Spondylitis includes swelling of the vertebra. It happens because of wear and tear of the ligament and bones found in your cervical spine, which is in your neck. While it is to a great extent because of age, it can be brought on by other reasons too. Side effects incorporate pain and stiffness starting from the neck to the lower back. The spine's bones (vertebrae) get fused, bringing about an unbending spine. These changes might be mellow or extreme, and may prompt a stooped-over posture. Some of the non-surgical methods to treat spondylitis are as follows-
ONCE THE CONSERVATIVE TREATMENT FAILS:
Early aggressive treatment plan of back & leg pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only approx 5% of total LBP patients would need surgery & approx 20% of discal rupture or herniation with Neurologically impending damage like cauda equina syndrome would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then. Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon patient`s pathology & response to treatment. Using precision diagnostic & therapeutic blocks in chronic LBP , isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5-S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed.
NEED FOR NON-SURGICAL OPTIONS: Outcome studies of lumber disc surgeries documents, a success rate between 49% to 95% and re-operation after lumber disc surgeries ranging from 4% to 15%, have been noted. “In case of surgery, the chance of recurrence of pain is nearly 15%. In FBSS or failed back surgery the subsequent open surgeries are unlikely to succeed. Reasons for the failures of conventional surgeries are:
EPIDURAL ADENOLYSIS OR PERCUTANEOUS DECOMPRESSIVE NEUROPLASTY is done for epidural fibrosis or adhesions in failed back surgery syndromes (FBSS). A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with EPIDUROSCOPE Sciatica gets complicated by PIVD with disco-radicular conflict causing radicular pain sometimes disabling. In this era of minimally invasive surgery lot many interventional techniques have evolved to address the disc pathology. We are still working for the ideal, safe & effective technique to tackle disco- radicular interphase. Here now we have devised a mechanical neuroplasty or foraminoplasty technique using an inflatable balloon tip catheter with guide wire via targeted transforaminal or interlaminar route aided by drugs instillation. Selected patients are procedured fluoroscopic guided with local anesthesia under prescribed sedation aseptically via preselected route depending upon location & type of PIVD causing root insult. First a suitable size needle is placed at desired site confirming with radiolucent dye through which hyaluronidase with saline or LA was injected. A flexible guide wire is passed at selected location & direction on which the inflatable balloon is threaded to the area of interest.
Adhesiolysis is achieved mechanically with inflating balloon for 10 seconds at a time & location. We inflated the balloon with contrast agent to have visualization of adhesiolysis & opening up of adhesions or root route. Here the balloon pressure & time has to be kept in minimum to avoid neurological damage, for which we inflate balloon for 10 seconds at a time. Close observation is made to balloon shape, pressure & patient`s response. Once dilatation is done the drug mixture of steroid with LA & or hynidase/ hypertonic saline is instilled over nerve in epidural space. We have logically used same approach for our Balloon Neuroplasty & foraminoplasty as it is safe & targets exactly the area of disco-radicular interphase or conflict. We can manage to address both the exiting and traversing nerve roots with single entry just by manipulating our guide wire to the place of offence. The procedure can be done via transforaminal route at level or level above or below, especially via S1 foramen. Now we are employing this technique for fresh cases coupling with Intradiscal decompression aided by instant disc retrieval by epidural balloon inflation with good results. The IDD is done by Coblation/ Laser/ DeKompressor or RF Biacuplasty. There is scope of coupling this technique with endoscopic spine surgery. By adding “Balloon Neuroplasty” to the armamentarium of the interventional pain management many patients can be benefited & relieved of previously interventionally unmanageable disco-radicular pain including FBSS sufferers.
PROVOCATIVE DISCOGRAPHY: coupled with CT A diagnostic procedure & prognostic indicator for surgical outcome is necessary in the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines.
PERCUTANEOUS DISC DECOMPRESSION (PDD): After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed.
OZONE-CHEMONEUCLEOPLASTY: Ozone Discectomy a least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a day care setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. Total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no post operative discomfort or morbidity and low cost. If despite the ozone therapy the symptoms persist, Percutaneous intradiscal decompression can be done via Transforaminal route with Drill Discectomy/ Laser or Coblation Nucleoplasty/ Biacuplasty/ Disc-FX / Endoscopic Discectomy are good alternatives before opting for open surgerical Discectomy; which has to be contemplated in those true emergencies, as mentioned above as the first choice. In Biacuplasty radiofrequency energy is used in bipolar manner heating & shrinking the disc & making it harder as well for weight bearing. It also seals the annular defect & ablates annular nerves relieving back pain. In Laser or Coblation Nucleoplasty energy is used to evaporate the disc thereby debulking it to create space for disc to remodel itself assisted by exercises.
DEKOMPRESSOR: A mechanical percutaneous nucleotome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression. A mechanical device cuts & drills out the disc material debulking the disc reducing nerve compression curing Sciatica & Brachialgia. It comes in needle size of 17G for lumbar discs & 19 G for cervical discs. In lumbar region postero-lateral approach is used & in cervical discs anterolateral approach is used.
DISC-FX & ENDOSCOPIC DISCECTOMY: In this novel technique A wide bore needle is inserted & placed sub-annular in post disc just under the disc protrusion. Disc is then mechanically extracted with biopsy forceps to empty the annular defect. This painful & sensitive annular defect supplied be sinuvertebral nerve is thermo-ablated with radiofrequency which also seals the defect to prevent & decrease recurrences. Next Higher procedure, Endoscopic Discectomy is done with endoscope put through sheath inserted via posterolateral transforaminal or posterior interlaminar approach. Mostly done under local anaesthesia its fast becoming standard of care for disc protrusion & extrusions causing spinal canal stenosis with root or cord compression with leg pain.
LASER DISCECTOMY done for closed bulging discs is an outpatient procedure with one-step insertion of a needle into the disc space. Disc material is not removed; instead, nucleus pulposus is debulked by evaporating it by the laser energy. Laser discectomy is minimally invasive, cost-effective, and free of postoperative pain syndromes, and it is starting to be more widely used at various centers.
SELD: Epiduroscopic laser neural decompression is considered an effective treatment alternative for chronic refractory low back and/or lower extremity pain, including lumbar disc herniation, lumbar spinal stenosis, failed back surgery syndrome with morbid adhesion neuritis that cannot be alleviated with existing noninvasive conservative treatment. This Procedure is done under vision via an epiduroscope inserted via Caudal canal or Transforaminally employing front or side firing Laser fibers &/or fine instruments. If you wish to discuss about any specific problem, you can consult a Pain Management Specialist.