New types of minimally invasive spine surgery are being developed continually, and that is giving new hope to people who are struggling with ongoing low back pain.
There are many people with chronic low back pain (CLBP) who either can’t be helped by traditional spine surgery, such as spine fusion, or who aren’t candidates. For these patients, the most important first step in finding relief is to find a spine surgeon who can tease out the real root of your pain. Often it is not a pinched nerve or herniated disc but a condition that many doctors don’t know to look for.
Here is a quick look at four new types of minimally invasive spine surgery that can help many patients.
Intracept for Vertebrogenic Pain Syndrome
A common cause of CLBP is compressed nerves or discs in the spine. However, research now suggests that many patients whose pain cannot be traced to these problems could be suffering from pain inside the bones of the spine, or vertebrae. Specifically, the vertebral endplates are the source of pain in many patients, even those previously diagnosed with disc pain. This pain is transmitted via a nerve inside the vertebra called the basivertebral nerve.
Intracept is a type of minimally invasive spine surgery that uses radiofrequency energy to ablate the basivertebral nerve, effectively shutting off the pain signals from the patient’s brain.
Benefits:
- Non-invasive procedure, with a rapid recovery period
- Long-lasting relief, with improvements sustained over five years in clinical studies
You may be a candidate if you have:
- experienced CLBP for at least six months that has not responded to six months of conservative treatment
- degenerative endplate changes (these can be seen on an MRI by a trained spine surgeon)
Reactiv8 Therapy for Multifidus Muscle Dysfunction
Ongoing lower back pain and strain can cause your deep spinal muscle that supports your back, called the multifidus, to “shut off” or atrophy. This leads to multifidus muscle pain and spinal instability, which causes further low back pain as other muscles try to compensate. Reactivating the multifidus is difficult, and physical therapy may not do the trick. In those cases, Reactive8, an implantable neurostimulator, can help relieve mechanical chronic low back pain by reactivating the multifidus.
Benefits:
- 80%+ patients report treatment satisfaction
- Significant reduction in pain and opioid use
You may be a candidate if you have:
- experienced CLBP for at least six months that has not responded to six months of conservative treatment
- multifidus muscle dysfunction diagnosed through imaging or physiological testing
Disc FX for Contained Herniated Disc
Herniated discs account for the vast majority of lower back pain. There are two types of herniated discs. A contained herniated disc, commonly called a bulging disc, occurs when the inner portion of the disc pushes into the outer layer and compresses the nerve. Uncontained herniated discs occur when the inner portion extends through the outer layer of the disc into the space between the vertebrae.
Patients with CLBP due to a contained herniated disc are treated with conservative therapies, including physical therapy, spinal injections and anti-inflammatory medication. When these are not effective at relieving the pain and the patient does not want to undergo spine surgery, Disc FX is a new type of minimally invasive spine surgery that provides an alternative. In this outpatient procedure, the spine surgeon uses imaging to guide a needle into the disc and remove a small portion of the jelly-like middle of the disc to provide more space to the compressed nerve. Patients go home the same day as the procedure with a small suture and bandage.
Benefits:
- Minimally invasive procedure, with a small incision and minimal tissue disruption
- Effective in reducing disc-related pain and improving spinal function
- Prevents disc from further herniation, reducing the need for more-invasive surgery later
You may be a candidate if you have:
- CLBP due to a contained herniated disc causing nerve compression
- Tried and failed conservative treatment
Spinal Cord Stimulation for Failed Back Surgery
If you have had back surgery that didn’t satisfactorily relieve your pain and you either can’t have or don’t want further surgery, spinal cord stimulation may be an option. This type of minimally invasive spine surgery also can be used for patients with degenerative disc disease.
Spinal cord stimulation involves implanting a small device that uses electrical impulses to block pain signals from reaching the brain. It’s very important that you are assessed by a spine surgeon with extensive experience in spinal cord stimulation as it does not work for everyone. If you are considered a good candidate, you will go through a temporary trial with the system connected externally. Only patients who find satisfactory and substantial benefit should then go on to have the implanted procedure.
Benefits:
- 50% or greater pain relief for patients who find relief during temporary trial
- Adjustable and reversible treatment, tailored to individual pain patterns
- Minimally invasive procedure with a shortened recovery period
You may be a candidate if you:
- Have back pain that has not improved with conservative therapies, such as injections or physical therapy
- Don’t want surgery (or further surgery)
- Are willing to do the temporary trial and you get satisfactory relief from that trial
SI Joint Fusion for Sacroiliac Joint Dysfunction
It’s estimated that up to one-third of lower back pain isn’t coming from the spine but rather from the sacroiliac, or SI, joint. The SI joint connects the base of the spine to the pelvis. One of its main jobs is to absorb impact from movement and disperse it. However, the SI joint can be impaired by arthritis as you age, by injury and even by pregnancy and cause pain in the lower back.
When SI joint dysfunction is the cause of chronic lower back pain, a type of minimally invasive spine surgery called SI joint fusion is appropriate. SI joint fusion “tightens” the joint using specialize implants, which then return the missing stability and reduce the pain.
Benefits:
- Smaller surgery than spinal fusion
- Long-lasting results with significant pain reduction and improved function for properly diagnosed patients
- Addresses root cause of CLBP
You may be a candidate if you:
- Are diagnosed with SI joint dysfunction
- Have not responded to physical therapy or injections
Lloyd Mobley III, MD, FAANS, is a board-certified neurosurgeon who sees patients in the Neurosurgery One Castle Rock and Lone Tree locations. One of Dr. Mobley’s areas of expertise is minimally invasive spine surgery. He is committed to staying at the leading edge of new minimally invasive techniques and is often one of the first spine surgeons in the region to become trained in and begin offering new procedures. Request an appointment with Dr. Mobley in our South Denver locations here.
