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Spine

Spine

Spine

Lower Back Pain / Disc Pain / Sciatica

spineLow back pain (LBP) is a common disorder involving the muscles, nerves, and bones of the back. Pain can vary from a dull constant ache to a sudden sharp feeling. Low back pain may be classified by duration as acute (pain lasting less than 6 weeks), sub-chronic (6 to 12 weeks), or chronic (more than 12 weeks). The condition may be further classified by the underlying cause as either mechanical, non-mechanical, or referred pain.

Many times, these pains are from old traumas (small or large), repetitive stress injuries or just activities of daily living with lifting bending or twisting. Many of these initial micro-injuries are forgotten as there was little or no pain or damage at the time, the symptoms show up years later as we age, weight increases or our muscles weaken due to them not being used as much with our sedentary lifestyles or work environments.

Disc pain Injury or weakness can cause the inner softer portion of the disc (the nucleus) to protrude through the tough outer ring (the annulus). This is known as a slipped, herniated, or prolapsed disc. This causes pain and discomfort. If the slipped disc compresses one of your spinal nerves, you may also experience numbness and pain along the affected nerve (Sciatica is what you may feel down your legs).

The most common signs and symptoms of a herniated disc are radiating or shooting arm or leg pain. If your herniated disc is in your lower back, you’ll typically feel the most intense pain in your buttocks, thigh and calf region as well as down to your feet and toes associated with numbness or tingling and weakness with possible loss of function in severe cases which is considered an emergency.

A disc bulge (many refer to as slipped disc), can potentially compress against or irritate the nerves where it exits from the spine at that level or the levels above or below. This nerve pressure can cause back pain, spasms, cramping, numbness, pins and needles or electrical pain into your legs.

 

Lumbar Disc herniation

If there is nerve entrapment in the lumbar spine, this leads to symptoms of leg pain or sciatica which include: leg pain which radiates below the knee to the foot/toes. The leg pain is usually more severe than the back pain. Numbness, paresthesia’s (pins & needles), weakness and/or loss of tendon reflexes, which may be present and are found in the same distribution and only in one nerve root distribution.

 

However, nerve root compression can lead to permanent nerve damage with sensory and motor deficits when left untreated or when people stay on pain killers for a long period of time.

Cervical (neck) Disc herniation (prolapsed disc)

Cervical disc herniation occurs most frequently at the levels of C4/5, C5/6 and C6/7. Posterior herniation causes symptoms by compressing the cord or a nerve root, or by stretching the posterior longitudinal ligament or posterior annulus.

Degenerative disc disease (cervical spondylosis)

It is a natural normal part of ageing; disc degeneration can also occur in young people as well. The cause is likely to be genetic, environmental, traumatic, inflammatory, infectious, sports and other factors. Degenerative disc disease may lead to disc herniation as well.

Treatment Options for Neck & Back pain as well as Disc Pain

An epidural steroid injection (ESI) is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain caused by inflamed spinal nerves. ESI may be performed to relieve pain caused by disc nerve pressure, spinal stenosis, spondylolysis, or disc herniation.

An epidural steroid injection is performed to help reduce the inflammation and pain associated with nerve root compression. Nerve roots can be compressed by a herniated disc, spinal stenosis, and bone spurs. When the nerve is compressed it becomes inflamed.

Radiofrequency ablation is a minimally invasive procedure that is usually performed with local anesthetic and mild sedation.

As with many spinal injections, radiofrequency neurotomy is best performed under fluoroscopy (live x-ray) for guidance in properly targeting and placing the needle (and for avoiding nerve or other injury).

Radiofrequency Ablation Treatment

The joints treated with radiofrequency ablation are: Facet joints – pairs of small joints that are situated at each vertebral level in the back of the spine. Each facet joint is connected to 2 medial branch nerves that carry signals (including pain signals) away from the spine to the brain.

Radiofrequency ablation (or RFA) is a procedure used to reduce pain. An special electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area but not effecting the motor or sensory parts of the nerve.

Patients are treated with radiofrequency ablation on a day care basis and require only local anesthetics with a sedative to feel calmer. The majority of patients are able to return home after treatment within a few hours.

 

Conditions Treated With Radiofrequency Ablation.

The success and usefulness of radiofrequency ablation on lumbar facet joint pain was first showed by empirical studies. Ablation therapy has also been shown to be effective over the years for a number of other conditions including arthritis related pain, lumbar and cervical facet pain (neck region), dorsal root ganglion, herniated intervertebral discs, lower back pain caused by sacroiliac joint complex, trigeminal neuralgia, sphenopalatine ganglion (characterized by chronic headaches and atypical facial pain), and sympathetic ganglia.

Lumbar Facet Pain and Cervical Facet Pain / Dorsal Root Ganglion

Neuropathic spinal pain which is pain starting in the back or neck and shooting into the upper or lowers limbs (radicular pain) can be caused by dorsal root ganglia (DRG) inflammation and has been successfully treated using RFA (ablation).

A herniated disc and unsuccessful/failed back surgery are frequently causes of lower back pain, with pain in the lower limbs also being experienced.

Low Back Pain

Evidence from clinical studies suggests that the radiofrequency ablation procedure for low back pain significantly reduces pain severity and this is sustained for one to two years in the majority of patients. In addition, the level of pain relief described by patients is greater and lasts longer compared to steroid injections alone. Furthermore, patients that had prior back surgery reported shorter recovery times, more wide-ranging pain relief, superior range of motion, decreased needs for painkillers, and improvements in their quality of life after undergoing radiofrequency ablation treatment.

Trigeminal Neuralgia

If the trigeminal nerve that mediates pain and touch sensations in the, eyes, nose, mouth, and the rest of the face becomes affected, trigeminal neuralgia can develop. Trigeminal neuralgia is typified by agonizing sharp pain that occurs during every day activities such as teeth brushing, shaving, applying makeup, chewing, drinking, or eating. However, radiofrequency ablation treatment provides greater durations of pain relief as evidenced to date.  Remarkably, many patients suffering trigeminal neuralgia treated with the RFA approach report symptom improvement lasting months to years.

Conclusion

The radiofrequency ablation procedure is regarded as one of the best minimally invasive and exact pain management therapies now available. The radiofrequency ablation approach uses a current that generates electro-thermal heat in the inflamed nerve region to temporarily destroy the nerves causing chronic pain. Patients experience substantial pain reduction due to the after effects of the procedure.

Micro-discectomy and Artificial Disc Replacements or Fusion

These types of surgeries were once considered only for long stay hospitals. Now with current advances in surgery we have been able to perform hundreds of artificial discs and micro-discectomies as One Day Surgery procedures.

The first type of spine surgery that became commonly performed as an day care procedure is the lumbar discectomy. This surgery is conducted to remove the herniated portion of the lumbar disc. It has a high success rate, especially in relieving leg pain (or sciatica), caused by the herniated portion of the disc pressing against a nerve.

There are two common options in an outpatient lumbar discectomy—microdiscectomy and endoscopic (or percutaneous) discectomy:

Using modern microdiscectomy techniques, the surgeon is able to minimize the extent of the operation and potential for tissue damage by using a standard incision of 2-4cm and focusing the tissue dissection on spreading the muscles and ligaments rather than cutting them.

Due to minimal dissection of the muscles and other soft tissues, post-operative pain is tolerable. By removing the portion of the disc that is irritating the nerve, usually the pre-operative radiculopathy pain has diminished or resolved, and many patients feel immediate improvement in their leg pain when they wake up from the surgery.

Typically, patients will leave the recovery room, and go home, with less pain than they had before the surgery.

For the carefully selected patient, outpatient lumbar micro-discectomy has become a routine surgical choice with highly predictable success rates.

A micro-discectomy is one of the most minimally invasive procedures that can be done to alleviate pain associated with nerve root irritation. In this surgery, a relatively small incision (e.g. 2-4 cm) in the lower back, and the portion of the herniation that is in contact with the nerve root is pulled out.

The goal is to relieve symptoms associated with pressure on the nerve root. The surgery has a relatively high success rate – about 90-95% – in providing relief of leg pain and/or buttock pain.

Artificial disc replacement surgery involves replacing a painful disc with an artificial disc. Artificial disc surgery may be performed on the lower back (lumbar spine) or the neck (cervical spine). Artificial discs are designed with the goal of mimicking the form and function of the spine’s natural disc.

The theoretical advantages of the artificial cervical disc compared with a fusion include:

  • Maintaining normal neck motion
  • Reducing degeneration of adjacent segments of the cervical spine
  • Allowing early postoperative neck motion

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