Wednesday, March 9, 2011

"I Don't Want Spine Surgery"

This is one of the most common 'chief complaints' I hear from patients with back pain. Often they have seen several doctors and lumbar fusion has been recommended.

Often, lumbar fusion surgery is contemplated in patients who have spinal stenosis with 'neurogenic claudication'. This occurs when you have pain that is worse with standing and/or walking and relieved by sitting. Fortunately, in cases like this, then the Vertos MILD (minimally invasive lumbar decompression)procedure is usually helpful.

With MILD ~70% patients have complete or significant pain relief. Although not perfect, it is about a 2/3 response rate, better than most things in modern medicine. Better yet, if it doesn't work, there are no implants and it doesn't preclude you from having something else done if you're in that unlucky 1/3. Here are the main advantages of this procedure over a fusion:

outpatient procedure - go home after 1-2 hours.
procedure time only 1, maybe 2 hours
light sedation (rather than anesthesia)
return to usual activities next day (as opposed to months)
no surgical incision - done through a needle hole about the size of a pencil
no implants
does not affect spine stability
I've yet to have a patient who was WORSE after the MILD procedure
you can always have a fusion after a MILD if it is really needed
no blood transfusions or dural tears reported to date in the US (vs. ~10% in open surgery)

In addition, the MILD procedure can provide relief in patients who are 'poor surgical candidates' for spine surgery, such as the elderly, those with heart disease or other medical conditions.

The other option to think about if your pain is mainly in your lower back and not into your legs is a facet block--works well typically for lower back pain that doesn't radiate.

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