Non-Operative Spine Care

Spine Surgery Alternatives

Read about non-operative spine care & spine surgery alternatives in this article regarding medications, physical therapy, acupuncture, injections, & more. Request an appointment with Dr. Keenen at Pacific Spine Specialists in Tualatin Oregon to determine if you are a candidate for spine surgery or should seek spine surgery alternatives.

Medications

One of the spine surgery alternatives is medication for treating back pain, which includes:

  • STEROIDS: Cortisone, Prednisone, Methylprednisilone (Medrol Dose Pack)
  • NSAIDS: (Non-steroidal anti-inflammatory)
  • Celebrex, Aspirin, Ibuprofen(Advil, Motrin), Naproxen (Alleve), Diclofenac, Salsalate, Voltaren, Daypro, Indomethicin(Indocin)
  • OPIATES: Vicodin, Tylenol#3, #4, Percocet (Oxycodone and Tylenol), Percodan, Norco, Lorcet (Hydrocodone and Tylenol), Lortab, Darvocet (Propoxyphene and Tylenol), Darvon, MS Contin (Morphine SO4), Oxycontin (Morphine S04 sustained release), Duragesic Patch (Fentanyl)
  • MUSCLE RELAXANTS: Robaxin, Soma, Flexaril, Zanaflex, Baclofen, Parafon Forte, Skelaxin
  • OTHER: Elavil (Amytriptlilline), Neurontin, Paxil, Prozac, Zoloft, Remeron Sinequan, Deseryl

Physical Therapy

  • Modalities: Hot packs, cold packs, ultrasound, iontophoresis, electrical stimulation, TENS (transcutaneous electrical nerve stimulation), NMES (neuromuscular electrical stimulation), IF (interferential current).
  • Traction: Traction is performed for temporary relief of neck or back pain. Small amounts of weight are placed to create distraction forces in order to relieve pain and spasm.
  • Myofascial Release: This involves hands-on techniques that are somewhat similar to deep tissue massage. It is sometimes uncomfortable but is often helpful in reducing spasm in hard-to-stretch areas.
  • Postural Education: One of the keys to preventing reinjury to the spine is education. Posture is a very important factor in avoiding a relapse of a spinal injury. During initial phases of physical therapy visits, patients receive instructions on proper posture.
  • Body Mechanics: This is another vital part of spine education. The average person does a great deal of bending, lifting, and possibly twisting on any given day. These movements are commonly associated with the onset of back pain or sciatic symptoms. Therapists give instruction on proper ways to perform these activities, and also point out movements that should be avoided at all times. It is important to continue to follow proper body mechanics after the injury and throughout the rest of your life.
  • Stretching and Stabilization: There are a number of exercises for the spine. Most of them require no special equipment and can be performed on the floor either with a therapist or at home. They include stretching and stabilization exercises, which produce low amounts of stress and strain at the point of injury, yet help greatly with proper alignment and stabilization of the spine.
  • Resistance Training: Once a patient is showing improvement of pain and adequate efficiency of the basic stretches and stabilization exercises, it is time to move onto the more intense muscle building routines. These include use of weight machines specifically designed to focus on the back, abdominal, and oblique muscles. During this phase, it is extremely important that a patient uses the proper technique with the machines in order to avoid making the injury worse.
  • Work Hardening: This is a work specific type of therapy that is usually implemented after the initial phase of physical therapy is completed. These programs are designed to simulate normal occupational activities in a controlled environment, under the supervision of a therapist.
  • Sports Preparation: Patients that have been active in sports prior to an injury can get help returning to their respective sport with a careful and sport-specific training program after their initial spine problem has been addressed. This will help patients return to the previous level of activity and decreases the likelihood of reinjury due to a particular sport (golf, basketball, softball, football, etc.).
  • Aquatic Therapy: In some patients, land-based physical therapy may make symptoms worse. These patients can often benefit from aquatic physical therapy, which reduces the mechanical stress effects of gravity. Aquatic therapy also helps with cardiac conditioning; cardiac workload increases by approximately 3 times once someone is submerged in water up to his or her neck. This is due to an increase in efficiency of blood return to the heart. Aquatic therapy allows patients to get the same cardiac benefit as doing approximately one third of the exercise. This, however, does not translate to improved fat burning.

Acupuncture

  • Acupuncture has long been used as a treatment for pain in Asian culture. In recent times, western medicine has accepted it as a legitimate part of the treatment of pain. Many insurance companies are now accepting acupuncture as a reimbursable form of treatment.

Body Braces

  • Anterior Cervical Orthosis (ACO): These can be either soft or rigid. Soft collars are often used for minor cervical injury and can provide a great deal of comfort after a whiplash injury. Rigid collars are commonly used as a postoperative treatment to assist in neck immobilization. They can also be used to temporarily treat instability of the cervical spine.
  • Thoracolumbosacral Orthosis (TLSO): This is usually a rigid brace and comes in various styles. It is designed to immobilize the upper and lower back. It is commonly used in thoracic or lumbar spinal fractures, and also during postoperative periods.Lumbosacral Orthosis, Lumbar Corset, Back Brace (LSO): Lumbar corsets can be rigid or soft. They provide support for the lumbar spine, help reduce the load on back muscles, and are helpful during episodes of acute and chronic low back pain. They are also used for support after spine surgery such as discectomy, and fusion surgeries. Patients should avoid becoming dependent on the lumbar corsets. If they are used for prolonged periods (weeks and months), the back muscles may begin to weaken and cause a patient to be more prone to reinjury.

Injections

  • Epidural Injections: The epidural space is within the spinal canal and surrounds the spinal cord. Steroid injections into this space can help to decrease inflammation of nerves and other soft tissues in the problematic area. These injections are usually given in a set of three for a cumulative effect. They are used for problems such as: Herniated discs, Sciatica, Radiculopathy, Narrowing of the Spinal Canal (Spinal Stenosis), and occasionally for Discogenic Low Back Pain. They can be given in the neck (cervical spine), upper back (thoracic spine), lower back (lumbar spine), and from the level of the tailbone (caudal approach).
  • Facet Injections: Facet joints are the joints in the posterior portion of the spine. There is one set of two facet joints between each vertebra in the spine. These joints can commonly be affected by arthritis and can cause back pain. Injections of local anesthetic and steroid can be used to relieve this pain.
  • Selective Nerve Root Blocks/Transforaminal Epidural Injection: Nerve root blocks use medications such as local anesthetics or steroids to disable a specific nerve root that is causing pain. Nerve root injury can often be localized by electrodiagnostic testing, and can be caused by herniated discs, stenosis, facet cysts, whiplash, or hyperextension injuries.
  •  Sympathetic Blocks: These blocks are used to disrupt an abnormal pain cycle that can be caused by an overactive sympathetic nervous system. This condition is commonly referred to as complex regional pain syndrome (CRPS). It is also known as reflex sympathetic dystrophy (RSD), causalgia, shoulder hand syndrome, or sympathetic pain syndrome.
  • Intrathecal Pain Pump (Morphine Pump):Intrathecal drug delivery systems are indicated for chronic intractable pain, cancer pain, and for chronic spasticity. Intrathecal drug delivery has been shown to increase pain relief and comfort for people with severe pain. It may also cause fewer side effects than oral medications. These benefits may help people with chronic pain improve their quality of life and participate more fully in daily activities.Delivery makes the difference with intrathecal drug delivery. This therapy uses a small pump that is surgically placed under the skin of the abdomen to deliver medication directly in to the intrathecal space (the area surrounding the spinal cord). The medication is delivered through a small, soft tube called a catheter that is also surgically placed.The spinal cord is like a highway for pain signals on their way to the brain, where your body experiences the feeling of pain. Because the drug is delivered directly to where pain signals travel, intrathecal drug delivery offers significant pain control, with a small fraction of the dose that would be required with pills. This helps minimize side effects. Clinical studies show that of people who did not experience enough pain relief with high doses of oral medication, most achieved significant pain control with intrathecal drug delivery and were able to improve their activities of daily living.