Roughly 80% of Americans experience back pain at some point in their life. While the pain goes away in the vast majority of cases, about 5% of patients with aching backs will develop chronic pain. In the United States, at least $50 billion is spent each year on medications, hot and cold packs, and other methods of treating back pain. Data show that back pain is second only to headaches as the most common neurological ailment in the United States. Until recently, the only option for people with back pain when other methods of pain control have failed has been open surgery, which involves general anesthesia, a hospital stay, large scars, and long recovery times. Unfortunately, these surgeries fail to provide lasting relief in many cases, leaving many patients to rely on narcotic pain relievers for the rest of their lives.
Smaller is Better
Newer, minimally invasive procedures are being explored and appear to be particularly promising for patients with chronic back pain. Endoscopic spine procedures can be used to correct many of the conditions that cause chronic back pain or to repair failed previous surgeries. These procedures allow surgeons to see the spine and surrounding tissue without making large incisions.
Spine surgery is a common procedure for the treatment of lower back pain, and these operations typically use cages, bone grafts, bars, and screws. If patients continue to have pain, they may develop failed back surgery syndrome (FBSS). For people suffering with FBSS, the pain is often much worse than it was prior to their surgery. Many FBSS patients are disabled, isolated, and heavily medicated. Research suggests that FBSS occurs in 20% to 40% of open spine surgeries. Ironically, it’s often caused by scarring that was created by the surgery itself.
“Endoscopic spine procedures can be used to correct many of the conditions that cause chronic back pain or to repair failed previous surgeries.”
In endoscopic spine procedures, the muscles surrounding the spine are gently eased apart. This is much gentler than the cutting that is done in open surgery. The tiny incision—less than the diameter of an adult small finger—leaves the surrounding tissue unharmed. The surgery can be done more quickly and simply with less pain, a lower risk of infection or other complications, and a shorter recovery time for patients. In fact, most people leave the hospital the same day of their procedure and are back to their regular activities in about 6 weeks.
Any change in the bones, nerves, and other tissues of the spine can cause chronic pain. The most common are disc degeneration, herniation, bone spurs, pinched nerves, and spinal stenosis. A foraminotomy is an endoscopic spine technique that can be helpful for many causes of chronic pain. They remove bone spurs, scars, protruding discs, and other problems. Lumbar discectomy is another endoscopic approach that can be used to repair disc bulges and hernias; this surgery has been shown in the literature to produce outcomes similar to that of standard discectomy surgery. Many patients are pain-free after 2 years. The endoscopic approach offers several important advantages, including faster recovery and less postoperative pain.
One drawback to endoscopic spine surgery is that the learning curve is steep for surgeons. The technique is still in its infancy, and most residents have not been exposed to it. The hope, however, is surgeons that will become better trained and more educated about endoscopic spine surgery in the future to optimize outcomes for patients.
Readings & Resources (click to view)
Atlantic Spinal Care, LLC treats spinal pain patients with non-surgical and minimally invasive procedures. For more information, go to http://www.laser-spine.com/about/atlantic_spinal_care/.
Korinth MC. Treatment of cervical degenerative disc disease – current status and trends. Zentralbl Neurochir. 2008;69:113-124.
Jagannathan J, Sherman JH, Szabo T, Shaffrey CI, Jane JA. The posterior cervical foraminotomy in the treatment of cervical disc/osteophyte disease: a single-surgeon experience with a minimum of 5 years’ clinical and radiographic follow-up. J Neurosurg Spine. 2009;10:347-356.
Chedid KJ, Chedid MK. The tract of history in the treatment of lumbar degenerative disc disease. Neurosurg Focus. 2004;16:E7.