FAQ Category: Spine

Spinal cord stimulation is the use an electrode implanted into the spinal cord to help control chronic pain. This implanted electrode provides stimulation to the nerves that come from the source of the pain. This electricity changes the impulse of both the excitatory and inhibitory neurotransmitters to effectively block the sensation of pain. Since its inception in the 1960s many innovations such as smaller and more effective electrodes, and better surgical techniques have made SCS an increasingly viable option for treating chronic back pain.

Patients with failed back surgery syndrome are typically treated with conventional medical management, which mostly includes medicines for pain and depression, physical therapy, and psychosocial therapy. Other treatments may include epidural injections, nerve blocks, and home based electrical stimulation units (TENS). If these usual courses of treatment continue to fail, the last options are either to perform another back surgery or to implant a spinal cord simulator. According to a recent report by Shivanand et al, repeat back surgery has poor outcomes ranging from only twenty-two to forty percent success rate. Repeat surgery also increases the risk for complications and is very expensive. Spinal cord simulator implantation has been shown in several studies as a viable option and Shivanand et al have shown it to have less than half the complications, shorter hospital stay and similar total cost over the first two years compared to repeat back surgery.

According to a recent study by Aleksiev the type of exercise, strengthening or flexibility, does not matter. Both caused a similar pain decreasing effect for patients with low back pain over a ten year period. The most important aspect of the exercise, according to this study, was the frequency, the more the better. It was also shown in this study that the use of an abdominal brace during daily whole-body movements or exercises also further increased the pain reducing effect of exercise over a ten year period.

There is a lot of evidence that increasing abdominal strength can help to decrease low back pain. This increased strength improves lumbar spine stability and can decrease the effect of sudden loads on the muscles, joints, discs and ligaments in the spine which is often the cause injury and pain. According to a recent study by Aleksiev in 2014 there is new evidence that performing abdominal bracing for every day movements that involve the whole body can decrease pain. He found that over a ten year study the groups doing the abdominal bracing had decreased intensity and frequency of pain by more than one and a half times over the group doing exercise alone. The hypothesis by Aleksiev is that performing the abdominal brace frequently through out the day greatly increases the frequency of said exercise, and thereby improving the strength gains. Doing this exercise also seemed to have the effect of reminding people to do their other exercises, again increasing overall abdominal strength.

There are multiple options out there: physical therapy, injections, medications, surgery and facet joint radiofrequency denervation. Each person’s case will be different as well as the intervention. It is a discussion to have with your healthcare provider.

According to the longest prospective study to date on lumbar fusion due to degenerative spondylolisthesis, the best long term outcomes occur when the result is a solid fusion. The body needs time without movement to fully fill in the spaces from the surgery around the bone graft and or instrumentation in order to complete the solid fusion. If there is too much movement during this critical healing phase this biological process may not run its full course and the result may be incomplete fusion. Even though twelve weeks seems like a long time, it will be over before you know it, and will greatly enhance your likelihood of a successful result.

When surgeons suggest using ceramics as an adjunct to a posterior lumbar fusion they aren’t meaning chips of your dinner plates. They use base substances that form ceramics, such as B-tricalcium phosphate or hydroxyapatite. In scientific studies these types of substances have been shown to attract osteopromotive cells called mesenchymal cells. It was then shown in animal studies that these substances needed to be used in conjunction with bone marrow cells in order to see positive bone growth. It is in this way that ceramics have become an option as a bone graft extender to increase the amount of bone available.

This systemic review utilized search terms such as Quality Adjusted Life Years (QALYs), cost-benefit and cost-effectiveness in specific relation to economic studies. Two studies both demonstrated that patients with spondylolisthesis treated with a surgical procedure had gains over non-operative treatment in terms of QALYs ranging from 0.0991 to 0.22 during a two-year horizon and one going on to further analyze at a four -year horizon showing a QALY of 0.34.

While there seems to be an increasing amount of interest related to this topic the authors of this review conclude that there must be research efforts that focus on “higher quality trials with pre-determined cost values and longer follow up”.

A recent review by McGregor, et al, mentions a few studies that support pre surgery rehabilitation. There is a suggestion by McGregor, et al, that the older age of spinal stenotic patients puts them at greater risk for comorbidiites and have a greater need for rehabilitation to improve outcomes. Along the same lines there is evidence from Nielsen, et al, whose study included both pre and post operative rehab with good results. This included both length of stay in the hospital and functional recovery. McGregor, et al, suggest that there is usefulness in looking at the entire care pathway in a more holistic way rather than simply focusing on the surgery. Based on these few examples there is evidence that pre surgical rehab can improve surgery and there is a need for more research in this area.

There are numerous treatment options for back pain caused by discs. Injections sometimes work but there is debate over if the type of injection matters or if it is the needle itself that does the trick. There are also nerve ablative therapies that deaden the nerves so you don’t feel the pain, but those nerves also send signals to muscles and other important tissues so this is a desperate measure.  Other types of injections are showing promise in the literature, called methylene blue injections. Conservatively, however there is always physical therapy, which can help alleviate symptoms through manual techniques and change body mechanics and inner core strength to prevent future problems.

An injection into the disc can help to alleviate symptoms.  There is controversy over whether lidocaine alone or lidocaine with a steroid is more beneficial, with the latest overview of the literature showing a lidocaine injection alone is just as effective as when combined with a steroid.  This is something that you can discuss further with your surgeon, knowing that you have options as far as what they are actually injecting, possibly with the same result.

If you are looking into this procedure talk with a medical doctor that has performed this technique and discus with them the procedures positives and negatives.

This question is highly dependent upon many factors and needs to be carefully assessed by a medical professional. If you have a severe bulging disc in your low back that is putting debilitating pressure on your nerves, then yes selective discectomy surgery can be effective for reducing radiating low back pain.