Effective Pain Relief Alternatives to Back Surgery

Back pain is the most common chronic pain condition and can result in significant disability, loss of function, and missed time from work. Patients are often desperate to relieve the pain, and back surgery can feel like the only option. There is, of course, a time and place for back surgery, and it is commonly performed to treat spinal instability, spinal stenosis, or severe radiculopathy (sciatica or pinched nerve) that does not improve with conservative treatment options. But, it is also crucial that patients know there are effective alternatives to back surgery, and surgery is not the best option for every patient.

Why Should You Look Into Alternatives to Back Surgery? 

There is a significant cohort of patients who typically benefit from alternative treatments to back surgery. The alternatives to back surgery are often minimally invasive or non-surgical options and prevent patients who would not be ideal surgery candidates from the risks of undergoing surgery and the associated recovery time.

Many patients have multiple chronic medical problems known as comorbidities that can prevent them from safely having anesthesia.  Other patients want to delay surgery as long as possible, given their busy lives. Often patients will not want to undergo surgery because of family events or travel plans that they wish to attend. And, of course, is a group of patients who already have had back surgery and continue to have pain. These patients often are looking for alternatives to avoid repeat surgery.

All of these reasons are great reasons to explore effective pain relief alternatives to back surgery.

Pain Relief Alternatives for Each Cause of Back Pain

There are multiple etiologies or causes that patients develop chronic back pain and low back pain. The type of injury, duration, and patient goals all play a role in creating a comprehensive treatment plan. Below are approaches and options to consider that can reduce and treat chronic lower back pain.

Spinal Arthritis or Spondylosis

Back pain commonly results from degeneration within the facet joints or joints of the spine.  There are many names for this disease, including spinal arthritis, spondylosis, and facet joint arthropathy. This pain is often felt on either side of the spine at the affected levels and results in pain patterns along the hips, thighs, and legs. Pain is typically made worse with standing, walking, and arching of the back. 

Lumbar facet blocks, lumbar medial branch blocks, and lumbar facet joint injections are terms made to describe similar procedures used to treat pain from arthritis in the spine. 

Treating spinal arthritis is typical performed with a series of injections as follows:

• Step 1 – Lumbar Facet or Medial Branch Nerve Block:
• First, a diagnostic lumbar facet or medial branch nerve block is performed. During this procedure, the nerves that are believed to be causing the pain are blocked or numbed temporarily. This is meant to determine and confirm if these nerves are responsible for the pain. This relief is only intended to last approximately 8 hours. 
• Step 2- Repeat Lumbar Facet or Medial Branch Nerve Block:
• The initial procedure is repeated. Two sets of diagnostic (test) injections are completed on two different occasions to confirm the underlying cause of the pain. If two blocks (step 1 and step 2) are successful in temporarily alleviating a large percentage of your pain, this is a positive test. At this point, radiofrequency ablation can be considered.
• Step 3 - Lumbar Medial Branch Radiofrequency Ablation:
• Radiofrequency (RFA) Ablation can be performed, which should give long-lasting relief. Radiofrequency ablations involve using a special needle that heats up. This needle then burns or stuns the medial branch nerves going to the joints. The ablation interrupts the pain sensations originating from nerves and joints in the back for typically greater than six months.

Sciatica, or Radiculopathy, or Bulging Discs

Sciatica, nerve pain, and radiculopathy are all terms that describe pain shooting from the back down the leg. A common cause of this can be a pinched nerve from a bulging or degenerated spinal disc. 

A lumbar epidural steroid injection or (LESI) is an injection of a potent anti-inflammatory medication into the epidural space of the lower back using x-ray guidance. The epidural space is an area of the body where the spinal nerves are located and often inflamed, resulting in significant pain and sometimes weakness. The steroid medication provides an anti-inflammatory effect to reduce pain, nerve swelling, and irritation.

Sacroiliitis or SI Joint Pain

The sacroiliac joint or SI joint is a joint within the pelvis. This joint connects the spine and the hips. Arthritis or irritation in this joint is a common cause of back pain located near or below the beltline. 

There are various new treatments to reduce chronic pain in the SI joints, including:

1. Sacroiliac Joint Injections -A sacroiliac joint injection is a procedure using x-ray guidance to place an anti-inflammatory medication directly into the sacroiliac joint. 
2. Sacroiliac Nerve Ablations - The lateral branch nerves or SI Joint nerves are a set of nerves that transmits pain from the joint to the brain. Ablating these nerves can result in pain relief.
1. Step 1 - Lateral Branch Blocks: First, a diagnostic lateral branch nerve block is performed. During this procedure, the nerves that are believed to be causing the pain are blocked or numbed temporarily. This is meant to determine and confirm if these nerves are responsible for the pain. This relief is only intended to last approximately 5-8 hours. 
2. Step 2 - Lateral Branch Blocks: The initial procedure is repeated. Two sets of diagnostic (test) injections are completed on two different occasions to confirm the underlying cause of the pain. If two blocks (step 1 and step 2) are successful in temporarily alleviating a large percentage of your pain, this is a positive test. At this point, radiofrequency ablation can be considered. 
3. Step 3 – Lateral Branch Radiofrequency Ablation: Radiofrequency (RFA) Ablation can be performed, which provides long-lasting relief. Radiofrequency ablations involve using a special needle, which heats up. This needle then burns or stuns the nerves going to the joints. The ablation interrupts the pain sensations originating from nerves for typically greater than six months. 

• Sacroiliac Joint Fusion - SI joint fusions are typically performed on patients that have received minimal to no relief with SI joint injection and SI joint ablation. SI joint fusion is performed by using a small medical device or bone graft to prevent the joint from moving and causing lower back pain.

Failed Back Surgery Syndrome

Failed back surgery syndrome or post-laminectomy syndrome occurs after patients have chronic pain after prior back surgery. This pain typically results from nerve irritation and/or scar formation.  

Spinal cord stimulation is commonly used to treat the following conditions: failed back surgery syndrome, post-laminectomy syndrome, and refractory lumbar radiculopathy. Most patients with these conditions experience 50-100% relief.  The spinal cord stimulation is a multistep process used to ensure the best possible outcome for each patient.

Overview of the Spinal Cord Stimulator Trial and Permanent Implant Stages:

• Stage 1a: Pain Physician visit (evaluate your pain condition to determine whether your pain syndrome is helped by spinal cord stimulation).
• Stage 1b: Diagnostic imaging and lab ordering (an MRI may be ordered to determine whether you have enough spinal space to have a lead safely placed).
• Stage 2: Psychological evaluation (to understand your needs and expectations of therapy, also a requirement of insurance companies).
• Stage 3: Trial stimulation (to evaluate the effectiveness of pain reduction, 5-8 days).
• Stage 4: Permanent implantation (this may be performed by your pain physician or occasionally a spine surgeon depending on your pain syndrome needs). The surgical procedure will entail placement of the lead in the epidural space of the spinal cord and placement of the battery in the buttock or flank.

Spinal Stenosis

Patients who suffer from spinal stenosis typically have symptoms of back pain, leg pain, leg weakness, and/or leg cramping. These symptoms are made worse with walking; this is known as neurogenic claudication. Symptoms typically improve with rest and mildly bending forward. 

Patients often consider surgical decompression known as laminectomy. Direct or indirect spinal decompression is a minimally invasive approach commonly used for patients trying to delay surgery or who cannot have surgery due to their other medical conditions.

Spinal decompression can be performed via multiple techniques commonly used. Commonly performed techniques include Superion Vertiflex and Vertos Minimally Invasive Spine Decompression (MILD procedure). These procedures are intended to provide additional space for nerves compressed by spinal stenosis.  Your physician can better discuss what the best option for you is.

Muscle Spasm or Trigger Points

Trigger points are described as tender points, spasms, or hyperirritable areas in the muscles. Patients typically can feel the trigger points as nodules that are painful to pressure. The most common locations for trigger points are the neck, upper and low back. 

Trigger point injections are quick injections performed at the locations to provide rapid relief and decrease pain and muscle spasms.

Functional Back Pain Secondary to Muscle Weakness

A growing area of study and interest is functional back pain. There is growing medical literature that demonstrates a significant amount of patients are suffering from muscle weakness and/or improper nerve sensitization. 

Peripheral nerve stimulation or PNS is a rapidly growing effective treatment for nerve pain. PNS uses either a temporary or permanent implantable wire to stimulate nerves near the area of injury or pain. These wires use a small amount of electrical energy to block pain and provide relief. The benefit of this therapy is the precision and ability to focus on specific areas that otherwise could not be treated with previously available conventional measures. PNS does not eliminate the source of pain; it simply interferes with the signal to the brain. The goal for relief is a 50-100% reduction in pain. Your physician will discuss with you the temporary options vs. permanent options. Both have been shown to provide long-lasting relief.

Compression Fractures

Compression fractures are most commonly caused by osteoporosis or thinning of the bones resulting in weak bones. For some patients, bracing and oral medication can result in pain control; however, a particular cohort of patients requires more advanced care. 

Kyphoplasty and sacroplasty are procedural techniques used to address compression fractures in the spine. Sacroplasty is a rare procedure used to address fractures in the sacrum. Both kyphoplasty and sacroplasty use similar procedural techniques. Kyphoplasty is more commonly used to treat compression fractures of the thoracic and lumbar spine. The procedure is typically done in an outpatient setting and uses a large needle to access the fracture. A small space is created in the fracture, and then a medical-grade glue or cement is injected to help stabilize the fracture. This glue or cement is similar to what is used to hold joint replacements in place. The procedure typically reduces pain and prevents the fracture from worsening.

Let Us Help You Find Relief from Your Back Pain

There are many effective pain relief alternatives to back surgery that are minimally invasive, and we invite you to learn more. Find out if Excel Pain and Spine can help you find relief from your back pain. Contact us today to learn more about our unique approach to your pain management needs and if there are any alternatives to back surgery for your situation.