9 Ways to Avoid Back Surgery in the 21st Century

spinal stenosis

Back pain is a rampant problem in the United States. For example, did you know that over 1 million people are in bed today due to back pain? Back pain costs society over $100 billion every year in direct and indirect costs. There are over 400,000 spinal fusions performed each year in the United States. This represents a 15 fold increase over the past decade.

The vast majority of back surgeries in United States are elective. There are only really a few absolute indications for operating on one's back. The most prominent of these is called Cauda Equina syndrome, which is a condition that is an absolute surgical emergency. It involves pressure on the bottom part of the spinal cord and can affect permanent bowel and bladder function if not addressed right away. Unstable fractures of the back should be addressed in an emergency fashion as necessary. If the patient is having progressive neurologic deficit then that becomes a relative indication for surgery. Essentially what is being relayed here is that there are few relative and absolute indications for surgery, but the vast majority are actually elective.

Patient diagnoses such as to generate this disease or spinal stenosis with degenerative spondylolisthesis are the most typical types of issues that back pain patients have to deal with. These are never fatal, and are truly quality-of-life conditions. Nonsurgical measures should be exhausted prior to undergoing a spinal fusion procedure.

Is there a magic treatment to avoid surgery? The answer is truly not. There are no gimmicks, there are no holy grails, and there is no effective snake oil that can help patients avoid surgery. There are 9 treatments that have research behind them which can truly help patients avoid elective back surgery.

1. Activity modification-this refers to the old adage of if it hurts don't do it. Or simply do something else. For instance, if you are participating in a high stress activities such as jogging, that is probably not the best activity to pursue with significant degenerative disc disease. You'll probably be better off switching over to cycling or swimming. But benign neglect goes along with this and represents ignoring the pain if it's not too bad. These elective types of conditions by and large don't need prophylactic intervention.

2. Physical therapy and aerobic exercise-PT can strengthen the muscles around the spine, called the paraspinal muscles, and take pressure off the painful areas. A number of studies have shown that aerobic exercise maintains excellent results and is probably the single best activity for degenerative disc disease patients. Patients may need interventional treatments prior to undergoing PT to ensure their ability to perform the exercises properly. Especially if they are experiencing acute exacerbation of the pain.

3. Chiropractic treatment-this is now mainstream and is covered by many insurance companies. Over 10% the American public at any one point in time is under the care of a chiropractor. Research has shown that chiropractic manipulations are effective for pain relief for low back pain for a number of conditions.

4. Medications-chronic narcotics are a terrible idea for back pain and may lead to side effects such as depression, tolerance, and addiction. A better idea is to only use them on a short-term basis and stick with the tried and true Tylenol and NSAIDS. These are lower risk and very effective especially if taken within the manufacturers dosing recommendations. Muscle relaxers can help on a short-term basis, and as of recently dropped in and Lyrica are being used more fluidly for low back pain with good success. Non-narcotic medications such as old tram are also being used successfully for back pain. It is a good idea to utilize medications in conjunction with a complex of pain management program. That way not just throwing pills at the problem and you can obtain better results with less medications and side effects.

5. Interventional pain management procedures-the procedures for interventional pain management continue to improve every year and they can really help patients avoid surgery for back pain. These include facet injections, medial branch blocks, epidural injections, radiofrequency ablation, and spinal cord stimulation. Injections into the disk and diskograms are much less common now because some researchers showed a connection with disc degeneration and these procedures. There are some exotic procedures like the MILD procedure, which stands for minimally invasive lumbar decompression. These are not very commonly used.

6. Spinal decompression therapy became FDA cleared in 1996. It has minimal risk, is affordable, and is very effective for back pain, sciatica, facet arthritis, spinal stenosis, bulging or herniated discs, and failed back surgery. The actual cost of spinal decompression is less than 5% of spinal surgery.

7. Tens units-tens units are small battery-powered devices about the size of an iPod. They're safe and noninvasive and transmit small electrical impulses to electrodes on the skin. They can help steadily with suppressing pain and reduce the amount of pain medication necessary for comfort. Of note is that they do not cure anything, they are simply symptom relieving machines.

8. Lumbar bracing can be very effective for short-term pain relief. They can protect the lumbar spinal muscles similar to a splint like for wrist pain. They should not be used for chronic usage secondary to the fact that they can cause deconditioning of the spinal lumbar muscles.

9. Manipulation Under Anesthesia-this procedure is becoming more popular in the chiropractic community. It also can help patients avoid surgery and is typically done over 3 sessions on 3 consecutive days it can be an excellent resort unresponsive back pain to other treatments with intravenous sedation.

These 9 treatment methods can help patients avoid surgery over 95% of the time. Patients should try several or all of these prior to undergoing the knife for spinal fusion.