Creating Additional Space

The purpose of this form of surgery is quite simple: by opening up more room for the vertebrae pressure is taken off the affected nerve(s). Most often this is done for patients with spinal stenosis. In this condition the spinal canal has become too narrow, with the result being a lack of suitable space for the spinal cord and nerves that causes pain in the back and weakness of the legs.

In order to provide more space a laminectomy is performed. This involves removing portions of the laminae, the bones on the back of the vertebrae.

Spine Stabilization

In this form of back surgery two vertebrae are joined together in a process called spinal fusion. It is accomplished by putting bone grafts either between or alongside the vertebrae. Hollow metal cages filled with bone graft can also be inserted between the vertebrae. The bones may be attached to the vertebrae with metal plates or screws that serve as a brace.

Once the grafts are in place the bones begin growing together, which serves to fuse the vertebrae. This serves to bring normal stability and strength to structures that have been fractured or damaged by disease.

Disc Surgery

There are general standards that must be met before one can be a candidate for disc surgery, a procedure that is usually done when a disc is herniated (protrudes from its normal spot) and causing severe discomfort.

• An MIR or CT scan reveals that a disc is pressing against the root of a nerve.
• Persistent pain is experienced despite the use of more conservative measures, such as weight loss, exercise, and ergonomic measures.
• Severe pain is radiating down the leg or into the buttock, despite conservative interventions of physical therapy or medications.
• Neurological warning signs are observed, such as the loss of reflexes or bodily control. These may be indicators of a surgical emergency.
  

Once the need for disc surgery has been established there are a number of approaches available:

• Discectomy: This is the most frequently performed back operation. In general, an incision is made over the disc and a part, or all of it, is removed in order to relieve pressure on the nerve.
• Microdiscectomy: The procedure is much the same as for a discectomy. The difference is that a smaller incision is made because magnification is used to enlarge the view of the target space.
• Laser Decompression: A needle is inserted into the disc and a portion of it is destroyed with a laser. This relieves pressure on the nerve. The advantage of the procedure is that it is less invasive than traditional surgeries and can be performed on an outpatient basis.
• Percutaneous Removal: A small tube called an endoscope is inserted into the back and used to remove portions of the disc. This allows the surgeon to pinpoint the problem and leave the surrounding area intact. This, too, can be performed on an outpatient basis.
• Chemonucleolysis: This is an alternative to taking out part or all of a disc. A preparation from papaya plants, called chymopapain, is injected and has the effect of decreasing the size of a disc, with the intention of relieving nerve pressure.

Surgical Treatments

The good news about surgical treatments for back pain is two fold:

• Less than 1 percent of those who suffer from back pain ever need it.
• Medical advances have made back surgery easier to tolerate and recover from, with more optimistic prospects for recovery than ever before.

At present, many experts agree that more back surgery than was medically necessary was performed in the past, with too many of the recipients not benefiting from it. Some even became worse as a result. Today the standard for back surgery is that an individual has a clearly defined medical condition with a specific solution that will provide clear benefits.

Below we will look at the three most common types of back surgery: disc surgery, spine stabilization and creating additional space in the spine.

Water Therapy

Several types of water therapies exist and can be broken down into two very different groups: water exercise therapy and hydrotherapy. Water exercise therapy should be done only by a qualified physical therapist, while hydrotherapy may be done by a therapist but can also be done at home to relieve backaches.

Water exercise therapy has many benefits. The buoyancy of water supports the patient’s weight, allowing a greater range of motion when the person has too much pain to exercise on land. This makes water exercise therapy ideal for everyone who seeks relieve from back pain. Additionally, the water temperature should be warm enough to relax muscles, which also helps relieve pain. A physical therapist will have you do in the pool the same exercises you would do on land; they will just be easier to do. Some people transition to land exercises when their back allows it, some continue treatment in the water because they prefer it, and some incorporate both land and water exercises into the therapy.

Hydrotherapy for back pain relieves pain by loosening the muscles and ridding the body of toxins that produce pain and inflammation. Studies have shown that people who soak in a hot tub or warm bath have less stiffness, more flexibility, and tend to use less pain medication. Hydrotherapy consists of douches, sauna or steam baths, wraps, and hot baths with or without herbal additives. It has been used for centuries and is most popular in Europe. Many spas now offer various hydrotherapy treatments. The only risks involved are to people who are temperature sensitive and to those who have diabetes. You must be careful, though, not to get overheated.
To douche your back, use a hose hooked up to your bathtub faucet. Direct the stream of warm water over the painful area and toward the heart. The water should not splash, but rather wash gently over the skin. Do this for ten to fifteen.

Saunas and steam baths help relieve mild back pain because they stimulate the flow of blood, which relieves the pain of pulled muscles. You should not use a sauna if pregnant and never stay in longer than fifteen to twenty minutes. To keep from getting over heated, wipe your face frequently with a cold cloth. Drink plenty of water to keep from becoming dehydrated.

Warm baths are excellent for relieving mild backaches. Fill the tub with about 6 inches of tepid water and get in. Gradually add hot water until the water level in the tub reaches your naval. The final temperature should be no hotter than 104 degrees. Anything higher can induce a mock fever. Soak for fifteen to thirty minutes, and when you get out, wrap up warmly and go to bed. For even more benefit, you can add ½ cup of Epsom salts to the water to help draw toxins from the body. Essential oils can also be added to the bath. Some good ones for alleviating back pain are lavender, marjoram, rosemary, clary sage, black pepper, ginger, and birch. First mix two or three drops of the essential oil with two tablespoons of a carrier oil, such as sweet almond, peanut, olive, grape seed, or walnut oil, and then pour the mixture under running water. The mixture can also be massaged directly into the skin. To get a similar effect, tie ½ cup of herbs in cheesecloth and hang under the faucet so the water runs through the bag. Some good herbs for alleviating back pain are birch, German chamomile, white fir, wintergreen, and lavender. Using herbs and essential oils for healing is called aromatherapy; it promotes self-healing by indirectly stimulating the immune system.

Sometimes a physical therapist may do a heat wrap for your back pain, or you can also do one yourself at home. Moisten a cloth with warm water, wring it out, and wrap it snugly around the painful area of your back. Then wrap up in a dry cloth and next a blanket. Relax for 45-60 minutes. Herbs or hot mud may be added to the water for added benefit.

Massage Therapy

Massage therapy breaks down scar tissue and releases muscles from spasms. It is becoming increasingly more recognized as a form of medical treatment; a study by the American Massage Therapy Association found that 54% of healthcare providers encourage massage therapy, along with other types of therapy for back pain. Studies have shown that massage therapy is more effective than both chiropractic and acupuncture for relieving pain due to muscle spasms. The benefits of massage therapy include improved circulation, which helps alleviate muscle soreness; muscle relaxation, which helps muscles move without pain; and increased endorphins, the body’s natural pain relievers. If muscle spasms do not relax with massage therapy, that means inflammation is likely present and cannot be treated with massage. So if you know your back pain is due to inflammation, it won’t help to seek out massage therapy.

You should be aware that the kind of massage you receive in a spa is not the same kind of massage used to treat back pain. Swedish massage is the most common type of massage found in spas and similar places that offer massages, and while it feels good, it is too superficial to reach deep tissue and muscles and have any lasting affect on back pain.
The kind of massage used to treat back pain is called Neuromuscular therapy (NMT), or trigger point myotherapy. This type of massage works to relieve pain by balancing the musculoskeletal and nervous systems. NMT incorporates special massage therapy techniques, myofacial release, and stretching to relive both acute and chronic patterns of pain.

There are many massage training schools throughout the United State. Along with massage, neuromuscular therapists study neurological laws governing pain, the roles of soft tissue in pain, and palpation, as well as anatomy, physiology, and the function of the spine. In order to practice, massage therapists must be licensed and you should make sure that when looking for a massage therapist, you choose one that has had training in neuromuscular therapy. To find a massage therapist, get a referral from your doctor or contact the American Massage Therapist Association.

A neuromuscular therapist will ask you for all of the information that other therapists do and examine your spine to determine where exactly the pain is and what’s causing it. She will determine where nerves are compressed and where they are trapped within soft tissue. The therapist will work to relieve your back pain with her hands, fingers, elbows, and pressure bars, which are used to reach deeper into spinal muscles and tendons. She will use some kind of lubrication and start first on superficial tissue before moving deeper. This should not hurt, but you will feel pressure, and you may be sore afterwards due to the muscles releasing lactic acid. The therapist will also palpate trigger points, elevated neurological areas deep within the muscles. This may hurt initially, but the pain should go away quickly as the therapist continues to work. Back pain should respond to massage within four treatments over six weeks. If not, massage is clearly not the best treatment.

Physical Therapy

Physical therapy uses different techniques, such as ultrasound, electrical stimulation, cryotherapy, massage, exercise, and heat in order to relieve muscle spasms, increase flexibility, strengthen muscles, relieve pain, and accelerate the healing process. A study in The New England Journal of Medicine found that the effectiveness of physical therapy for low back pain was about the same as that of chiropractic treatment and better than no treatment at all.

Physical therapists must graduate from an accredited physical therapy program, many of which offer master’s and doctoral degrees along with bachelor’s degrees. Most schools require two to four years of pre-physical therapy coursework before admittance. Like other physical treatment programs, physical therapists spend time in both the classroom and medical settings before graduation. After graduation, they must take exams to become licensed, and some states require continuing education to maintain that license.

After it is determined by a doctor or back specialist that you are a candidate for physical therapy—some time between two to six weeks after the onset of low back pain or sooner if the pain is severe or recurs frequently—you will meet with the therapist to determine the best plan of treatment for you. You will be asked how your back pain developed, how long you’ve had it, whether or not it’s recurring, what actions make the pain better or worse, and any relevant medical history you have. The therapist will also give you a physical exam of your spine movement, muscular flexibility, sitting and standing posture, muscle strength, reflexes, respiration, motor function, and repetitive movements. From there, he or she will determine which treatments will be best for you. There is some trial and error involved, so if one treatment doesn’t work to alleviate pain, the physical therapist may try something different.

There are basically two types of physical therapy, passive and active. Passive therapy is done to you and includes heat, cryotherapy, electrical stimulation, ultrasound, massage, and lontophoresis. In heat, or thermal, therapy, the therapist applies heating pads, heat wraps, or warm gel packs to the affected area. This works to increase the flow of oxygen to the muscle, allowing it to heal faster and relieve pain by softening muscles. In cryotherapy, cold is applied rather than heat, and is considered more effective than heat in reducing inflammation. Electrical stimulation sends mild electrical impulses to the nerves and spinal cord, which releases endorphins and blocks pain signals from the brain. Ultrasound heats the deep tissue and allows it to relax and stretch more easily. Massage breaks up scar tissue and encourages the relaxation of muscle spasms. During lontophoresis treatment, a painkiller and steroid are rubbed into the skin and a low level electrical current is applied to speed up the absorption of the drugs. It works similarly to transdermal patches used to quit smoking.

You participate in active therapy, and it includes stretching, strength building exercises, and aerobic exercise. A good physical therapist will combine passive and active treatments, as exercise is essential to treating back pain. The therapist will determine which exercises are best for your particular condition and supervise you in those exercises to ensure you are doing them correctly. You will likely be given stretches to be done daily, fifteen to twenty minutes of strengthening exercises, and thirty to forty minutes of low-impact aerobic exercise, such as swimming or walking, to be done three times a week.

You may feel some soreness or discomfort after active physical therapy, but it should go away in about twelve to eighteen hours. If it doesn’t, let your therapist know. You may need to change exercises or how you are exercising. Results vary depending upon the type of treatment done and the severity of symptoms, but a physical therapist should know in about two weeks if the treatment is working or not.

Acupuncture

Acupuncture is an ancient form of Chinese medicine that has been around for more than 2500 years and is becoming an increasingly popular treatment for back pain. According to the theory of acupuncture, energy—called chi or qi—flows through the body along pathways called meridians. If the flow of chi is interrupted, pain or illness can occur. When that happens, very thin needles can be inserted along the meridians to correct the flow of chi.

No one is sure exactly why acupuncture works. Eastern philosophy holds that the needles unblock interrupted chi. Western medicine has a few theories of its own. Some believe acupuncture stimulates the nervous system and the 2000 energy centers in the body, which in turn triggers the release of natural painkillers in the form of endorphins, opioid peptides, and chemicals from the hypothalamus and pituitary gland. Others believe that acupuncture needles help contracted muscles relax, stimulate nerves in the legs, and decrease inflammation of the nerves in the lower back.

Studies by the National Institute of Health show that acupuncture is effective in treating back pain, and 2500 years of success for the Chinese backs this up. Like all back pain treatments, acupuncture seems to be most effective when used in conjunction with other treatments. It is also very safe, with no known risks as long as you chose a reputable practitioner. Needles are sterile, disposable, and FDA-approved. In the U.S. they are used only one time, sealed before use, and disposed as hazardous waste after treatment.

In the United States there are over fifty acupuncture training schools, which require approximately 3000 credit hours of study and offer the equivalent of a Master’s Degree. Often an undergraduate degree is required for admittance to an acupuncturist college. The first two years in acupuncture school are spent in classroom study, the third year is spent as an apprentice to a licensed acupuncturist, and the fourth year is spent as in intern working under supervision on patients. States have different requirements for acupuncturists, but all must take a state examinations and/ or a national exam in order to be licensed to practice. To find an acupuncturist, contact the American Academy of Medical Acupuncture.

During an acupuncture treatment session, the practitioner will insert anywhere from one to twenty needles into various places in the body. Some needles may go in just under the skin, while others may go deeper into muscle and fat. Needles will be left in from fifteen to thirty minutes. The practitioner may turn needles one way or another after inserting them into the body, or leave some in for only a few seconds before removing them and inserting them elsewhere in the body. Don’t be surprised if the practitioner treats your back pain by putting needles in your ankles, knees, or fingers. This is a technique called percutaneous electrical nerve stimulation (PENS), where needles are inserted into nerve centers and electrically stimulated. You can expect to feel relief for chronic pain in about ten to fifteen treatments and sooner for acute or sudden pain.

Other things an acupuncturist may do: 1) Use moxibustion, an herb that is burned onto the needle before insertion to stimulate the area being treated; 2) Cupping: burn cotton in a glass cup, which is then placed on the skin to create a vacuum; and 3) prescribe herbal supplements in addition to physical treatment.

You may be surprised to learn that acupuncture is rarely described as painful. In fact, many people find it relaxing and even fall asleep during treatment. Some people feel energized. One reason for this is the type of needles used. Acupuncture needles are very different from hypodermic needles. Instead they are very thin and fine, like hair. They are also solid, whereas hypodermic needles are not, as they are made to extract tissue. So getting acupuncture needles inserted into your skin will feel nothing like getting a shot at the doctor’s office.

When you are considering acupuncture, it is important to make sure the practitioner is someone you feel comfortable working with. Look for someone who is interested in your whole health and takes time to ask and answer questions. Since some medical doctors also practice acupuncture, you will want to make sure they are licensed in acupuncture in addition to their other training. To check if a practitioner is licensed and accredited, contact the American Association of Acupuncture and Oriental Medicine.