Minimally Invasive Interventional Techniques For Management Of Back and Neck Pain

By Netsere Tesfayohannes, MD, ABA, ABAP

Georgetown Pain Management

. http://gtpain.com/

More Pain Management & Rehabilitation Articles

Minimally Invasive Interventional Techniques For Management Of Back and Neck Pain

In general there are two kinds of pain patients often complain about nociceptive (dull achy pain) and neuropathic pain. Nociceptive pain results from activation peripheral nerve receptors while neuropathic pain results from dysfunction of the nervous system that can result from injury.

Disc Herniation (Slipped Disk)

The notion that disc herniation leads to low back pain and sciatica was popularized in 1934, but some patients with large disc herniations have no sciatica while others have sciatica in the absence of disc herniations. Experimental compression of nerve roots by mechanical pressure results in motor deficits but no pain.

Chemical irritation of the nerve roots by herniated discs is a result of leakage of inflammatory chemicals from the damaged discs resulting in nerve inflammation and burning pain. Sciatica pain therefore can be caused by mechanical compression as well as chemical irritation due to inflammatory substances released from the damaged discs.

This explains why cortisone injections work for the majority of back and neck pain shooting to the extremities. Although oral steroids are prescribed as the first line of treatment for this condition, research indicates that it is not significantly more efficacious than having no treatment.

Pain In the Neck

Pain in the neck can be with or without sharp shooting pain radiating to upper extremities. In addition, pain in the neck can be associated with headache.

Various interventional blocks can offer the promise of pain relief.

Transforaminal blocks Selective nerve blocks that target the damaged nerve is used most commonly in patients who suffer neck and back pain radiating to the extremities.

The conditions most commonly associated with these symptoms include disc herniation and spinal stenosis in the neck and lower back. The majority of the patients who undergo this procedure obtain significant pain relief, increasing their function as well as decreasing the use of pain medications.

Cervical Transforaminal Blocks – Selective nerve blocks that target the damaged nerve; used most commonly in patients who suffer neck and back pain radiating to the extremities.

This procedure utilizes image guidance by X-Ray and must be performed by a specialist with extensive experience in the profession as results are usually user dependent. Failed blocks because of improper needle placement may result in avoidable pain and suffering as well as unnecessary surgery.

The conditions most commonly associated with these symptoms include disc herniation and spinal stenosis in the neck. The majority of the patients who undergo this procedure obtain significant pain relief, increasing their function as well as decreasing the use of pain medications.

Cervical Facet MBN Radiofrequency Ablations – This treatment modality is minimally invasive and very effective in dealing with patients with neck and shoulder pain as well as some headaches (occiptial).

In patients with chronic cervical spine pain, prevalence of cervical facet syndrome was about 55%. While history and physical exam are useful adjuncts, diagnostic facet blocks are necessary to make the definitive diagnosis prior to recommending the Cervical Facet MBN Radiofrequency Ablations.

Low Back Pain

Low back pain is a “waste basket diagnosis” with multiple pain generators at play.

Pain strictly localized in the low back without sciatica is usually caused by wear and tear of the disc (discogenic syndrome) or arthritis and inflammation of the lumbar facet joint. This is, of course, true in the absence of prior spine surgery. Patients with prior spine surgery can exhibit various symptoms that are difficult to predict (failed back syndrome).

Low back pain with sciatica can be caused by slipped disc, spinal canal narrowing, or piriforimis syndrome. Careful history and physical exams are extremely crucial in making the correct diagnosis as X-Ray and MRI findings may not be adequate in explaining the patient’s pain and suffering.

While the majority of patients respond to conservative therapy with rest and physical therapy, millions of people throughout the country continue to suffer from back pain.

Fortunately, there are a number of state-of-the-art minimally invasive interventions that are useful in preventing pain and suffering as well as unnecessary dependence to narcotic pain killers and invasive spine surgeries. These include

• Lumbar Transforaminal Blocks These interventions are highly selective and utilize image guidance to achieve maximum accuracy.
• Lumbar Facet Block/Radiofrequency ablation Diagnostic nerve block followed by radiofrequency ablation to alleviate low back pain is effective in treating patients with Facet joint painful inflammation.
• Percutaneous Discectomy In cases where epidural injections are not helpful, percutaneous disc decompression can be performed.
• Spinal Cord Stimulator Therapy Interventional neuromodulation is considered an advanced non-destructive and reversible therapy that utilizes electrical stimulation systems. It has a very diverse application but the most common include failed back surgery syndrome, and complex regional pain syndrome.

In summary, minimally invasive interventional pain management techniques can offer a variety of options for patients suffering from chronic and acute pain.