The Good Life: Health: Backs of the Future
Two years ago, a trip on the stairs left my husband with chronic, sharp pains shooting from his back down along his left leg. An MRI quickly revealed the problem: a herniated disc. And as it turned out, he wasn’t alone — in 2003, the American Academy of Orthopaedic Surgeons treated more than four million of them. Whether triggered by a fall or simply
Two years ago, a trip on the stairs left my husband with chronic, sharp pains shooting from his back down along his left leg. An MRI quickly revealed the problem: a herniated disc. And as it turned out, he wasn’t alone — in 2003, the American Academy of Orthopaedic Surgeons treated more than four million of them. Whether triggered by a fall or simply by age, the condition causes a disc to “spring a leak”; the gelatinous material that oozes out puts pressure on the nerves along the spine and leads to inflammation and symptoms ranging from mild to severe pain, weakness, tingling and numbness. Ouch.
Wanting to avoid surgery at all costs, my husband opted for a strict daily regimen of Advil-gobbling. But after weeks with no progress, I persuaded him to call Dr. Curtis Slipman at the Spine Center at the Hospital of the University of Pennsylvania. Slipman is an interventional physiatrist — a doctor devoted to pain management — who was recruited by Penn to develop nonsurgical techniques for dealing with back and neck pain. What he told us brought relief to my husband for the first time in weeks: Contrary to popular (and our) belief, there are ways of treating herniated discs that don’t involve hospitals, tens of thousands of dollars or a scalpel.
Slipman went on to explain that while he ordinarily starts his patients with a nerve block injection and physical therapy, my husband was an ideal candidate (more on that later) for a procedure called coblation. The technique, which he helped pioneer, involves inserting a radio-frequency probe into the center of the damaged disc to make excess disc material evaporate — thus relieving the pain-causing pressure. All it takes is 30 minutes, mild sedation and an insurance-covered fee of about $2,500. After undergoing it, my husband got off the table and walked home pain-free. He hasn’t had a problem since (and just a few months of physical therapy strengthened his weakened leg).
These days, Slipman limits coblation to the treatment of discs in the neck or cervical spine. For the lumbar or lower spine, he prefers something even newer: the decompressor. The concept is the same, but the instrument is different; a drill-like tool is passed through a narrow needle into the disc to remove the leaked-out particles. A third option known as LASE relies, as its name implies, on a laser to vaporize the pressure-causing goop. The beauty of all three options is that if they don’t work, the patient can always move on to traditional surgery.
So why, I wondered, aren’t these newer, less invasive treatments better known? For one, they aren’t part of the orthopedic surgeon’s repertoire, which leans heavily on surgical procedures that can cost up to 10 times as much as coblation and come with typical risks of an operation. But more significantly, cautions Dr. Kenneth Rogers, a Jersey-based interventional anesthesiologist and pain specialist, they’re not right for everyone. They’re best suited for small herniations in patients who meet very specific criteria: The herniated disc has to be visible on a CT scan or an MRI, and the symptoms of pain and weakness must correlate with the location of the damaged disc on a diagnostic test like a discography. For patients who do meet the criteria, Rogers and Slipman both report a cure rate of 80 to 90 percent. Luckily, my husband was one of them.