Back pain is one of the most common reasons people go to the doctor or miss work, and most people have back pain at least once in their lifetime. At MedStar St. Mary's Hospital, our goal is to relieve your back pain and restore your ability to enjoy your favorite activities. Our back and spine specialists have extensive experience diagnosing and treating nearly every type of back and spine injury and condition, from the most common to those that are extremely rare.
One of the best ways to ensure you get the most successful back and spine treatment is to describe your pain accurately and in detail—where it is, when it starts and what helps to relieve it. This way, our back and spine specialists can understand what you are dealing with. Consider the following questions when thinking about describing your pain to your specialist:
- When does the pain happen?
- How long does it last? Does the pain come and go? Or is it there all the time?
- Is this pain new? Have you ever had this pain before?
- Does it hurt in more than one place?
- Does it feel like it's on the inside or on the outside of your body?
- Does the pain keep you from doing certain things?
- Does pain interrupt your sleep? Does it change your mood? Affect your appetite?
- What makes the pain better? What makes it worse? What have you tried to relieve the pain?
Once you have been examined by one of our specialists, they will work as a multidisciplinary team with specialists from other disciplines to determine the best possible treatment options for you. Your specialist will also work with you and your family, teaching you about your condition and answering any questions, so that you can help to determine which treatment option is most appropriate for your needs. Whenever possible, our specialists recommend non-surgical treatments, such as physical therapy and medication, before recommending surgery.
Non-Surgical Back and Spine Treatments
Different kinds of pain respond to different kinds of treatment, and your specialist will help to determine what non-surgical treatment options are right for you. Some of the treatments we offer include the following:
- Epidural steroid injections are anti-inflammatory and anesthetic medications injected into your spinal canal. They're used to decrease swelling and the pain associated with it. This procedure may be appropriate if you suffer from herniated/bulging or degenerated discs.
- Epidural lysis of adhesions are injections of medication at an affected nerve root to dissipate scar tissue and help decrease chronic low back pain.
- Facet joint blocks are anti-inflammatory and anesthetic medications injected into a facet joint, which is located on the back of the spine where the vertebrae overlap and help guide the movement of the spine. Patients with degenerative disc disease and increased weight and pressure on the joint will benefit from the procedure.
- Nerve root blocks are injections to relieve pain in the nerves that are directly off the spinal cord. The nerve that's causing the pain is pinpointed and blocked.
- Radio frequency ablation heats a nerve to eliminate its function, thereby eliminating the pain triggered by that nerve.
- Sacroiliac joint injections reduce inflammation and discomfort in the hip joint.
- Intradiscal electrothermal therapy heats a needle inserted into a painful disk to eliminate the pain receptors there. This procedure can help patients with chronic disc pain who wish to avoid surgery or patients whose previous surgery has been unsuccessful.
Back and Spine Surgery
When non-surgical back and spine treatments are unsuccessful, or if your injury or condition is too advanced for non-surgical treatment, you may need surgery. The back and spine surgery specialists at MedStar St. Mary's and the MedStar Orthopaedic Institute will work together with our multidisciplinary teams of specialists, including neurosurgeons, physiatrists, rheumatologists, orthopedic surgeons, and physical and occupational therapists, as well as with you, to determine what surgical option will deliver the best possible outcome.
Microscopic and Minimally Invasive Spine Surgery
During minimally invasive procedures, your surgeon uses specialized instruments to access your spine through small incisions, and you can often return home the same day. Compared to traditional back surgery, minimally invasive surgery provides less muscle injury, smaller incisions, less bleeding, and shorter recovery time.
We also offer microscopic surgery, which combines minimally invasive techniques with highly sensitive, cutting-edge surgical microscopes to access even the most delicate areas with precision.
Kyphoplasty and Vertebroplasty
Kyphoplasty and vertebroplasty are minimally invasive spine surgery procedures used to relieve the pain from a vertebral fracture, especially if it does not improve over a number of weeks with pain medication and treatment with a brace. Both vertebroplasty and kyphoplasty procedures involve placing cement into the fractured vertebra through small incisions in the skin under X-ray guidance.
Kyphoplasty can also be very helpful when there is severe collapse of your broken vertebra or wedging. By correcting the wedging, kyphoplasty may help restore the spine to a more normal alignment and prevent severe kyphotic (hunchback) deformity to the spine. If you have had multiple fractures with previous wedging, kyphoplasty can prevent further worsening of the deformity.
- A special bone cement is injected under pressure directly into your fractured vertebra.
- Once in position, the cement hardens in about 10 minutes, solidifying the fragments of your fractured vertebra and providing immediate stability.
- A balloon catheter is guided into your vertebra and inflated with a liquid under pressure.
- As the balloon inflates, it can restore the collapse in your vertebra and correct abnormal wedging of the broken vertebra.
- Once the balloon is fully inflated, it is deflated and removed, and the large cavity created is filled with a special bone cement.
- The cement then hardens in place, maintaining any correction of collapse and wedging.
The purpose of spinal fusion surgery is to join (fuse) two or more vertebrae in your lower back. It was first used to treat fractures, but it is now also used as a follow-up after surgery to treat problems such as herniated discs, spinal stenosis, tumors, infection, and injuries. Our physicians use two methods to perform spinal fusion surgery, and they will determine which method is most appropriate for you. These methods are as follows:
- Your surgeon removes part of your pelvic bone or gets bone from a bone bank and then uses the bone to form a bridge between your vertebrae. This bridge will help new bone to grow.
- Your surgeon uses metal implants to hold your vertebrae together until new bone forms between them.
You may need to wear a back brace following spinal fusion surgery, and your physician will work with you to determine the proper rehabilitation plan for you.
Motion-Sparing Spinal Surgery
Traditional spinal fusion surgery merges your vertebrae, which relieves pain and pressure but also restricts your movement. Motion-sparing spinal surgery relieves pressure on your spinal cord while preserving your range of motion. Motion-sparing techniques can be used in cervical artificial disk replacement and laminoplasty (removing spinal cord pressure from cervical spine stenosis).
Used to treat severe cases of spinal stenosis that haven’t responded to non-surgical treatments, decompressive laminectomy helps to relieve pressure on the spinal nerve roots that cause lower back pain. Sometimes performed in combination with spinal fusion, decompressive laminectomy can also help to treat herniated discs, spine injuries or tumors.
During the surgical procedure, your surgeon removes bone (part of your vertebrae) and/or thickened tissue that is narrowing your spinal canal and, therefore, compressing your spinal nerve roots. This procedure may help to relieve your lower back pain right away.
Following the surgery, your physician will develop a rehabilitation plan that will get you back on your feet as quickly and safely as possible.
Spinal Deformity Surgery
If you or your child suffers from a spinal deformity, such as scoliosis or kyphosis, our spine surgeons will work to correct the problem with braces and other non-surgical approaches. In most cases, we try not to treat scoliosis and other spinal deformities with surgery, but if more conservative treatments do not improve the deformity, surgery may be the best option.
The goal of surgery to treat spinal deformities is to straighten the spine and/or release the pressure on spinal nerves. This often requires uniting the vertebrae using special implants to keep the spine together. The most common surgeries for spinal deformity are as follows:
- Surgery from the back: You surgeon makes an incision and strips the muscles off your spine to reach the bone. The surgeon then inserts screws and rods into your spine to reduce the curvature and adds bone (from your hip or a cadaver) to start the bones of the spine fusing together. The fusion process takes approximately three to six months and can continue up to 12 months.
- Surgery from the front: Your surgeon makes an incision and removes a rib (usually on the left side). The surgeon then releases your diaphragm from your chest wall and spine, exposing your spinal vertebrae. Discs are removed to loosen your spine, and the screws and rods are put in place to reduce the curvature or your spine. Your surgeon adds bone (from your hip or a cadaver) to start the bones of the spine fusing together. The fusion process takes approximately three to six months and can continue up to 12 months.
You will need to remain in the hospital for about four to seven days, and young patients can return to school two to four weeks after surgery. Activity will need to be limited until the spine is finished fusing, about 6 to 12 months after surgery.
The unique spine care program at MedStar St. Mary's through the MedStar Orthopaedic Institute features talented physical therapists working closely with both their patients and a multidisciplinary team of physicians to obtain the best outcome for conservative treatment. Our therapists are continually enhancing their knowledge with up-to-date techniques regarding back and spine care, and they offer the following services:
- Back School: This rehabilitation program is in a group setting and is designed to educate patients to take control of their back pain.
- Aquatic Therapy: Your therapist uses water and heat to decrease pain and swelling and increase movement. The pool is heated and handicapped accessible.
- Manual Therapy: Our therapists have taken many additional courses to provide highly skilled services using their hands. This may include massage, mobilization of joints and more.
- Exercise: Your therapist works with you to develop an individualized exercise program to stretch or strengthen appropriate muscles. Emphasis is placed on you continuing these exercises at home.
- Arthritis Foundation Exercise Program: This is a six-week program where you can exercise in a group setting specially designed for people with arthritis. Our therapists have been trained by the Arthritis Foundation to teach this course.