Philly Doctors Explain Which Treatments to Get for Every Kind of Back and Neck Pain
For those who suffer from it, there are few sources of pain as frustrating and omnipresent as back and neck pain. Whether it’s a consistent neck ache or lumbar issue, pain can affect your ability to exercise, perform everyday chores–even breathe or sleep.
While in the past the concept of spinal surgery might have seemed like a big commitment for many people, modern advances in spine treatment have made treating the spine for all types of conditions much more accessible. Treatment begins with a conversation about your symptoms before walking you through all available options, and spine surgeons can now apply non-invasive therapies and treatments before ever considering a fusion or other surgery.
This movement toward nonsurgical, alternative and minimally invasive treatment options has occurred alongside a wave of innovation in spine surgery. Here in Philadelphia, spine surgeons at hospitals like Jefferson Health are expanding patients’ options with transformative new techniques–everything from artificial lumbar replacements to spinal stimulators that can return mobility to those who’ve lost it.
So, to get the inside scoop on how you can tackle your own nagging aches and pains, we spoke to the experts at the spine program about how all the latest advancements, techniques and approaches in spine care can help you feel your best. (And if you want to learn for yourself how back and neck pain affects your life, and what you can do to manage it, they’ve provided this back pain assessment quiz.)
Diagnosis and Therapy
Thanks to the variety of treatment options, it’s now common for surgeons to talk with the patient to fully explore nonsurgical options prior to considering a procedure.
“As spine surgeons, our job is to diagnose patients with spinal pathology and offer both non-operative and operative treatments. Many times, we start with non-operative treatments, including medications, physical therapy and spinal injections,” says Dr. Alexander R. Vaccaro.
According to Dr. Ahilan Sivaganesan, determining a multi-modal treatment plan that could alleviate symptoms without surgery is an approach that doctors and patients should consider when possible.
“That treatment plan might even include exercises such as yoga to strengthen your back muscles,” says Dr. Sivaganesan. “I see myself as a physician who happens to do spine surgery–my goal is to be a guide in helping patients navigate the process to get better as quickly as possible—with the least amount of risk possible.”
Minimally Invasive Surgery
If rehabilitative techniques prove insufficient, the patient and physician may want to look to minimally invasive surgery. Minimally invasive techniques have accelerated in development in recent years, thanks to enhanced image guidance.
“The introduction of navigation and robotics has refined many minimally invasive techniques in spine surgery, and now, patients with conditions previously managed with larger, more morbid operations, can successfully be treated with one-inch incisions, often going home that same day,” says Dr. David Kaye. While previously the use of X-rays to aid surgery could expose the physician and patient to unnecessary radiation over time, the successful use of technologies like CAT scans have enabled a more consistent use of image guidance during surgery.
A whole new array of techniques have developed as a result. Whereas traditional surgeries required significant muscle damage and resulting recovery times because the surgeon needed a direct view of the spine, image guidance allows surgeons to operate using what’s called tubular surgery. Here, the surgeon can make an incision as small as a fingernail, then insert a small metal tube to give them clear access to the problem area of the spine. They then use image guidance to perform the operation entirely through the tube.
Alternatively, the use of endoscopic surgery, in which a tiny camera is inserted into the body and then guided to the problem area, also allows for incisions of similar size.
“You can solve certain problems with incisions that are six or seven millimeters in length, where you can basically just put a band-aid on this very small incision at the end of the surgery. And patients will leave within an hour or two hours of the procedure,” Dr. Sivaganesan says.
Minimally invasive techniques like these reduce patient recovery time even for advanced surgeries, such as fusions. It also makes surgery possible for those who might be ineligible for other kinds of surgeries due to factors like age.
“Thanks to less invasive surgical approaches to the spine, patients who may have previously been told they cannot have surgery sometimes have new better surgical options available to them,” says Dr. Alan S. Hilibrand.
For patients that do require a more traditional surgical approach, new techniques have allowed surgeons to ensure greater accuracy, safety and efficacy, with a reduced likelihood of a need for further surgeries.
One increasingly embraced technique is robotic surgery, which is used to enhance traditional procedures. During robotic surgery, the robot’s ability to place elements like screws in a hyper-precise spot ensures the physician’s vision is accurately executed.
Traditional surgery is also seeing some incredible results through clinical trials. Currently, Dr. Sivaganesan is leading a trial in which he will be studying the positive effects of a total joint replacement for the lumbar spine–akin to the same technology as a hip replacement, but for the spine–and how this might compare to outcomes after traditional lumbar fusions. By replacing worn down discs and joints instead of fusing them, there is a potential to preserve motion and possibly reduce the risk of future surgeries.
“I think it could really be a game changer for the world for lumbar degenerative spine disease,” Dr. Sivaganesan says.
No matter which path you and your surgeon decide on, it’s critical that you find a physician that can work with you to find a treatment that’s right.
“I think the most important thing for people to understand about what we do is that every case is very unique,” Dr. Anthony Stefanelli says. “Really seeking advice of a well-trained surgeon, with a good reputation and good technique to back him up, is the best way to get the best results.”
If you’d like to learn more about your own symptoms, you can try taking Jefferson’s online quiz. For many patients, today’s solutions make treatment for back and neck pain more accessible than ever before.
Alternatives to Traditional Surgery
But alternatives to traditional surgery aren’t limited to shifts in exercise, medications or spinal injections. One technique that has become particularly promising for a wide range of patients is the application of spinal cord stimulators.
“If the patient has exhausted physical therapy, or if they go to a pain management doctor, and they get injections, and they’re not improving with those treatments,” says Dr. Caio Matias. “That’s when they can benefit from a spinal cord stimulator.”
A spinal cord stimulator is an electrical device that surgeons like Dr. Matias implant along their patient’s spine, adjusting the way electrical signals move through the body. The stimulators can help not just those suffering from back pain. Because those electrical signals are so integral to our bodies’ function, Dr. Matias’s work and that of his fellow surgeons in studying the positive effects of different electrical wavelengths on spinal function is making possible astounding results.
The stimulators can be used to relieve the leg pain of diabetic patients with nerve damage, and Dr. Matias is currently studying their usefulness in a clinical trial for helping the body regulate blood pressure in patients who have had damage to their nervous system. He’s even studying how using stimulators can be used to reset neural pathways to restore mobility in those who lost it from spinal cord injury.This is a paid partnership between Jefferson Health and Philadelphia Magazine's City/Studio