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15 Remedies for Back Pain Relief

By Cathy Wong, About.com Guide

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Updated October 03, 2012

About.com Health’s Disease and Condition content is reviewed by our Medical Review Board

Most people struggle with back pain at some point in their lives. According to the National Institutes of Health, back pain is the second most common neurological disorder in the United States — only headache¹ is more common.

If you have back pain, the first step is to be properly assessed by your primary care provider. Back pain has many causes, from muscle strain to more serious conditions such as a herniated disc, spinal stenosis, spondylosisthesis, osteoporosis², or a tumor, so it’s important to find out what is causing the back pain.

Here’s a look at 15 of the more popular natural remedies. Although more research is needed before any of these options can be recommended instead of conventional treatment, some of them may provide relief for mild to moderate pain, especially when used as part of a comprehensive treatment plan.

1) Acupuncture

A 2008 research review published in the journal Spine found “strong evidence that acupuncture can be a useful supplement to other forms of conventional therapy” for low back pain. Analyzing 23 clinical trials with a total of 6,359 patients, the review’s authors also found “moderate evidence that acupuncture is more effective than no treatment” in relief of back pain. The authors note that more research is needed before acupuncture can be recommended over conventional therapies for back pain.

How does acupuncture work? According to traditional Chinese medicine³, pain results from blocked energy along energy pathways of the body, which are unblocked when acupuncture needles are inserted along these invisible pathways.

Acupuncture may release natural pain-relieving opioids, send signals to the sympathetic nervous system, and release neurochemicals and hormones.

An acupuncture treatment generally costs between $60 and $120. Acupuncture may be tax-deductible (it’s considered a medical expense) and some insurance plans pay for acupuncture.

If you want to try acupuncture, plan on going one to three times a week for several weeks initially.

2) Massage Therapy

When many people have backaches and pain, the first thing they think of is massage. Indeed, a number of studies indicate that undergoing massage therapy may help soothe back pain.

In a 2009 research review published in Spine, researchers looked at 13 clinical trials on the use of massage in treatment of back pain. The review’s authors concluded that massage “might be beneficial for patients with subacute and chronic nonspecific low back pain, especially when combined with exercises and education.” Noting that more research is needed to confirm this conclusion, the authors call for further studies that might help determine whether massage is a cost-effective treatment for low back pain.

Also found to reduce anxiety⁴ and depression⁵ associated with chronic pain, massage therapy is the most popular therapy for low back pain during pregnancy.

3) Chiropractic

Back pain is one of most common reasons people see a chiropractor. Doctors of chiropractic use chiropractic spinal manipulation to restore joint mobility. They manually apply a controlled force to joints that have become restricted by muscle injury, strain, inflammation, and pain. Manipulation is believed to relieve pain and muscle tightness and encourage healing.

Chiropractic care involving spinal manipulation appears to reduce symptoms and improve function in patients with chronic low back pain, acute low back pain, and sub-acute low back pain, according to a research review published in the Journal of Manipulative Physiological Therapeutics. In their analysis of 887 documents (including 64 clinical trials), the review’s authors concluded that combining chiropractic care with exercise is “likely to speed and improve outcomes” and protect against future episodes of back pain.

4) Capsaicin Cream

Although you may not have heard of capsaicin before, if you’ve ever eaten a chili pepper and felt your mouth burn, you know exactly what capsaicin does. Capsaicin is the active ingredient in chili peppers.

When it is applied to the skin, capsaicin has been found to deplete substance P — a neurochemical that transmits pain — causing an analgesic effect.

For a 2011 research review published in the British Journal of Anaesthesia, investigators sized up the available research on the use of topically applied capsaicin in treatment of several types of chronic pain⁶. This included two clinical trials on back pain, both of which found that capsaicin helped reduce low back pain without causing notable side effects.

Capsaicin cream, also called capsicum cream, is available in drug stores, health food stores, and online. A typical dosage is 0.025% capsaicin cream applied four times a day. The most common side effect is a stinging or burning sensation in the area.

If possible, wear disposable gloves (available at drugstores) before applying the cream. Be careful not to touch the eye area or open skin. A tube or jar of capsaicin cream typically costs between $8 and $25.

5) Vitamin D

Chronic muscle pain can be a symptom of vitamin D deficiency. What’s more, some research suggests that treatment with vitamin D supplements may lead to clinical improvement in back pain symptoms among people with low initial concentrations of vitamin D, according to a 2005 report published in the British Medical Journal.

An essential nutrient available in certain foods (such as fortified milk and fish with small bones), vitamin D is produced naturally by the body during exposure to the sun’s ultraviolet rays. But since it’s difficult to obtain your recommended daily intake of D solely through dietary sources and sun exposure, many medical experts recommend increasing your vitamin D levels by taking a dietary supplement.

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Stem Cells for Spine Surgery: 7 Points

Written by  Laura Miller | May 23, 2012

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Here are seven points about using biologics and stem cells during spine surgery from Richard Hynes, MD, President of The B.A.C.K. Center in Melbourne, Florida.

How we got here
Dr. Hynes was one of the many spine surgeons who participated in Medtronic’s original trials for BMP-2 in the 1990’s.  While scientists have known about the ability of stem cells and BMP to generate bone for several years, Medtronic was the first company to develop a safe and effective molecule to stimulate cell growth.  After completing the pre-market approval trials, the Food and Drug Administration granted approval for the BMP-2 product, Infuse, in 2002 for creating fusion in the Lumbar Spine placed through an anterior approach in a LT cage.

“In the original study, I experienced 100 percent of enrolled patients in my Practice achieving bone growth when combining BMP with the local cells that were already there,” says Dr. Hynes.  “Local ‘stem cells’ respond to BMP and become activated thereby creating bone.  When I saw it worked in 100 percent of my enrolled patients, I was a true believer.  I have used it in my practice since the study and FDA approval going back greater than 10 years.”

What has changed is our ability to concentrate stem cells; Dr. Hynes harvests the stem cells from the iliac crest to combine with the BMP.  It takes less than five minutes for his physician’s assistant to harvest the cells, which are spun in a centrifuge while he begins the operation.  After 10-15 minutes, the cells are ready and Dr. Hynes adds a small amount to the surgical field along with the BMP.  The collagen sponge is placed within an interbody LT cage to keep the material from migrating.

“This has been an effective Bone Graft method and it has been an advantage for my patients who can avoid Iliac Bone Graft surgery and Donor Bone issues and cost,” says Dr. Hynes.  “It doesn’t add to my usual procedure time.  It does add a small cost, but I find it’s worth the value proposition.”

Since its inception and release, surgeons have been experimenting with its use in several different capacities, on- and off-label.  However, articles published in The Spine Journal in July 2011 suggest complication rates may be higher than the original studies reported.  Several physicians have reported positive and negative events based on individual practice date, and further research into its use will be necessary going forward.  As with all products, on label and off label use is routine practice and common place.  When used correctly, minimal side effects of swelling, seroma and osteolysis occur.

What the research says
There have been several clinical studies and basic science research projects published in professional journals discussing the efficacy of using BMP with local stem cells to enhance fusion.  However, research on the impact of increasing the number of stem cells is still lacking.  Dr. Hynes’ current clinical work focuses on whether there is a better chance of achieving fusion with a higher concentration of stem cells.

He harvests stem cells from the iliac crest, percutaneously and painlessly, or vertebral body and extract about 60-80 ccs of blood.  The desired stem cells are concentrated to a few ccs with centrifugation and has about a 50,000 cell count per “Spine Smith research data.”

“We already know the mechanism by which BMP-2 activates stem cells.  The stem cells are already very effective,” says Dr. Hynes.  “If we add to the population of stem cells that are already there that are available to regenerate new bone, it could make the procedure even better.  Anecdotally, I have a high fusion rate for my spine patient population even before adding the extra concentration of stem cells.  With the additional stem cells, I hope to achieve fusion at almost any level no matter how many levels are needed such as in degenerative scoliosis.  In osteoporosis and aging spine patients, this has been extremely beneficial when compared to poor iliac crest from bone harvest.

Dr. Hynes’ ethereal practice goal is to someday be able to “guarantee” that they will achieve fusion for every patient who undergoes surgery.  This means stabilization.  However, fusion does not guarantee “success” of the surgery but increases odds of the surgical success.  At this point, he is close, with approximately a 95 percent fusion rate.  “What I want to do before I retire is to be able to guarantee a fusion,” he says.  “I can’t guarantee pain relief or other clinical outcomes, but I want to be able to confidently guarantee the fusion or stabilization component.”

Options for harvesting stem cells
There are several bone graft options spine surgeons can choose from to achieve a fusion, and in the wake of recent controversies some surgeons are looking for an alternative to using BMP.  Surgeons can go back to the traditional fusion method – the iliac crest – or using an allograft.  Dr. Hynes says harvesting bone from the iliac crest can leave 30 percent of patients in more pain and add significant surgical time in the OR with increased blood loss.  Allografts also have downsides, including graft consistency, quality, processing issues and less potential to achieve fusion than iliac crest or autogenous grafting methods.

“The bone for allografts may not be prepared correctly,” says Dr. Hynes.  “We don’t always know the quality or consistency of the allograft compared to the patient’s natural bone.  If I’m putting a piece of bone in patients, it’s better if it comes from their own bodies.  That way, you can’t tell the difference between the bone you grow and the natural bone.  (What we are doing is creating a nice bone graft that balances the biomechanics of the fusion construct better than the allograft.)”

In some cases, the allograft bone could migrate or fracture or reabsorb after the procedure, which can cause significant pain and complications, often resulting in revision procedures.  By using the combination of BMP and stem cells in an interbody device, Dr. Hynes is able to avoid most of those complications because the cells are attracted to the BMP, which is restrained in the cage.

Patients should have the final say – “Informed Consent”!
Like many surgeons, Dr. Hynes describes the different fusion options to his patients and allows them to choose which procedure they feel most comfortable with.  He discusses the pros and cons of each technique, including the most recent concerns about BMP, as well as his personal outcomes.  He says patients often choose BMP combined with stem cells because they like the idea of regenerating their own bone naturally, avoiding the extra surgery and potential pain of iliac crest bone grafts and decreased potential or effect of donor allograft bone.

“The psychology of healing is part of this,” says Dr. Hynes.  “Patients understand the procedure and like the idea of using their own cells as healing factors.  People are very positive about that process because they feel like they are doing something natural instead of synthetic.  Healing and surgery isn’t just biomechanics and science; it’s psychological as well.  Successful outcomes of surgery depend on subjective relief as well as objective factors.”

In his practice, Dr. Hynes says a significant number of his patients chose the BMP and stem cell combination with given the option.  However, when the patients choose a different option, he performs the other procedures as well.  “It’s our duty to give patients their choice,” he says.  “I’m not always smart enough to know what the best choice is for any one individual, but I’ve practiced many years and learned that if you take time to educate patients to all the reasonable options, they will make good decisions and take responsibility for them.”

Deciphering the complications
While Dr. Hynes hasn’t experienced significant complications among his patients, it’s clear that other surgeons have reported complications when they perform spinal fusions using BMPs.  One reason for the discrepancy could be the dosage; well-documented evidence suggests that a higher dosage of BMP could cause swelling complications when used in the cervical spine.  By using low doses of BMP and a pre and post-surgical protocol, swelling is completely avoidable in the cervical spine.  Another factor is the surgical approach; Dr. Hynes says retrograde ejaculation (“RE”) – one of the severe complications mentioned in the studies this past summer – is a complication risk of any anterior spine surgery and not related to use of BMP.  “I have performed thousands of anterior procedures before and after approval of BMP for anterior lumbar surgery and I find no difference in RE noted in my patients.”

“Every spine surgeon knows RE is a risk during anterior procedures and it usually will reverse on its own,” says Dr. Hynes.  “RE occurs in an extremely low frequency.  RE occurs because of disruption ‘surgically’ of small nerves to a sphincterine the bladder.  BMP does not cause this effect, but the use of the electrocautery tool, during surgery, likely does.  Use a small dose of BMP and a cage as well.”

In his practice, Dr. Hynes has never experienced a critical airway complication using cervical BMP.  In early years, too high a dose would lead to swelling but not airway compromise which more commonly occurs with hematoma or blood clot, says Dr. Hynes.  Papers published in The Spine Journal also mention cancer as an associated complication, which is something he hasn’t necessarily noted either.  “I haven’t seen a rash of cancer in my patients, but I haven’t been surveying for it either,” he says.

He is currently going through his patient base to determine whether he can detect any cancer cases that could be associated with the procedure.

Whether to use BMPs
As surgeons report different findings based on their individual practice data, many of the studies and discrepancies have been reported in the media.  However, full understanding of these complex issues is often lost in news reports.  “I hate to see some of the surgeons and journals duking it out in the media,” says Dr. Hynes.  “That isn’t the place to argue over the efficacy of stem cells and BMPs.  We have to do it in the meetings where people understand the context.  To lay this out in the newspapers exacerbates political agendas and confuses our patients.  We need to speak honestly with each other about this at professional and scientific meetings, not in the press.”

This controversy isn’t the first time new spinal technology and procedures have been under attack.  For a period of time, pedicle screws – which are a standard of care now – were under the microscope because complications were reported.  In some instances, surgeons were sued and restricted from use at their hospitals for their alleged unfavorable outcomes.  Now pedicle screws are the mainstay of spinal fusion procedures.

“At the time, there was only approval that pedicle screws could be used on single-level surgeries,” says Dr. Hynes.  “Now we use them at multi-levels.  The pedicle screws ultimately won the day, but with public stimulation ‘in the news’ in the early 1990s, we almost lost the ability to use them.  This was a public attack on the advent of a new fusion technology, and now we are seeing similar phenomenon’s with BMP and other medical products.”

Covering the cost of BMP
In some cases, surgeons may have a difficult time receiving reimbursement for BMP products because they were more expensive in the past.  Dr. Hynes and his colleagues have worked with hospitals and surgery centers to cover the cost in both out-of-network and in-network contracts.  In some cases, patients are willing to cover the cost of using stem cells with BMP.  Due to the success and demand, the cost has now become competitive considering operative costs of iliac bone surgery or allograft.  “The increased volume of use and effectiveness has caused a dramatic decrease in cost,” says Dr. Hynes.

“I see patients from out of the Country and they are usually cash pay patients,” says Dr. Hynes.  “We have to line item every part of the procedure to show the actual cost and there is almost no increased cost for the use of low concentrated BMP compared to iliac bone grafts or allograft when taking OR time, surgeon’s time and other OR costs into consideration.”

Fortunately, the hospitals in Dr. Hynes’ community allowed him to use BMP and conduct the clinical studies there.  “We have more experience in our community with the benefits of this technology because we started so early,” he says.  “Our surgeries are very efficient and our operative time is less because of our long-term experience with the procedure using stem cells and BMP.”

However, in some cases Dr. Hynes has made sacrifices to mitigate these costs.  “I think about what I could live without and forego those expenses for stem cells and BMP,” he says.  “I might use less expensive blades or a new set of tools for the next year.  I might continue to use my old led apron or do surgery without a super drape.  I’m there to give patients a better outcome and I want to make sure they have the opportunity to have the stem cells.”

More Articles on Spine Surgeons:
8 Spine Surgeons on the Future of Spinal Fusions
6 Spine Surgeons on How Young Surgeons Can Position Themselves for Success in the Future
What Percentage of Your Spine Practice is Medicare Patients?

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Tagged under

• spinal surgery
• bmp
• stem cells
• spinal surgeon
• Dr. Richard Hynes

 

Pain Prevention

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Once you encounter back or neck pain, you are four times as likely to experience it again. This is why prevention is essential to your long-term recovery.

One of the best ways to avoid back pain is by exercising and stretching. Low-impact aerobics, such as walking or swimming, is an ideal way to prevent or treat back pain. Stop if the exercise becomes painful, and always remember to stretch. Stretching is easy to incorporate into your daily routine. You can even do it in front of the television.

Below are some more specific ways to prevent back or neck injuries:

Sitting for long periods

The spine likes movement. Anything that puts the spine in a static position creates stress, which can cause back and neck pain. Every hour, stand, walk around, bend, arch backward gently, and twist. Doing so at regular intervals will lengthen the amount of time you can sit comfortably. Also, get an ergonomically-designed chair or an orthopedic insert to support your spine, especially if your job involves long periods of sitting. Or roll up a towel, and place it behind your low back.

A comfortable way to stand

Prolonged standing can also strain the back. If you have to stand for long periods of time, prop one foot on a small stool or telephone book to reduce stress in the low back. Alternate with the other foot. Every half hour, bend over and touch your toes, with your knees slightly bent, or do some of the stretching exercises shown in the Seton Spine and Scoliosis website. They will help loosen your muscles, ligaments and joints.

Plane rides

While traveling on a plane, it helps to raise your feet on a briefcase or a bag underneath the seat in front of you. Ask for a pillow to place behind your low back to improve lumbar support. It is important to get up frequently and walk to the bathroom and back, whenever possible. Avoid hour-long periods in your seat.

The best sleeping position

Avoid sleeping on your stomach, which arches your back and puts pressure on your spine. Instead, lie on your back with a small pillow tucked under your knees. This position unloads the spine. An alternate position is to lie on your side with a pillow between your knees. If you like sleeping on your stomach, place a soft, flat pillow under your stomach to eliminate some of the arch that can stress your back.

Mattress considerations

It is important to sleep on a mattress with optimal back support, whether it is a conventional mattress or a waterbed. Older waterbeds were mushy and provided little support. However, now there are waterbeds that allow you to adjust their firmness. A good mattress should relate to your body shape. Generally, go with what feels comfortable to you.

Pain is a signal from the body to the brain that something is wrong. Either the back is too weak, too inflexible, or the wrong body mechanics were used to perform a task.

 

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A new hope for back pain sufferers?

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(CBS News) Back pain is one of the most common of human complaints, which is why new treatments in the works are raising so many hopes. Our Sunday Morning Cover Story is reported now by Martha Teichner:

 

Consider the human spine, in all its glory.

 

The 24 vertebrae, cushioned by gelatinous discs . . . the little facet joints that help make your back flexible . . . all the ligaments and muscles and nerves.

 

The spine’s elegant complexity is a miracle of engineering, or a curse when something goes wrong.

 

Eight out of ten Americans will experience debilitating back pain sometime in their lives.

 

“My pain was very excruciating,” said Lenda. “I couldn’t walk, I couldn’t bend over. I couldn’t lie down.”

 

“I’d say, ‘Oh Lord, can’t you help my back, it does hurt bad’ – he didn’t help me a bit,” said Leila.

 

And the most common culprit?

 

“I think most people would think it’s the inter-vertebral discs, whether it’s herniated or whether it’s just worn and arthritic and associated with pain,” said Dr. Augustus White, a professor at Harvard Medical School. He has literally written the book on lower back pain.

 

He says the easiest way to understand a herniated disc is to think of a jelly doughnut: When what Dr. White calls “the jelly” gets squeezed out, it presses on nerves, which can mean excruciating pain. Barring serious illness, the first line of treatment may not be what the patient (who only wants a quick fix) wants to hear.

 

“You need to make sure the patient doesn’t have tumor or infection,” said Dr. White, “but once you rule those out, you can be confident that you’re not going to harm the patient by saying, ‘OK, give yourself four to six weeks.'”

 

Believe it or not, 90 percent of disc injuries heal themselves after a few weeks, especially with physical therapy. But waiting it out can be torture, and not everybody gets better. So that’s where surgery comes in.

 

More than 1.2 million Americans undergo spinal surgery each year. That’s more than TRIPLE the number of coronary by-pass surgeries (415,000), and nearly FOUR TIMES the number of hip replacements (327,000).

 

Approximately 300,000 of those back surgeries were spinal fusions, where vertebrae are joined surgically so they can’t move. They’re often held in place, permanently, with metal screws or rods.

 

For many patients, surgery is the only answer – salvation. But for all too many others, it can be a nightmare.

 

Which brings us to Dr. Kevin Pauza, a founder of the Texas Spine and Joint Hospital in Tyler, Texas.

 

“I spent decades treating patients who’ve had surgery, the surgery was fusions,” Dr. pauza said. “Patients would do well for a year or two, and they’d always come to me and need more help.”

 

In his experience, fusion was usually the wrong answer: “The spine’s made to be a structure that bends with every movement we make, and if we immobilize a segment of the spine, the adjacent segment breaks down. That’s known as the domino effect.

 

“So my thought was, can we do something to that disc so that we don’t have to fuse it? Can we bring the disc back to life?”

 

And that’s the headline of this story. Just imagine: A procedure that repairs and re-grows discs, that doesn’t involve spinal fusion, that’s no more than minimally invasive, outpatient surgery.

 

The inspiration came to him when he thought about something as basic as how an ordinary cut heals.

 

“I realized what heals a cut is something that’s very simple: It’s two products that are in you and I, they’re in everybody.”

 

In our blood plasma – they’re called thrombin and fibrinogen. For the cut to heal, the two components come together, and they make a substance called fibrin.

 

When the two components, in concentrated form, are injected into the disc through a kind of squirt gun Pauza invented, just like epoxy glue, they combine and become fibrin.

 

Injected into the damaged disc, the compound acts like a sealant, filling cracks and crevices, and eventually allowing the disc to re-grow. “It allows our degenerated disc to turn into a young, healthy, normal disc,” said Dr. Pauza.

 

Rusty Templeton is typical of Dr. Pauza’s failed fusion patients. He had his surgery in 2008, but the pain came back and was agonizing.

 

“I’ve kind of damaged the disc above and below my fusion, and of course that fusion disc is also in pretty bad disrepair,” said Templeton.

 

Templeton is given a local anesthetic. The procedure takes about five minutes…there’s no incision..no hardware…

 

Typically, at first, patients feel discomfort. “Some patients even say, ‘Gosh, I wish I never had this done,'” said Dr. Pauza. “And then several weeks later, the patients just turn a corner. We tell them that they can expect that there will be one day where they have pain, and the next day, it’ll just stop.”

 

Dr. Pauza is hoping for Food and Drug Administration approval of the procedure by 2015, and to make it available to the public shortly thereafter. Phase III clinical trials are underway now at 20 sites around the U.S.

 

Dr. Pauza has successfully treated more than a thousand patients in his private practice. “We started treating the first patients approximately five or six years ago, and the success rate is approximately 86 percent,” he said.

 

So how did Rusty Templeton do? “My pain before was at least a ten,” he said. And two months after the procedure? “It’s still around a five, because I have underlying issues. But I can lay down now. I can, you know, walk around. I can drive where I couldn’t drive before.

 

“The pain level I had before the procedure was probably around anywhere from about a six to worse, eight,” he said.

 

Christopher Joseph is a home restorer who was in a car accident. How was his pain two months after the procedure? “Right now, it’s at zero.”

 

Dr. Michael DePalma is a spine specialist in Richmond, Va. The North American Spine Society has just published his paper on the latest experimental therapies involving disc restoration.

 

“Stem cells are something that’s being investigated to replenish cells within the disc directly, injecting growth factors, which are proteins, to try to stimulate repair in a disc have also been evaluated,” said Dr. DePalma.

 

He is involved in 4 different FDA trials of the new procedures and believes these so-called biologics are the future of back treatment. Based on the results so far, he thinks Dr. Pauza’s fibrin sealant offers the most promise.

 

If the treatment, asked Tecihner, is even 50% successful with someone, is that significant? Dr. DePalma replied, “It’d be huge.”

 

And then there’s the cost. Compare spinal fusion and fibrin treatment: “The treatment for a fusion – and this is the hospital fee – typically is in the $100,000 range, not including the physician’s fee,” he said. “We don’t have a set cost for [fibrin] treatment yet, but it’s approximately 95 percent less than the cost of a fusion.”

 

Dr. Pauza expects it to be widely available within five years.

 

“It’s the first time in history that we’ve been able to cause new tissue to grow within the spine. This procedure is the procedure that really the world has been waiting for,” he said.

 

Is it? The procedure is only for back pain sufferers with specific disc problems, but there are a lot of those . . . and Dr. Kevin Pauza is absolutely sure he’s found a better, safer, cheaper way of improving their lives.

 

 

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Top Orthopedic Surgeons in Texas, Top Back Surgeons in Texas, Top Spine Surgeons in Texas

Looking for an Orthopedic surgeon that you can trust is a daunting task. You do not want to chance that the person you are going to for ankle, knee, hip, or even spinal surgery may not be among the best in their field. Though this is a decision you have to make for yourself after meeting the orthopedic surgeons in person we are giving you a good start. Hopefully an end to your frustration even.

Orthopedic surgery is becoming ever more common as advancements allow for better hip and knee replacements which of course makes the demand for orthopedic surgeons higher. Find the best ones in Texas so you can find the surgeon that is right for you and your needs. Something as important as a hip replacement or any other orthopedic surgery, can’t be left to chance and all the time spent researching surgeons around can take up an awful lot of time. So here are the top orthopedic surgeons we have chosen in Texas.

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Steven J. Cyr, M.D.

San Antonio, TXDr. Steven Cyr, is a Board Certified Orthopaedic Surgeon who received extensive training to specialize in the delicate science of Spine Surgery. He has brought innovative techniques to the military and was the first to perform the total disc replacement procedure as well as endoscopic spinal surgery. He specializes in complicated spine issues and has gained notoriety for successful repairs of failed surgeries on patients from numerous other states and around the world.

Dr. Henrik Mike-Mayer, M.D. 

2504 Ridge Road, #206, Rockwall, Texas, United States, 75087

Dr. Mike-Mayer is a fellowship trained Orthopaedic Spine Surgeon specializing in the non-operative and surgical treatment of spinal disorders. He completed his undergraduate degree at Drake University. He earned …

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Dr. Neil D. Shah, MD 

Dallas,, Tx, United States

Neil Dilip Shah, MD is a Board-Eligible Orthopedic Surgeon and Fellowship-Trained Spine Surgery. Dr. Shah brings a conservative approach to low back and neck pain while also offering the most current minimally invasive surgical techniques when a procedure …

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Dr. Venkat Sethuraman M.D. 

2021 N. MacArthur Blvd, Irving, Tx, 75061

Mayo Fellowship Trained Board-Certified Spine Surgeon Minimally Invasive Spine Specialist Education Undergraduate: Rutgers College, New Brunswick, NJ Medical: Medical College of Pennsylvania, Philadelphia, PA Training Orthopaedic Surgery Residen …

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Dr Saqib Siddiqui M.D.

14450 T C Jester Boulevard #100, Houston, TX, 77014

BOARD ELIGIBLE ORTHOPEDIC and SPINE SURGEON Dr Siddiqui is proficient in treating cervical, thoracic and lumbar spinal conditions and disorders whether they require surgical treatment or non-operative treatment. Degenerative disc disease is a common pro …

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Dr. Eric Gioia, M.D

2900 N I-35, Ste 110, Denton, Tx, USA, 76201

Dr. Eric Gioia has been practicing neurosurgeon in Texas for over 20 years. A graduate of the University of Mississippi Medical School (1979), Dr. Gioia completed his neurosurgical residency at the University of Tennessee, Memphis (1985) and served his su …

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Dr. Huntly Chapman M.D.

3900 Junius St., Dallas, Texas, 75246

www.becomepainfree.com

Dr. Huntly Chapman is an fellowship trained Orthopedic Spine surgeon, specializing in the treatment of low back and neck pain. Dr. Chapman utilizes both conservative non-operative and surgical treatments. Dr. Chapman received his medical degree from th …

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Dr. J. Kevin Kaufman, M.D.

3625 Camp Bowie Boulevard, Fort Worth, TX, USA, 76107

Dr. Kaufman is a specialist in cerebrovascular, skull base and complex spine surgery. He has published numerous articles, manuscripts and abstracts on subjects such as brain tumors and complex spinal surgery. He has also made presentations on skull base a …

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Dr. John A. Sazy, M.D.

431 Omega Dr. #104, Arlington, TX, USA, 76014

Dr. John Sazy is a fellowship trained Orthopaedic Surgeon with extensive training in Spine Surgery with offices in Arlington and Fort Worth, Texas. Dr. Sazy evaluates for and performs reconstructive spine surgery, revision spine surgery, scoliosis surger …

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Dr. Kenneth J.H. Lee, M.D.

16929 Southwest Freeway, Suite 100, Sugarland, TX, 77479

Orthopaedic Spine Surgeon Board Certified/Fellowship Trained Surgery of the Cervical, Thoracic, and Lumbar Spine Kenneth J.H. Lee, M.D. Born in Chicago, Illinois and a native of North Carolina, Dr. Kenneth Lee graduated from Duke Universi …

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Dr. Marvin Van Hal, MD

2301 S Hampton Rd Suite 800, Dallas, TX, USA, 75224

Orthopedic spine surgery

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Dr. Richard Marks, M.D.

399 W. Campbell Rd. #408, Richardson, TX, USA, 75080

Knee/Lumbar Spine Surgery

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Dr. Shawn Henry, DO

3600 W 7th St, Fort Worth, TX, USA, 76107

Dr. Henry earned his Doctorate of Osteopathic Medicine from Ohio University. He participated in a traditional rotating internship and an Orthopedic Surgery through Ohio University. Dr. Henry’s fellowship work was completed with the Texas Back Institut …

Telephone(214) 396-3647

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Dr. Steve P. Courtney M.D.

5228 W. Plano Pkwy, Plano, TX, United States, 75093

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As a highly skilled specialist in surgical procedures involving the spine, Dr. Stephen P. Courtney has established an excellent reputation with his professional colleagues and patients. He is a board-certified, fellowship- trained orthopedic spine sur …

Telephone(214) 396-3647

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Dr. Zach Kelley

7777 Forest Lane, Bldg. C, Suite 500, Dallas, TX, 75230

Dr. Zach Kelley is a fellowship trained spine surgeon who specializes in minimally invasive spine procedures. Patients who have minimally invasive spine procedures have smaller incisions, less blood loss, and a shorter hospital stay. Dr. Zach Kelley co …

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BecomePainFree.com Treats

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  Herniated discs
• Pinched nerves
• Degenerative spine disease
• Spinal stenosis
• Spondylolisthesis (slipped spine)
• Scoliosis (deformity)
• Low back pain / neck pain
• Spine trauma
• Spine infection
• Osteoporotic fractures
• Spine and spinal cord tumors
• Peripheral nerve injury
• Chiari malformation
• Cavernous malformation
• Vascular malformation

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Minimally Invasive Spine Surgery

Minimally Invasive Surgery:

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Recent surgical advancements have focused on performing surgery through smaller incisions, with less disruption to surrounding soft-tissues. The idea behind minimally invasive surgery is to perform the same treatment without damage to normal surrounding tissues. The drawback of minimally invasive surgery is that sometimes the underlying problem may not be adequately addressed because of an inability to get to the problem. Whenever a new minimally invasive procedure is introduced, there is almost always controversy as to whether or not the procedure is as good as traditional surgery.

Endoscopic Spine Surgery:

Endoscopic spine surgery uses specialized video equipment inserted through small incisions to see the structures of the spine. Similar to arthroscopic surgery of a joint, endoscopic surgery has advanced over the past decade from merely being able to look to the area of interest, to the ability to repair and reconstruct a variety of complex problems.The benefit of endoscopic spine surgery is the potential to address problems through very small incisions. By not damaging the muscles around the spine, recovery can often be much faster than with a larger surgical exposure.

Microdiscectomy, Microlaminectomy and Microforamenotomy:

All of these micro-surgeries are variations of standard surgeries used to take pressure off of the nerves around the spinal cord. Traditionally done through larger incisions, the micro procedures use smaller incisions and specialized surgical instruments to accomplish the same goals of traditional surgery.There is no rule on where the line between traditional surgery and micro surgery is drawn. To some doctors this means a smaller incision, to others it means the use of special surgical instruments. Many variations of a procedure could be considered micro surgery.

Laser Spine Surgery:

Laser spine surgery is a technique that uses a laser to remove damaged tissues. Because a laser can be inserted through small incisions, it can be used to cut away damaged tissues (such as disc fragments) without having to make a large incision.There is significant controversy about laser spine surgery as this technique has not been shown to have significant benefits, despite advertising that may make you think otherwise. Often marketed in magazines and the Internet, laser spine surgery has become the focus of some lawsuits formisleading patients about expected results from surgery.

Is It Better?:

Is minimally invasive surgery better? There are many ways to answer this question. The bottom line is that we simply do not know. There are theoretic advantages, and there are possible downsides. But there are very few studies that compare the possible risks with the potential benefits of minimally invasive surgery.The bottom line I suggest is to find a surgeon who, above all, is interested in fixing your problem, not someone who is selling you on a smaller incision. If the same benefit can be achieved without damage to normal tissues, then minimally invasive surgery may be a good option.

_Sources:

_{Mathews HH and Long BH “Minimally Invasive Techniques for the Treatment of Intervertebral Disk Herniation” J. Am. Acad. Orthop. Surg., March/April 2002; 10: 80 – 85.}

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Kyphoplasty Surgery, Kyphoplasty, Kypho, Vertebroplasty, Back Surgery, Spine Surgery

What is Vertebroplasty & Kyphoplasty?

Vertebroplasty and kyphoplasty are minimally invasive procedures for the treatment of vertebral compression fractures (VCF), which are fractures involving the vertebral bodies that make up the spinal column.

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When a vertebral body fractures, the usual rectangular shape of the bone becomes compressed, causing pain. These compression fractures may involve the collapse of one or more vertebrae in the spine and are a common result of osteoporosis. Osteoporosis is a disease that results in a loss of normal bone density, mass and strength, leading to a condition in which bones are increasingly porous, and vulnerable to breaking. Vertebrae may also become weakened by cancer.

In vertebroplasty, physicians use image guidance to inject a cement mixture into the fractured bone through a hollow needle. In kyphohplasty, a balloon is first inserted into the fractured bone through the hollow needle to create a cavity or space. The cement is injected into the cavity once the balloon is removed.

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Performing Kyphoplasty Surgery

1. During kyphoplasty surgery, a small incision is made in the back through which the doctor places a narrow tube. Using fluoroscopy to guide it to the correct position, the tube creates a path through the back into the fractured area through the pedicle of the involved vertebrae.
2. Using X-ray images, the doctor inserts a special balloon through the tube and into the vertebrae, then gently and carefully inflates it. As the balloon inflates, it elevates the fracture, returning the pieces to a more normal position. It also compacts the soft inner bone to create a cavity inside the vertebrae.
3. The balloon is removed and the doctor uses specially designed instruments under low pressure to fill the cavity with a cement-like material called polymethylmethacrylate (PMMA). After being injected, the pasty material hardens quickly, stabilizing the bone.

Kyphoplasty surgery to treat a fracture from osteoporosis is performed at a hospital under local or general anesthesia. Other logistics for a typical kyphoplasty procedure are:

• The kyphoplasty procedure takes about one hour for each vertebra involved
• Patients will be observed closely in the recovery room immediately following the kyphoplasty procedure
• Patients may spend one day in the hospital after the kyphoplasty procedure

Patients should not drive until they are given approval by their doctor. If they are released the day of the kyphoplasty surgery, they will need to arrange for transportation home from the hospital.

Recovery from Kyphoplasty

Pain relief will be immediate for some patients. In others, elimination or reduction of pain is reported within two days. At home, patients can return to their normal daily activities, although strenuous exertion, such as heavy lifting, should be avoided for at least six weeks.

Candidates for Kyphoplasty

Kyphoplasty cannot correct an established deformity of the spine, and certain patients with osteoporosis are not candidates for this treatment. Patients experiencing painful symptoms or spinal deformities from recent osteoporotic compression fractures are likely candidates for kyphoplasty. The procedure should be completed within 8 weeks of when the fracture occurs for the highest probability of restoring height.

It is not known whether kyphoplasty or vertebroplasty will increase the number of fractures at adjacent levels of the spine. Bench studies on treated bone have shown that inserting PMMA does not change the stiffness of the bone, but human studies have not been done. Osteoporosis is a chronic, progressive disease. As stated earlier, patients who have sustained fractures from osteoporosis are at an increased risk for additional fractures due to the loss of bone strength caused by osteoporosis.

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Central Cord Syndrome

Central Cord Syndrome (CCS) is an incomplete injury to the cervical cord resulting in more extensive motor weakness in the upper extremities than the lower extremities. The mechanism of injury occurs from a hyperextension injury with pre-existent osteophytic (abnormal bony outgrowth) spurs, without damage to the vertebral column.

Mechanism and Causes of Injury

CCS occurs typically in patients with hyperextension injuries where the spinal cord is squeezed or pinched between anterior cervical spondylotic bone spurs and the posterior intraspinal canal ligament, the ligamentum flavum. The ligamentum flavum is a strong ligament that connects the laminae of the vertebrae. It serves to protect the neural elements and the spinal cord and stabilize the spine so that excessive motion between the vertebral bodies does not occur.

The injury occurs as a result of anterior and posterior compression of the spinal cord, leading to edema, hemorrhage or ischemia to the central portion of the spinal cord. The site of most injuries is in the mid-to-lower cervical cord. Due to the anatomical lamination of the corticospinal tract with the arm fibers medially, and the leg fibers laterally, the arms are affected more so than the legs, resulting in a disproportionate motor impairment.

Symptoms

Patients are typically left with motor weakness of the upper extremities and lesser involvement of the lower extremities. A varying degree of sensory loss below the level of the lesion and bladder symptoms (urinary retention) may both occur.

Incidence

This syndrome more commonly affects patients age 50 and older who have sustained a cervical hyperextension injury.

CCS may occur in patients of any age and is seen in athletes who present with not only hyperextension injuries to their neck but associated ruptured disc(s) with anterior cord compression.

CCS affects males more frequently than females.

Diagnosis

Evaluation of the patient includes a complete history, a thorough neurological exam, MRI and CT of the cervical spine, and cervical spine x-rays including supervised flexion and extension x-rays.

• Magnetic resonance imaging (MRI): A diagnostic test that produces three-dimensional images of body structures using powerful magnets and computer technology; can show direct evidence of spinal cord impingement from bone, disc, or hematoma.
• Computed tomography scan (CT or CAT scan): A diagnostic image created after a computer reads x-rays; can show the shape and size of the spinal canal, its contents, and the structures around it.
• X-ray: Application of radiation to produce a film or picture of a part of the body can show the structure of the vertebrae and the outline of the joints. X-rays of the spine delineate fractures and dislocations, as well as the degree and extent of spondylitic changes. Flexion/extension views assist in evaluation of ligamentous stability.

 

Surgical Treatment

Acute surgical intervention is not usually necessary unless there is significant cord compression. Prior to the CT-MRI era, surgical intervention was thought to be more harmful because of the risk of injuring a swollen cervical cord and worsening the deficit. However, with advanced imaging technology such as CT and MRI, patients with compression of the spinal cord secondary to traumatic herniated discs and other lesions can be quickly diagnosed and surgically decompressed. In cases with anterior bony ridges and spinal canal narrowing secondary to ligamentous thickening and or stenosis, acute surgery is usually not performed until the patient has made maximum recovery. Reassessment at that time may lead to surgery depending on the underlying cause. If there is significant motor weakness after a period of recovery, or neurological deterioration or spinal instability, then surgical intervention may be considered.

Nonsurgical Treatment

Nonsurgical treatment consists of immobilization of the neck with a cervical orthosis, steroids unless contraindicated, and rehabilitation with physical and occupational therapy.

Outcome

Many patients with CCS make spontaneous recovery of motor function while others experience considerable recovery in the first six weeks post injury.

If the underlying cause is edema, recovery may occur relatively soon after an initial phase of motor paralysis or pareses. Leg function usually returns first, followed by bladder control and then arm function. Hand movement and finger dexterity improves last. If the central lesion is caused by hemorrhage or ischemia, then recovery is less likely and the prognosis is more devastating.

The prognosis for CCS in younger patients is favorable. Within a short time, a majority of younger patients recover and regain the ability to ambulate and perform daily living activities. However, in elderly patients the prognosis is not as favorable, with or without surgical intervention.

 

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