Conservative (non-operative) management of spinal pain

Non-operative management of spinal pain may include one or more of the following:

• Activity modification – bed rest, job restrictions, exercise
• Medications – analgesics, steroids, muscle relaxants
• Education
• Referral for Chiropractic Services
• Referral for Physical Therapy

Conservative management of spinal pain is not always successful and surgery becomes necessary. Your doctor may recommend spinal surgery if you have increasing numbness or weakness of the legs, loss of bladder or bowel control, severe pain, or severe limitations on your lifestyle due to pain, in spite of conservative treatment. The type of surgery recommended will depend upon your diagnosis & symptoms.

Treatment of Compression Fractures

The bones in your spine are called vertebrae. The thick portion of bone at the front of each vertebra is referred to as the vertebral body. A vertebral compression fracture occurs when the vertebral body fractures and collapses.

Operative treatment options include:

• Verbebroplasty – A minimally invasive treatment involving the placement of a special stabilizing material into a damaged vertebra. The material hardens and stabilizes the vertebra, preventing further collapse, and may reduce the pain caused by bone rubbing against bone. Patients can resume their activities almost immediately.
• Balloon Kyphoplasty – A minimally invasive treatment in which orthopaedic balloons are used to gently elevate bone fragments in an attempt to return them to the correct position. Once the vertebra is in the correct position, the balloon is deflated and removed, creating a cavity within the vertebral body. The cavity is then filled with a special cement to support the surrounding bone and prevent further collapse.

Treatment of Spine & Disk Problems

Disks are the soft pads of tissue between the vertebrae. The disks absorb shock caused by movement. The most common back problems occur when disks tear, bulge, or rupture. When this happens, an injured disk can no longer cushion the vertebrae and absorb shock. The disk may press on or pinch a nerve. This can lead to pain, stiffness, and other symptoms.

Operative treatment options include:

• Laminotomy – A portion of the lamina (back of the spinal canal) is removed from the vertebra above and below the pinched nerve. The small opening created is sometimes enough to take pressure off the nerve. But in most cases, disk matter or a bone spur that is pressing on the nerve is also removed.
• Laminectomy – The entire lamina is removed from the affected vertebra. The opening created may be enough to take pressure off the nerve. If needed, the surgeon can also remove any bone spurs or disk matter still pressing on the nerve.
• Diskectomy – A portion of the disk nucleus is removed, releasing the pressure on the nerve.
  As a disk degenerates and flattens, the vertebrae slip back and forth. This is referred to as instability and can irritate nerves.

Operative treatment options include:

• Spinal fusion – Adjacent vertebrae are joined together, or fused. This limits the movement of these bones, which may help relieve pain. Fusion can be done from the front (anterior) side of the body or the back (posterior) side of the body. The neurosurgeon decides which is best for each individual patient.