Conservative Treatments of Spinal Disorders
The treatment of spinal disorders can be broadly categorized into non-surgical and surgical. Depending on the severity of the symptoms, as well as the expectations of the patients, treatments can be custom tailored. Of the many conservative non-surgical treatments that are currently available, a few of the most commonly practiced treatments will be discussed here.
The most frequently prescribed treatments are NSAIDs (Ibuprofen, Celebrex, etc.) and Physical Therapy. The goals of these treatments are to decrease the immediate symptoms by decreasing the acute inflammatory process, and by using passive modalities to promote healing. Additional long-term benefits of Physical Therapy include strengthening the core musculatures in order to better stabilize the spinal structures.
Epidural Steroid Injection procedures can be performed in different parts of the spinal column utilizing the various openings in the spine. They can be performed, for example, in the cervical (neck) or the lumbar (lower back) spine either through translumbar, caudal, or transforaminal approaches. Typically, injected medications can include a local anesthetic agent in combination with a corticosteroid compound. Local anesthetic agents can provide an immediate relief of pain, and the corticosteroid compounds usually take a few days to provide relief through their powerful anti-inflammatory actions. The route and the medications used are determined by a patient’s particular pain pattern, findings on imaging studies (i.e. MRI and CT scans), as well as the particular clinician’s preferences. Epidural injections can be utilized in various spinal disorders, including annular tears, disc herniations, degenerative disc disease, and spinal stenosis.
Intradiscal thermoplasty (IDET) is a relatively newer method of treating discogenic pain and annular tears, as well as painful disc disruption. The treatment involves repairing and possibly denervating the posterior fibers of the annulus within a disc. IDET is usually preceded by discography studies that help in locating and analyzing the disc that is the pain generator. The benefits of this procedure are that it does not require an incision to be made, and recovery is relatively short and uneventful. Clinical outcomes indicate that IDET is an effective tool in treating discogenic pain with success ranging from 60 to 70 percent.
Nucleoplasty is also performed without an actual incision, but through a needle catheter like the IDET procedure. This procedure involves reducing the volume of disc material either through heat or coagulation method. It is most widely used for contained disc herniation that places pressure on neurological structures, thereby producing radiculopathic or radiating symptoms.
Facet Injections, and/or Medial Branch Blockade are procedures, which are used for posterior element pain (does not result from disc or pressure on nerves). The most common etiology of these pains can be from traumatic injuries, such as in automobile accidents, but also as a result of degenerative joint process within the facet joints.
Radio Frequency Rhizotomy or Denervation procedures are employed usually in pain that is mediated by nerves. Nerves are either irritated by trauma, degeneration, or by unknown causes.
Conservative treatments of spinal disorders have improved significantly over the years. Many patients who had previously required surgical interventions have been helped dramatically with conservative treatments, thereby reducing the risks imposed by surgery. It should be noted however, that each spinal disorder is unique, and that all patients should be evaluated as thoroughly and carefully as possible by utilizing good history taking, physical examination, and imaging studies (X-rays, MRI’s CT scans), as well as electro-diagnostic studies (EMG). Proper patient selection, as well as understanding the nature of each patient’s pain generator is critical in making sound judgments with regards to deciding on appropriate spinal procedures delivered, whether it be non-surgical or surgical.