Conservative Treatments of
Spinal Disorders
(Note: addtional information on the items in bold text
is available within the spine animation patient
education module).
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.
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