. Any loss of flexibility depends
on how many vertebrae are fused together and where they are located. Most
fusions involve a small number of vertebrae and the loss of flexibility
is minimal. Plus, the reduction of pain allows most patients to feel even
more active.
Scoliosis surgery
Spinal fusion is a major component of most operations to correct scoliosis
curves. If an adolescent has a curve measuring 40 or 45 degrees or a curve
that continues to progress despite bracing, or if an adult has a curve
that exceeds 50 degrees or severe back pain because of scoliosis, surgery
is generally recommended to stop the progression and relieve any pain.
Before the spinal fusion, the surgeon will first correct the spinal curve
by straightening it using special metal rods used for internal fixation.
Remember that the curved spine is not just curving, it is bent and twisted
like a corkscrew. The metal rods will hold the spine in its proper place
as the bones fuse. Generally no braces or casts are necessary after scoliosis
surgery.
Removal of Spinal Tumors
Whether or not surgery is necessary with a spinal tumor depends on the
type of tumor. Primary tumors originate in the spine and surgery is usually
recommended. Metastatic tumors came from somewhere else in the body. With
these tumors, radiation and chemotherapy may be used, but if tumor is
painful or growing too close to the nerves, surgery may be necessary.
When a tumor is removed, some of the bone may need to be removed as well,
and perhaps rebuilt with bone graft or metal.
Recovery from Surgery
It is difficult to give general advice on recovering after surgery since
so much depends on the seriousness of your condition and what type of
surgery you had. Your physician can help you decide when you should return
to work, if physical therapy is recommended, what medications can help
relieve pain, what activities you can resume and when. Be patient and
follow your surgeon’s advice carefully. For most spinal operations in
today’s setting, hospitalization is less than one week.
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