One of the most frustrating things to live with is chronic back pain. Besides the discomfort, it can be challenging to diagnose and treat. And even with treatment, it can be a tricky process to recover full function.
One of the difficulties in dealing with back pain is that the back is made up of numerous structures, any of which might be contributing to the discomfort. Often the source of the problem lies in or around the spine, or backbone, which runs up and down the center of the back. The spine is made of a column of bones called vertebrae.
Each vertebra has a hole in the center. Through this central space run the spinal cord and nerve roots, which carries nerve signals to and from the brain. Nerves exit the spinal cord between the vertebrae, carrying information to and from the body.
However, bones and nerves aren’t the only players where the spine is concerned. Contributing to the function of the spine, as well as to any problems it may have, are muscles, ligaments, discs and joints. These supporting structures need to be intact and functioning well for a healthy back.
The roles of the structures in and near the spine are appreciated by doctors who treat back pain. One such doctor is Columbia University Medical Center/NewYork-Presbyterian Hospital neurosurgeon Dr. Alfred T. Ogden.
As the director of Columbia’s program in minimally invasive spine surgery, Dr. Ogden is a nationally recognized leader in the treatment of spinal disorders. He recently lent his expertise to an article in the journal Clinical Spine Surgery.
The article deals with a particular type of back problem known as lumbar spinal stenosis. In this condition, the central spaces in the middle of the vertebrae in the lower spine are narrowed. This can happen for several reasons, although it most commonly happens in older people due to degenerative arthritis.
The narrowing of the central space can put pressure on the spinal nerve roots. It can also affect the nerves exiting the spinal column and running to the body.
When the nerves are affected, there can be many symptoms, including muscle pain, weakness and numbness. Sometimes the nerves running to the bladder and bowel are affected, leading to difficulties with control.
How is this debilitating condition treated? Nonoperative treatments are tried first: medications to relieve pain and inflammation, physical therapy and weight control are all commonly used options.
When nonoperative treatments aren’t solving the problems brought on by the stenosis, surgery may provide relief. The surgery, known generally as laminectomy, involves removing a piece of bone from a vertebra. This relieves symptoms by easing pressure on the nerves running through, into and out of the spine.
Different types of laminectomy are performed for this condition, and the article by Dr. Ogden and his colleagues* focuses on comparing them.
Traditionally, spinal surgeons would perform a procedure known as “open lumbar decompression.” In this procedure, the surgeon would first need to move out of the way the muscles, known as paraspinal muscles, that cover the bones of the spine. The surgeon would then be able to access the vertebrae.
In order to have full access to the spine, sometimes a piece of muscle would have to be removed permanently. Unfortunately, this can sometimes affect the nerves and blood vessels around the muscles, leading to atrophy, or loss of muscle. This can cause weakness and pain in the back.
An alternative option to open lumbar decompression is minimally-invasive decompression of stenosis, or MDS. This newer procedure involves using a smaller incision. Small tubes are then used to create a slight separation of the muscles. Once this has been achieved, the surgeon uses a tube with a microscope or camera known as an endoscope to visualize and remove a small piece of bone and ligament.
The authors compared open lumbar decompression and MEDS by using magnetic resonance imaging (MRI) to measure the amount of muscle in the problem area before surgery. They measured again between six and 30 months after surgery.
When they looked at the patients who underwent open decompression, the researchers discovered muscle loss averaging 5.5 percent after surgery. In the MEDS patients, however, muscle mass actually increased 9.9 percent.
The study by Dr. Ogden and his colleagues indicates that when it comes to spinal stenosis, less invasive surgery can mean less post-operative loss of muscle. And more muscle means better function and less pain.
*Full list of authors: Lacey E. Bresnahan, Ph.D., Justin S. Smith, M.D., Ph.D., Alfred T. Ogden, M.D., Ph.D., Steven Quinn, B.A., M.D., George R. Cybulski, M.D., Narina Simonian, B.S., Raghu N. Natarajan, Ph.D., Richard D. Fessler, B.A., Ph.D., Richard G. Fessler, M.D., Ph.D.