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Non-Surgical Spine Treatment

Spinal Manipulation

Spinal manipulation is a non-surgical “hands-on” technique using leverage and exercises to adjust spinal structures and restore mobility of the back. During pain, the nerve that is interconnected with the muscles, joints, bone becomes weak and loses its ability to function. With this therapy, the nerve will be made to work normally and the blood circulation in these areas also increases.

There are two types of osteopathic manipulation — direct- and indirect- method. In direct method, the problematic or tight tissue is moved towards the area of tightness. In indirect procedure the doctor pushes the tight tissues away, in opposite direction of the muscle resistance.

Osteopathic manipulation is not recommended for people having broken bones, dislocation, bone cancer, infection of the bone, damaged ligament, and also for people who have recently undergone surgery and are on medicines such as aspirin and warfarin. Untoward effects of this therapy include increase in pain, headache and fatigue. However these are of mild severity and may disappear within a day. Severe complications are very rare..

Epidural Spinal Injections

Epidural spinal injection is a non-surgical treatment option utilized for relieving back pain. Spine degenerative conditions such as herniated disc, spinal stenosis and many others may induce back pain due to the compression of the associated spinal nerves. This pain or numbness may extend to the other parts of the body such as hips, buttocks, and legs. Doctors start with non-surgical methods to treat back pain and epidural spinal injection is one of these preferences. In cases where the patient finds no relief from non-surgical methods then finally surgery is recommended.

Epidural spinal injections contain a strong anti-inflammatory agent called corticosteroid and an anesthetic for pain relief. It is not the same as epidural anesthesia given before birth to decrease labor pain. Epidural injections are administered into the epidural space of the spine. The epidural space is the space between the outermost covering of the spinal cord (dura mater) and the wall of the spinal canal. It is approximately 5mm wide and is filled with spinal nerve roots, fat and small blood vessels.

Indications

An epidural spinal injection may be employed both for diagnostic and therapeutic reasons, including:

  • Medications to determine the specific nerve root involved in the spinal problem (diagnostic purpose)
  • Medication for inducing short or long-term relief from pain and inflammation (therapeutic purpose)
  • It is to be noted that epidural spinal injection is not a curative intervention rather it’s a treatment tool to reduce the discomfort of the patient so that rehabilitation programs such as physical therapy may be well executed.

    Procedure

    Pain management in different conditions such as spinal stenosis, disc herniation and arthritis can be done through epidural injection. Different types of physicians such as physiatrists, anesthesiologists, radiologists, neurologists, and surgeons may recommend epidural injections for pain relief.

    Usually epidural spinal injection is done on an outpatient basis. The procedure involves the following steps:

    • Patient is taken to the pre op area where trained nursing staff makes prepares the patient for the procedure by taking vitals and reviewing medications. Blood sugar and coagulation status may also be checked if needed.
    • Patient is taken to the procedure room and will lie face down on a table.
    • The injection site is then cleansed and injection of a local numbing agent is given in the area so that you don’t feel pain during the procedure.
    • A thin hollow needle is then inserted into the epidural space, guided by fluoroscopic X-ray to place the needle in the correct position. This system gives real time X-ray images of the position of the needle in the spine on a monitor for the surgeon to view.
    • A contrast material is then injected through the properly placed hollow needle to confirm that the drug flows to the affected nerve when injected.
    • When the doctor is satisfied with the position of the needle, the anesthetic drug and corticosteroid are injected through the same needle inserted in the spine.
    • Finally, the needle is removed and the injection site is covered with a dry, sterile bandage.
    • Patients may feel some pressure during the injection but mostly the procedure is painless. The procedure takes about 15-30 minutes to complete. After injection, the patient should not drive or go back to work and should rest and avoid any vigorous activities. Your surgeon may give specific post-care instructions. Please follow the instructions to recover faster.

      Recovery time

      Patients may feel numbness in the arms or legs just after procedure along with other side effects related to the anesthetic component that usually settles down within 1-8 hours. Patients may continue to feel some back pain, as epidural spinal injections takes about 24-72 hours before showing its pain-relieving action. In some cases, if the desired effect is not obtained then reinjection may be recommended. The standard guidelines for steroid injections state a maximum of 3 injections per year. In case no relief is obtained from spinal injection, then surgery is considered as the final option.

      Risks and complications

      With any procedure some risks factors will always be there. Likewise, epidural spinal injections have complications such as bleeding or infection at the injection site, pain during or after injection, post-injection headache, nerve injury, bladder dysfunction, fluid retention, respiratory arrest, epidural hematoma, and spinal cord infarction. Discuss with your doctor if you have any concerns prior to the procedure.

      Spine Injections

      Spine injection is a nonsurgical treatment modality recommended for treatment of chronic back pain. Injection of certain medicinal agents relieves the pain by blocking the nerve signals between specific areas of the body and the brain. The treatment approach involves injections of local anesthetics, steroids, or narcotics into the affected soft tissues, joints, or nerve roots. It may also involve complex nerve blocks and spinal cord stimulation.

      • Proliferation Injection: Proliferation injection is also known as sclerotherapy and is a non-surgical treatment for musculoskeletal injuries. It involves injecting the dextrose solution (irritant) into the damaged or injured ligaments and tendons. Macrophages, the defense cells of the body, reach the site of injection to attack the irritant. Meanwhile the body brings in fibroblasts which heal the damaged ligaments and produce connective tissue. This injection helps in the proliferation of new cells and helps in the repair of connective tissue.
      • Neural Prolotherapy: In neural prolotherapy an irritant solution is injected into the painful areas where the ligaments and tendons are injured. The irritant solution irritates the local area causing inflammation. The macrophages arrive at this site to dispose the irritant solution. This encourages the repair process where the fibroblasts, the connective tissue builder cells, stimulate the production of connective tissue. Release of growth factors at the site of injury may help in strengthening, reducing the pain, inflammation, and weakness.

      Spinal Cord Stimulator

      Back and leg pain often have causes which either improve on their own or which the surgeon can correct. Sometimes there is no easily correctable cause of the pain.

      Among other things, scar tissue around the nerves or chronic inflammation of the nerves such as arachnoiditis may cause leg and back pain. When the neurosurgeon feels that open surgery to decompress the nerves is unlikely to help the pain, an operation to implant a spinal cord stimulator may be very beneficial for the patient.

      For reasons not completely understood, the stimulator sends electrical impulses to the areas of the spinal cord causing the pain and interferes with the transmission of pain signals to the brain. It blocks the brain’s ability to sense pain in the stimulated areas, thus relieving pain without the side effects that medications can cause. The electrical impulses can be targeted to specific locations and, as pain changes or improves, stimulation can be adjusted as necessary.

      Before implanting a permanent stimulator, the patient will undergo a trial stimulation period to see if the stimulation helps with their pain. If it does, a permanent stimulator may be implanted. A battery pack will also be implanted to provide charge to the stimulator.

      Procedure

      There are several ways of implanting the stimulator. The initial implantation of the trial is generally done with the patient awake up so that it can be determined in the operating room if the stimulator is covering the appropriate spot of the spinal cord in order to give the patient pain relief.

      Either a paddle lead is placed over the spinal cord through a small open incision and removal of lamina, or a percutaneous insertion of a lead is performed through the skin. The permanent implant will occur several days later if the patient achieves good pain relief with the trial stimulator.

      Postoperative Care

      Patients are generally discharged home the day of or the following day of the procedure. They should keep the wounds very clean and dry.

      Risks

      Risks for the procedure are low. Potential risks include bleeding, infection, injury to nerves, injured spinal cord, paralysis, and death.

  • duke-john-kelly
  • American Board of Orthopaedic Surgery
  • Orange County Medical Association