When Conservative Care Fails

After conservative care has failed, patients are often referred from their primary care doctor to a pain management physician for diagnostic imaging, therapeutic injections, and interventional procedures.

An MRI and X-rays of the spine are taken along with a physical exam to determine the pain generator. For example, patients that complain of chronic low back pain are typically diagnosed with facet joint syndrome. These facet joints, which allow our backs to turn and bend, can become arthritic and degenerative or injured and become very painful.

Pain management physicians will use a medial branch nerve block injection, next to the facet joint, to diagnose what is causing the pain you feel in your back. If the injection provides relief for a few hours, and the pain returns, they typically will recommend a radiofrequency ablation of those nerves. A nonsurgical procedure, done under X-ray, places small needles through the skin, over the nerves and then heats them forming a lesion on the nerves that discontinues the back pain.

Clinically, about 80 percent of patients receive relief for about six months to one year. Unfortunately, these nerves will regenerate, and for some patients routinely they will seek additional pain management treatments.

The Gap Between Failed Pain Management and Minimally Invasive Spine Surgery

Pain management, which works for many people, can often fail to provide optimal or long-term pain relief. Patients who fail to get long-term relief are then recommended for a consultation with a spine surgeon. Too often, patients suffering from chronic back pain undergo invasive spine surgery and lengthy recovery time. After spine surgery, some patients suffering from low back pain, struggle to return to work and in some cases get little to no additional relief.

For these reasons, many patients fear spine surgery. They have heard stories from friends that have had spinal fusion surgery that resulted in a long, painful recovery and not always ideal results. Spine surgery is an excellent choice for some well-qualified candidates, however in the case of low back pain due to the facet joints, the only treatment option surgeons have had is to perform a spinal fusion of the facet joint.

Advantages of Endoscopic Medial Branch Nerve Transection Vs. Minimally Invasive Spinal Fusion

First and foremost, the endoscopic medial branch nerve transection (MBT) can spare a patient a spinal fusion. Also, unlike spinal fusions performed under general anesthesia, the endoscopic MBT can be performed under local anesthesia with oral or Intravenous (IV) medication and numbing of the skin. The incision is about ½ inch for the endoscopic surgery versus at least 1 to 2 inches with the spinal fusion surgery. The smaller incision is likely a reason for less post-operative pain. Patients go home within a couple of hours of operation with little to no pain and return to work within a couple of weeks. On the other hand, there is significant post-operative pain after a spinal fusion and patients typically return to work in about 2-3 months.