An estimated eight of ten adults will experience back or neck pain at some time in their life. As people age, they are more likely to develop debilitating pain from spinal injury or degenerative change. The magnitude and impact of this problem is continuing to rise as the baby-boom generation matures. The past decade has witnessed rapid advancement in both diagnostic and treatment options with nonoperative treatments becoming more effective and surgery becoming less invasive and more predictable.
The Spine Program at Scripps Memorial Hospital Encinitas provides the latest diagnostic technology and treatment options for spinal disorders. The surgeons are also participating in several Food and Drug Administration (FDA)-approved clinical trials that include the ProDisc® total disk replacement, a new investigational drug, Chrysalin®, and Cortoss® vertebroplasty.
The surgical team is headed by spine surgeons Raymond Linovitz, MD; Timothy Peppers, MD; and Erik Westerlund, MD, and has integral support from a multidisciplinary team of pain management physicians, operating room personnel, physical therapists and others. “This team is a rare, closely integrated group of professionals who are successfully working to set the national standard for excellence in spine surgery,” Dr. Westerlund says.
The Spine Program surgeons pursue nonoperative treatment whenever possible for their patients with back or neck disorders. “In the case of a lumbar disk herniation, most patients will be successfully treated with a carefully directed nonoperative course – only if conservative measures fail should a patient and surgeon consider surgical options,” says Dr. Linovitz.
When meeting a patient for the first time, the spine surgeons at Scripps Encinitas thoroughly review and discuss the history of the problem with the patient, perform a comprehensive physical examination, and determine whether further diagnostic tests are required. “Advanced imaging techniques, such as MRI, have significantly improved our ability to identify and treat specific spinal disorders, though these studies do not replace a detailed history and physical examination,” Dr. Westerlund notes.
Nonoperative treatments will oftentimes include physical therapy, activity modification, and non-steroidal anti-inflammatory medications. Certain therapies, such as VAX-D® treatment or therapeutic and diagnostic injections, may also be recommended. The injections are generally performed on an outpatient basis by pain management specialists.
“While outcomes may vary from patient to patient, most patients with back pain will respond very well to a nonoperative approach,” says Dr. Peppers. “They eventually are able to return to their normal daily routine with little or no discomfort.”
Some patients do ultimately require surgery as a means of definitive treatment. “That’s when the skill of a cohesive, dedicated surgical team can really make the difference,” says Dr. Westerlund. “Having three fellowship-trained spine specialists working together affords distinct advantages that distinguish Scripps Encinitas from other medical facilities in San Diego.”
Endoscopic, thoracoscopic and other minimally invasive techniques are becoming more routinely available to accelerate the recovery process and return to normal function. Recalcitrant osteoporotic vertebral compression fractures, for example, may be amenable to treatment with either vertebroplasty or kyphoplasty. With a vertebroplasty, the surgeon injects a cement material to immediately stabilize the bone fracture. Kyphoplasty includes an additional step. Prior to injecting the cement-like material, a special balloon is inserted and gently inflated inside the fractured vertebrae.
“Kyphoplasty uses an inflatable balloon as a tamp to restore vertebral bone alignment and height in cases of severe fracture collapse; once alignment is restored, cement may be injected in a manner similar to vertebroplasty,” Dr. Westerlund explains. He adds, “Our program is presently investigating the merits of a bone cement with characteristics designed specifically for vertebroplasty. This keeps us at the forefront of improving patient safety and outcomes with these procedures.”
The IDET (intradiscal electrothermal annuloplasty) procedure is also being used with success in carefully selected patients with low back pain. In the procedure, an electrothermal catheter is inserted into a damaged disc and heated. The heat contracts and thickens the collagen fibers that make up the disk wall, which can sometimes promote the closure of tears and cracks.
Some patients may require a spinal fusion as part of their treatment. This operation is typically performed to stabilize the spine or to correct spinal malignment or deformity. Titanium implants (such as pedicle screw and rod constructs) are often required to establish immediate spinal stability.
Nonfusion technology, such as the total disk replacement, is an area of particular recent interest. “This procedure may eliminate the need for a spinal fusion in some patients, and maintain more normal overall spine mechanics – FDA studies remain underway, though our initial results are very promising,” says Dr. Linovitz.
To find an orthopedic specialist call 1-800-SCRIPPS.