If back pain keeps you out of work or up all night and medications don’t help, what’s the next step?
Don’t be scared if your doctor says “back surgery.” New treatments for spinal pain aren’t as invasive as old-school operations that required weeks of recovery in bed.
Surgeons using special tools can correct joint or disc problems through tiny incisions that heal quickly. Or they can use implants made of high-tech materials that mimic bone instead of steel screws and rods that could cause infections. From stem-cell research to 3-D printing, the future is here in back pain treatment.
With minimally invasive surgical techniques and other innovations, we’re able to pinpoint exactly where we need to go, says Michael Gleiber, MD, an orthopaedic surgeon in Boca Raton, FL, and medical spokesman for the American Academy of Orthopaedic Surgeons. That means less damage to muscle and nerve endings.
"You’ll have less pain after your operation and get out of bed only a few hours later in many cases." There’s also less blood loss, less scar tissue, and a lower chance of infection, he says.
Before you explore any type of surgery, try more conservative back pain treatments like losing weight, nonsteroidal anti-inflammatory drugs, appropriate exercise, getting some rest, or steroid injections. If those don’t work, minimally invasive surgery is the next step, says Chris Cornett, MD, an orthopedic surgeon at the University of Nebraska Medical Center in Omaha.
What Are the Procedures?
Common minimally invasive back surgeries include:
- Discectomy: Trimming or removing bulging disks in your spine
- Laminectomy: Removing the covering that’s pressing down painfully on your spinal cord
- Spinal fusion: Pinning unstable joints to those around them to ease pain
Doctors use the same basic techniques to repair back problems, but through smaller incisions and from better angles, aided by high-tech tools that make their work more precise and accurate, Gleiber says.
Microdiscectomy, where the doctor trims down the bulging bump on a disk, is less aggressive than it used to be, Cornett says. Fusion surgery can shore up unstable joints in your spine. Your surgeon inserts rods or screws to hold the damaged joint to the ones around it. “Sometimes, you can also put a tiny cage in, or a disk spacer. We can do all of this with smaller incisions now,” Cornett says.
Your surgeon inserts a device called a tubular retractor into the tiny hole and down your spinal column, he says. Image guidance tools, like tiny CT scanners or microscopes on the end of the retractor, project video on a screen in the operating room. The doctor can see the bone and tissue up close.
Minimally invasive surgery can also be performed through your side, offering better access to tissues, says Khoi Than, MD, a neurosurgeon at Oregon Health and Science University in Portland.
It’s called anterior column release. It’s used to correct a condition called severe kyphosis. That’s when your back falls forward. You see it a lot in older people, Than says. When you cut into the ligament, it releases the spine and straightens the person back up.
New and Improved Implants
Minimally invasive surgery can correct curved spines or unstable back joints. But surgeons use implants to keep your joints in the right position, Gleiber says.
Your surgeon should test you to see how unstable your back joints are when you bend forward or backward. If they don’t slip out of place when you bend, fusion surgery may not help your pain, he says.
The quality of these implants -- like screws, rods, and cages -- has greatly improved in quality and material in recent years, Than says. Researchers are working on new materials that are similar to bone or that can encourage bone formation.
Rather than the old stainless steel, new implants are made of titanium, a durable metal less likely to cause an infection. “Now they’re even experimenting with acid-etched titanium, because the rough edge of the metal can attract bony growth.” That helps it fuse more effectively, he says.
Other high-tech implants are made of hydroxyapatite, a bone-like material made from sea coral, and PEEK (polyetheretherketone), which is like a hard plastic, Than says.
If your back pain is caused by nerve damage, you may find relief with a different type of implant called a spinal cord stimulator, Cornett says. They’re placed under the skin of your buttock or belly and send electric pulses to distract you from the pain.
“You can do a trial to see if it works for you, and then you can go with a permanent, long-term implant. These work better for leg pain, like sciatica, than back pain,” he says.
Stimulators “essentially hide the pain with numbness,” Than says. “You may feel tickling or a numbing feeling instead of the pain.”
A last resort for severe pain from bone damage that can’t be treated any other way is an intrathecal pain pump, an implant that drips pain medicine like morphine around your spinal cord.
New research focuses on building new tissue to replace what’s broken down, Than says.
“How do you regenerate degenerating things? During my residency, we looked at injecting statins into discs.��� Doctors can now also inject stem cells into your back to regrow worn tissue to ease pain, he says.
Other high-tech back pain treatments include:
- 3-D printing to create spinal implants with customized shapes that fit better after insertion.
- Nanotechnology, a way to customize molecules, to create a gel that’s injected into damaged spinal cords. Right now it’s being tested on rodents, but scientists hope the gel could trigger new human cells to grow and repair disks, cartilage, or bone.
“It’s kind of a Pandora’s box. There are so many things being studied now for back pain, but it’s hard to know what may work best for patients,” Than says.