Health professionals can assess acute lower back pain by reviewing medical, work and social history, together with a simple physical examination. For 95 percent of patients with lower back pain, this type of assessment is all that is necessary to make treatment recommendations.
Occasionally, imaging tests are used to gather more information about the cause of back pain. Imaging tests for lower back problems include magnetic resonance imaging scan (MRI), computed tomography scan (CT), bone scan and X-ray. If an examination suggests a serious underlying health condition, or if symptoms have lasted longer than four to six weeks, or are severe, imaging tests are also indicated.
Individuals at increased risk for developing lower back pain are middle-aged males, those with a personal or family history of back problems, and females who have carried a pregnancy to term. Lifestyle factors that increase risk include: smoking; being overweight; being sedentary; regularly straining, vibrating or twisting your back; sitting for long periods; and taking medications — such as long-term corticosteroids — that weaken bones.
Recommended treatment for disc-associated conditions and nerve impingement is typically open back surgery. This treatment involves significant surgical risks, a long hospital stay and lengthy recuperation time. In recent years, however, less negative outlooks have become possible. Laser Spine Institute offers minimally invasive spinal surgery on an outpatient basis. Minimally invasive procedures can correct the causes of many back pain symptoms with less anesthesia and surgical risk, as well as reduced expense and convalescent time.
Multiple procedures at Laser Spine Institute target specific back pain conditions:
1. Percutaneous Discectomy
Percutaneous discectomy is used to treat the following conditions:
- Herniated disc
- Radiculopathy caused by disc fragments
- Sciatica caused by disc fragment impingement on nerve rootlets
- Nerve impingement caused by disc fragment impingement on nerve rootlets
This procedure is performed with deep sedation or light general anesthesia in an outpatient surgical setting. After anesthetic administration, a small incision is made. A cylindrical tube is placed through the incision into the disc under X-ray guidance. This tube allows minimal damage to the surrounding muscles. (The muscles are pushed out of the way and are not torn or cut.) Through this working tube, the surgeon inserts an endoscope, suction, irrigation and various surgical instruments. Special instruments are used to remove the disc material, diminishing the pressure on the spinal cord and/or the spinal nerve. Since the nerve rootlet compression is removed, some patients feel immediate relief of their presurgery back pain following percutaneous discectomy.
When the procedure is complete, the tube is slowly removed, allowing the muscles to move back into place. A percutaneous discectomy is a relatively short procedure, typically taking only 30 to 45 minutes. Since anesthesia is light, recovery in the postoperative care unit is rapid and often without undesirable side effects. After one to two hours of safety monitoring and postoperative instruction, the patient (with a companion) is discharged from the facility.
We commonly encourage patients to enjoy several short walks the afternoon or evening of their percutaneous discectomy procedure. The patient returns within 48 hours for a postoperative visit to receive clearance for the return home.
Foraminotomy is used to treat the following conditions:
- Foraminal stenosis
- Sciatica caused by inadequate foraminal size
- Pinched nerve caused by inadequate foraminal size
- Bone spurs
- Hypertrophic facet joints caused by arthritis of the spine
At Laser Spine Institute, we use an endoscopic approach to enlarge the foramen in an outpatient surgical setting. After anesthetic administration, a small skin incision is made. A series of cylindrical retractors are placed under X-ray guidance through the incision to the area of the desired foraminotomy. This slowly creates a small opening to the patient’s body and allows performance of the foraminotomy with minimal damage to the surrounding muscles. (The muscles are pushed out of the way and are not torn or cut.) The final retractor is generally about 18 millimeters in diameter (about three-fourths inch). The surgeon inserts an endoscope, suction, irrigation and other surgical instruments through this retractor. The surgeon then removes the bone and tissue compressing the nerve, without distress to the patient. Since the nerve rootlet is decompressed following the foraminotomy, some patients feel immediate relief from their original back pain while in the postoperative care unit.
When the procedure is complete, the tube is slowly removed, allowing the muscles to move back into place. Usually subcutaneous self-dissolving sutures are used to close the surgical wound. Since anesthesia is light, recovery in the postoperative care unit is rapid and often without undesirable side effects of anesthesia. After one to two hours of safety monitoring and postoperative instruction, the patient (with a companion) is discharged from the facility.
We generally encourage patients to take multiple short walks the afternoon or evening of their foraminotomy procedure. The patient returns within 48 hours for a postoperative visit to receive clearance for the return home.
Laminotomy is used to treat the following conditions that cause back pain:
- Spinal stenosis
- Bone spurs
- Arthritis of the spine
- Herniated disc
- Bulging disc
- Nerve impingement
A laminectomy is a procedure used in open back surgeries that involves removing the lamina to increase the amount of space available for the neural tissue. The term laminectomy is derived from the Latin words lamina (thin plate, sheet or layer), and -ectomy (removal).
A laminotomy is also a procedure used to partially remove the lamina and frequently the ligamentum flavum. The ligamentum flavum is a ligament in the spinal canal that can thicken to the point where it is actually compressing on the spinal cord, attributing to spinal stenosis. Through a laminotomy, this ligament can be partially removed, therefore opening up the spinal canal and releasing the nerve(s).
Our philosophy at Laser Spine Institute is that tissue not causing undesirable symptoms should be left intact to preserve the strength of the spine and reduce scar formation. Therefore, at Laser Spine Institute we perform laminotomies rather than laminectomies. A laminotomy is used to remove such things as scar tissue formed following prior spinal surgery, bony obstructions, part of the ligamentum flavum, and/or herniated/bulging discs causing the nerve impingement. Most of the lamina is left intact. After the administration of anesthesia, a small skin incision is made. A series of cylindrical retractors of increasing size are placed to slowly create a small opening from the skin to the spine, allowing minimal damage to the surrounding muscles. (The muscles are pushed out of the way and are not torn or cut.) The last retractor is about 18 millimeters in diameter (about three-fourths inch). An endoscope, suction, irrigation and other surgical instruments are placed through the final retractor while performing the laminotomy.
When the procedure is complete, the tube is slowly removed, allowing the muscles to move back into place. Usually a subcutaneous self-dissolving stitch is needed for the incision closure.
Since anesthesia is light, recovery in the postoperative care unit is rapid and often without the undesirable side effects of anesthesia. After one to two hours of safety monitoring and postoperative instruction, the patient (with a companion) is discharged from the facility. We encourage patients to take multiple short walks the afternoon or evening of their laminotomy procedure. The patient returns within 48 hours for a postoperative visit and to receive clearance for the return home.
The patient will often experience relief of the original chronic back pain following these procedures. After a short postoperative period most patients are capable of walking. As outlined above, short walks are encouraged and expected. As with all surgery, however, surgical pain, easily controlled by prescribed analgesics, is expected.
4. Facet Thermal Ablation
Facet thermal ablation is used to treat the following conditions:
- Facet disease
- Facet joint syndrome
- Facet arthritis
- Degenerative facet joints
In general, all of the above terms are synonyms. The facet joint, like all other joints in your body, has cartilage covering the joint articular surface. This cartilage surface allows the bones to glide smoothly over one another. A capsule surrounds the joint.
The function of the facet joint is to provide support, stability and mobility to the vertebrae (spine). There are two facet joint articular surfaces on the top and two facet joint articular surfaces on the bottom of each vertebra. These surfaces are located on each side of the vertebrae. Facet disease results from damage to the vertebra’s articular surfaces. With age, the surface desiccates and may wrinkle. Trauma can also destroy articular surface. Pain results when roughened surfaces grind against each other. This is the genesis of facet pain. Facet disease can occur at any level of the spine, but most commonly occurs in the lumbar region where destructive forces are greatest.
At Laser Spine Institute, we perform facet thermal ablations in an outpatient surgical setting.
After administration of anesthetic, a small skin incision is made. A small cylindrical retractor is placed under X-ray guidance through the incision to the facet joint. This tube allows facet thermal ablations with minimal damage to the surrounding tissue.
This procedure is performed through a small 5 millimeter tube about the size of a straw. The laser, fiber optics and irrigation are all placed in the tube and surgery is performed on the facet joint. The surgeon uses a laser to debride (clean) the joint capsule. This truncates the nerve innervating the joint. This procedure takes about 20 minutes. The patient’s postoperative course is identical to that described above. After one to two hours of monitoring, the patient (with a companion) is discharged from the facility.
Modern medicine has evolved over the years and made incredible strides toward providing minimally invasive treatments for back pain. In the past, a spine surgery patient could expect a long hospital stay, higher risks of complications and a painful recovery. Laser Spine Institute utilizes modern technical advances to reduce the negative features of spinal surgery. With these advances, the process of spine surgery can be accomplished in a shorter time, the need for a hospital stay has been erased, the convalescent period significantly shortened and the risks of spine surgery reduced. Read more about Laser Spine Institute and realize just how easy it may be for you to regain spinal health.
On average, 80 percent of Americans will feel back pain at some point in their life. Laser Spine Institute has help thousands. Take a moment and read through a few of our previous patient testimonials to see what kind of an impact Laser Spine Institute has had in our patients’ lives.
The expert staff at Laser Spine Institute compiled a list of frequently asked questions concerning our surgery center’s treatment of back pain. Feel free to contact us with any remaining questions.