Relief For Back Pain

Archive for the ‘Spinal Treatment’ Category

San Antonio, Texas (June 6, 2011)—A study introduced at SNM’s 58th Annual Meeting shows potential relief for patients who suffer chronic pain after back surgery.

A molecular imaging procedure that combines functional and anatomical information about the body is able to zero in on the site of abnormal bone reaction and provide more accurate diagnoses and appropriate pain management for patients who have received hardware implants or bone grafts.

“With PET/CT we can pinpoint the exact screw or rod that was loose or failing. We can help doctors and patients accurately decide whether surgical and nonsurgical treatment is the best option,” says Andrew Quon, MD, assistant professor of radiology and chief of clinical PET/CT for the molecular imaging program at Stanford University, Stanford, Calif. “This eliminates unnecessary or erroneous hardware replacement surgeries and provides a surgical map for patients who need further operations to treat their chronic pain.”

Serious spinal instability and disease often necessitate the implantation of hardware such as plates, cages, rods and screws or bone grafts to support the spine. There are many reasons why patients experience pain after initial surgery, including hardware failure and infection, or both. Determining the source of pain can be difficult, especially when patients have complex medical histories. In this study, a combination of positron emission tomography and computed tomography (PET/CT) and F18 NaF, an injected radio tracer that uses sodium fluoride to target “hot spots” or areas of high bone turnover and inflammation during imaging, was used to evaluate patients with back pain after spinal surgery. This form of molecular imaging was shown to be highly accurate in determining the culprit of patient’s chronic pain by highlighting both the structure of the bone and the physiological processes involved in inflammation, an indication of injury and infection.

For this prospective study, 20 patients presenting with spinal pain were evaluated with PET/CT using F18 NaF at least eight months after surgery. A total of 24 bone or tissue abnormalities were found in 17 of the 20 subjects. Of the original 20 patients, 12 received exploratory surgery and four participants received local anesthetic nerve blockade, a common and minimally invasive treatment that numbs the affected nerve, providing short-term pain management as an alternative to surgery. The research indicates that F18 NaF PET/CT is highly effective for the evaluation of pain after spinal surgery—in more than 85 percent of cases, this form of molecular imaging was able to identify the exact source of patient’s pain.

Contact: Susan Martonik
smartonik@snm.org
703-652-6773
Society of Nuclear Medicine
Molecular imaging pinpoints source of chronic back pain

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Failed back surgery syndrome is the term used to describe recurring or persistent pain in the back or legs following a lumbar spine surgery.

Often, surgery is used to fix an anatomical problem, such as a herniated disc pushing on a nerve. Unfortunately, even in the hands of the most skilled surgeon, some patients will continue to have pain after the anatomical problem has been repaired. The exact number of patients who continue to suffer pain is not clear, but more surgeries appear to increase the risk of this condition.

There are many reasons why patients may continue to have pain. Low back pain is often from more than one source. For example, there could be pain from a herniated disc, or pain from arthritis in the small joints, known as facet joints. After repair of one problem, pain may persist from the other. There can be a problem related to the surgery itself, such as a complication of hardware that was inserted or an infection. Continued degeneration of the discs and joints of the spine can also cause pain. Scar tissue formation (known as epidural fibrosis) and inflammation around the nerves (known as arachnoiditis) may also cause pain.

The best treatment for FBSS is prevention. Non-operative therapy should be the first step in treating low back pain, unless there is a clear anatomical problem that requires surgical intervention. Patients should be aware that even with a skilled surgeon, there is no guarantee of complete pain resolution from a low back surgery.

If a person develops FBSS, it is important to have a multidisciplinary approach to treatment of this complex problem. If there are no problems requiring surgical intervention, then multidisciplinary care involving physical therapy, medications and spinal injections should be pursued. Physical therapy should include not only treatments for pain, such as deep heat, but also muscular training exercises and instruction on how to do daily activities to prevent increased pain. FBSS therapy may also include spinal injections, such as injections around the nerves, discs or small joints in the back or neck. Epidural steroid injections are the most common, but there are several other injections that may be helpful for treatment or facilitating diagnosis.

There are some patients that do not respond to less invasive techniques, but they may benefit from more intensive treatments, including spinal cord stimulation or pain pump implantation. Spinal cord stimulation is frequently used for the leg pain associated with FBSS. A small lead is placed in the epidural space around the spinal cord and masks pain by producing a tingling or tapping sensation in the place where pain is felt. Before having the device implanted permanently, a screening trial is performed. A temporary lead is placed where the patient feels pain and they are able to test their response to the device. Once the device is permanently implanted, the patient can turn the device on and off, as well as make some adjustments to the stimulation they receive. Another treatment is pain pump implantation, also known as intrathecal drug delivery system implantation. This pump will place medication directly into the fluid around the spinal cord, which requires a much smaller dose of medication than when taken orally. Because the medication does not circulate throughout the body and a much smaller dose is used, the frequency of side effects is less. Though morphine is the most commonly used medication in these pumps, some other opioid and non-opioid medications can be used successfully.

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Free Back Pain Video and eBook

Low back pain can sometimes be traced back to a degenerative disc problem in the spinal column.  In order to understand why the pain happens it’s first important to understand how the spinal column is formed.  The spinal column is a vertical row of small round bones that are interconnected or articulated so that the bone can bend.  Through the center of the these round bones runs the spinal cord which is a bundle of nerves that travels from the base of the brain out to the rest of the body.  The spinal column protects the cord and gives the body flexibility and mobility.

Between each of the round bones, called vertebrae, are soft discs.  These discs are there to cushion the motion between the bones so there isn’t bone rubbing on bone during motion.

Degenerative changes to the spinal column are common and the intervertebral discs are one structure that is prone to those changes.  They are associated with wear and tear, aging and misuse such as smoking.  Long before any changes might be evident on imaging studies there are biochemical and structural changes that may seem to be similar to osteoarthritis.

The term degenerative disc disease refers to the changes to the discs which causes low back pain.  But, despite the rather dramatic label, this condition is very common among individuals.  It is estimated that approximately 30% of 30 to 50 year old people will have some degree of degeneration of the disc space.  And, after a person reaches age 60 this finding is expected and the exception.

Although the description of degenerative disc disease appears to be straight forward there is some degree of disagreement in the medical community about the description and the implications, especially when x-ray findings indicate changes in a young adult.   But, while there is some debate about the disease itself it is known how the changes in the spine cause pain.

Generally the pain that is associated with degenerative disc disease and low back pain are thought to stem from two different factors.  These factors are the inflammation from the changes to the disc and abnormal micromotion instability.

When inflammation occurs in the body there is release of chemicals that irritates the musculature which results in spasms of the muscles around the area.  If one of the out rings of the disc is damaged or worn it isn’t as effective in resisting motion in the spine.  This micromotion instability isn’t associated with gross instability such as a slipped disc but still causes pain or discomfort in the area.

Both the micromotion instability and the inflammation cause muscle spasms in the lower back.  As the body attempts to stability the lower back the muscles spasm further creating more pain.  This cycle is a reflex of the body and although it isn’t necessary to protect the nerve roots it can also be painful and result in an individual who appears crooked from one area of the back to the next as the muscle spasms pull the back out of alignment.

Published by Relief For Back Pain

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