Healthbeat

Beating back pain

Friday, December 09, 2011

Surgery for most people is a last resort, but new minimally invasive fixes are giving patients faster recovery with less pain and scarring.

Less invasive spine surgery, especially for damaged discs in the lower back, is becoming more common.

The definition of what this is, exactly, remains elusive, and there are few well-conducted studies to prove if one type is better than another. Specialists are taking steps to help clear up the confusion.

Whether it is a dull ache or a stabbing pain, it is estimated eight out of ten people will suffer from back trouble at some point.

In many cases conservative treatments such as over the counter pain relievers, massage or physical therapy will do the trick.

When it comes to the common problem of herniated discs, a small percentage of people may need a surgical fix. Craig O'Brien says he is one of them.

"My back was killing me," says O'Brien.

O'Brien says for the past 20 years he tried everything and was scared to even consider surgery, but the pain in his back and leg was getting worse. A bulging or herniated disc was the problem.

He finally found a surgeon at Swedish Covenant Hospital he was comfortable with and a minimally-invasive procedure that seemed to make sense.

"Minimally invasive overall is not bothering the structure of the body and the most important structure to the spine is the muscle," said Dr. Daniel Laich, neurosurgeon at Swedish Covenant Hospital.

Laich does what he calls a newer, more gentle endoscopic procedure that is done while the patient lies on their side. It is a type of microdiscectomy. Using very narrow tools and a camera, he goes in through a tiny opening about the size of a pen, slowly dilating the area so he can get to and fix the disc that's causing the pain.

He says it is not just the tiny incision that makes this minimally invasive; it is getting to the problem without disrupting important back muscles.

"I go around the muscle the same pathway the nerve comes out, but I only attack the problem - I still attack the disc herniation," said Laich.

While theoretically it seems reasonable, some doctors say there is not enough data showing sparing the muscles helps with anything.

In the short term, less invasive surgeries do seem to offer a rapid recovery and a faster return to normal activities, but with these evolving technologies, there is some degree of uncertainty. Compared to more traditional surgeries, critics say the long-term success is not well established.

"Companies have seized on the word minimally invasive and it's just a marketing tool vs. actual new product or new technology," said Dr. Harel Deutsch, neurosurgeon at Rush University Medical Center.

Deutsch says minimally invasive approaches play an important role, but he warns patients to spend more time finding a surgeon they trust, not the latest procedure.

"A lot of products out there, they're minimally invasive, but they are also minimally effective," said

A new registry organized by the society for minimally-invasive spine surgery aims to reveal what is safe and effective and put the debate to rest.

"That registry is to say, let's really prove definitely that minimally-invasive spine surgery does work, because the naysayers are on both sides," said Laich.

O'Brien was glad he finally got the surgery and says it has been months and he is still pain-free. He was even able to mow his lawn this past fall.

"I never realized what is normal, and then there is no pain anymore, which is fantastic," said O'Brien.

The Chicago Back Institute at Swedish Covenant is one of the five initial sites that will be collecting patient data for the new registry.

Again, most patients are advised to try all non-surgical treatment before opting for surgery. If surgery is necessary, patients are encouraged to ask doctors how long they have been performing a certain technique and how many people they have treated.

Swedish Covenant Hospital/Chicago Back Institute
(773) 271-BACK (2225)
http://www.ChicagoBackInstitute.org

SMISS
Society for Minimally Invasive Spine Surgery
http://www.smiss.org/smiss-registry.php

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