Surgery is not always necessary to effectively treat many different kinds of back problems. The University Spine Center may recommend a number of non-operative treatments for your back.
A brace is an external device designed to provide your spine with support and to help reduce movement, which can facilitate healing. Braces include:
- Cervical collar (a soft neck brace)
- Lumbar corset (rigid or soft)
- Thoraco-Lumbo-Sacracl-Orthosis or TLSO (plastic)
The University Spine Center will discuss when, how long, and why the brace is to be worn.
Complementary and alternative therapies (CAM) are gaining increasing attention in medical circles. While the University Spine Center does not endorse these practices, many patients do get pain relief from such things as acupuncture, biofeedback, yoga, aromatherapy, and massage.
Drug therapy can be a crucial element in managing your back problem. There are many effective medications available both by prescription and over-the-counter to help relieve pain. The University Spine Center may also recommend muscle relaxants and sedatives in certain cases. While medications can provide much-needed relief, they are powerful drugs that should be treated with respect.
- Tell the University Spine Center about all drugs you are taking, including over-the-counter medications as well as vitamins and supplements.
- Take drugs exactly as prescribed.
- Ask the University Spine Center about side effects you should know about. If you experience any side effects, contact the University Spine Center at once.
- Do not give your prescription medication to other people.
- Ask your physician how to manage breakthrough pain—don’t just double up on your dose on a bad day.
Pain Management for Spinal Disorders
Back pain is one of the most common types of pain, and there is a new medical specialty called pain management that helps people cope with long-term persistent pain. The University Spine Center may provide pain management consultation as part of your therapy.
In some cases, pain specialists may recommend some of the latest technological breakthroughs such as spinal cord stimulation, radiofrequency ablation, or an intrathecal infusion pump.
Physical therapy or PT works to help improve your physical condition which can reduce pain and help you gain strength. PT might be:
- Active (exercise on land or in the pool)
- Passive (spinal manipulation, ultrasound)
- Biomechanical (improved posture)
The University Spine Center may recommend that you have a local anesthetic and corticosteroid injected into your spine. These injections are done under a kind of video X-ray called a fluoroscope. Your physician will insert the needle into the precise area necessary to deliver the medication.
- An epidural injection injects the medication into the area between the dura mater, which protects the spinal cord, and the bony spinal canal
- A transforaminal injection or nerve block is injected into the protective membrane or pia mater that covers the nerve root
- A facet block injects medication to treat pain arising from the facet joints or the point where one vertebra forms a joint with the one below it (this joint is called the zygapophyseal joint)
Many people have benefited from a spinal cord stimulator or neurostimulation device. These devices send low-energy electrical pulses to a specific area of the spine in order to help block pain signals. A spinal cord stimulator is implanted in the body in your abdomen with a wire (called a “lead”) placed near the spine.
Radiofrequency ablation (sometimes used to treat cancer or heart problems) can also be performed to help treat spine pain. Under fluoroscopy (a video X-ray), the physician will insert a needle into the facet joint (the joint formed between two adjacent vertebrae). Once the needle is in place, radiofrequency energy is transmitted which can ablate or destroy very small areas of tissue. This procedure is sometimes called a rhizotomy.
The Goals of Non-Operative Treatments
The University Spine Center knows that some back problems require surgical interventions, but others do not. The goals of non-operative care are to correct problems and relieve symptoms in a way that is most appropriate for your condition.
What to Expect from Injections, Radiofrequency Ablation, or Spinal Cord Stimulation
If you need an injection or radiofrequency ablation, you will be given a local anesthetic for the procedure,. The most time-consuming portion of the procedure is locating the exact right spot for the injection or ablation, which usually involves fluoroscopy. You will be given numbing medicine so that you do not feel pain with the injection or ablation.
A spinal cord stimulator is an implantable device. The implantation procedure is typically done under local anesthetic and involves placing a wire at or near your spine and connecting it to the pulse generator (main unit) which is implanted in your abdomen. This surgery can often be done on an outpatient basis and in some cases can be performed in an hour. The spinal cord stimulator is battery powered and will last for several years, but will eventually require replacement.