5 Types of Minimally Invasive Spine Surgery for Chronic Low Back Pain

If you have chronic low back pain that has not responded to injections, physical therapy, or other conservative treatments, you may be wondering whether there is a surgical option that does not require a major operation. The answer is yes — and as a Denver spine surgeon, I want to walk you through the most important types of minimally invasive spine surgery available today.

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.

Below I outline five types of minimally invasive spine surgery, what conditions each treats, and whether you might be a candidate.

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.

In a 5-year pooled analysis of three prospective clinical trials published in The Spine Journal , 249 of 320 patients were followed for a mean of 5.6 years after basivertebral nerve ablation. Pain scores improved by an average of 4.32 points on a 10-point scale, nearly one-third of patients reported being completely pain-free, and 68.7% had resumed activity levels they had prior to onset of CLBP. This makes Intracept one of the most evidence-backed types of minimally invasive spine surgery for vertebrogenic pain.

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 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, Reactiv8, an implantable neurostimulator, can help relieve mechanical chronic low back pain by reactivating the multifidus.

In the 5-year longitudinal follow-up of the ReActiv8-B pivotal trial, published in Neuromodulation: Technology at the Neural Interface, 88% of participants were “definitely satisfied” with treatment, 72% achieved at least 50% pain reduction, and 65% of patients who had been taking opioids at baseline had stopped taking them. These results support Reactiv8 as a durable minimally invasive spine surgery option for patients with multifidus dysfunction.

Benefits:

• 80%+ patients report treatment satisfaction (88% in the 5-year ReActiv8-B follow-up study)
• 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 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.

At Neurosurgery One, I have found that high-frequency spinal cord stimulation is particularly effective for patients with failed back surgery syndrome. A large randomized study published in Diabetes Care also confirmed long-term benefit for patients with painful neuropathy — a growing area of application for this technology.

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 specialized 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.

Which Type of Minimally Invasive Spine Surgery Is Right for You?

As a board-certified Denver spine surgeon, I want to be clear that no two patients with chronic low back pain are alike — and the right procedure depends entirely on an accurate diagnosis. The five types of minimally invasive spine surgery described above each address a distinct cause of pain:

• Vertebrogenic pain → Intracept
• Multifidus dysfunction → Reactiv8
• Contained herniated disc → Disc FX
• Failed back surgery or degenerative disc disease → Spinal cord stimulation
• SI joint dysfunction → SI joint fusion

If you are living with chronic low back pain that has not responded to conservative treatment, the board-certified Denver spine surgeons at Neurosurgery One can help determine whether one of these minimally invasive procedures is right for you.

We can see new patients within 5 days at our Back and Neck Pain Clinics, located at all six of our clinics in

Castle Rock

Denver

Lakewood

Littleton

Lone Tree

Parker

Call us at 720-638-7500 or request an appointment online.