Nonsurgical Treatments
The vast majority of spine problems will not require an operation. For nearly all conditions, the risks of nonsurgical treatment are significantly less than having an operation. It is important to have a detailed discussion with your provider about any nonsurgical treatments that may provide a similar benefit to surgery.
Living a Healthy Lifestyle
In addition to providing relief from your symptoms, living a healthy lifestyle is an important part of whole body wellness. It is important to maintain a healthy body weight. Unnecessary weight causes undue stress on the spine and other joints. Having excess weight in front of the body means that the spine needs to work harder to maintain upright posture.
Physical Therapy
Bedrest has a limited role in the nonsurgical treatment of neck and back pain for most conditions. Limiting one's activity may actually be counterproductive to recovery. Physical therapy is beneficial for surgical and nonsurgical patients to decrease pain and restore function. Your physical therapy team will consist of a physical therapist, physical therapist assistant, and physical technician. Patients will learn how to increase strength and flexibility to restore their prior level of activity. Your physical therapy treatments may include therapeutic exercise, manual techniques, and various modalities to help reduce pain and inflammation. Physical therapy strengthens the muscles surrounding the spine and can increase flexibility. Most patients will receive a thorough home program to continue strengthening. A home therapy program, combined with a stronger, more flexible back can prevent future strain and decrease the chance of future injury.
Medication
Over-the-counter pain medication may be very effective for chronic pain conditions. However, it is important to understand the risks of any medication you are taking, especially long-term. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen or naproxen reduce swelling and inflammation of muscle strains and mild to moderate spinal arthritis. For patients without gastrointestinal problems, up to 3200mg of ibuprofen (Advil, Motrin) or 1500mg of naproxen (Aleve) may be used under a doctor's supervision. For patients who cannot tolerate NSAIDs, acetaminophen (Tylenol) may be equally as effective.
Dr. Bjerke does not recommend the use of long-term narcotic pain medication for treatment of chronic spine problems. For chronic pain conditions requiring narcotic pain medicine, he recommends supervision by a pain management specialist.
Spinal Injections
Spinal injections or nerve blocks may be used in the neck or back to both treat, and to help diagnose the cause of a patient's symptoms. In addition to providing relief, they also provide useful information for your provider to pinpoint the cause of symptoms. If you have an injection, it is important to document how the injection affected your symptoms.
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Epidural injection: This is also known as an "interlaminar epidural steroid injection." During this procedure, a needle is placed into the spinal canal under "fluoroscopic" guidance, using an x-ray machine. A small amount of sterile "dye" is placed into the spinal canal, so that the provider knows exactly where to inject. A small amount of steroid and/or local anesthetic is then injected into the spinal canal, bathing the nerves and providing pain relief. This is similar to an "epidural" done for pregnant women giving labor, except that a catheter tube is not left in place.
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Selective nerve block: This procedure is also known as a "transforaminal epidural steroid injection," or abbreviated "TFESI." Unlike an interlaminar injection, a TFESI is performed from one side of the spine. Following confirmation with sterile "dye," steroid and/or local anesthetic are injected directly over a specific nerve root on one or both sides of the spine.
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It is important to discuss all risks, benefits, and alternatives of any procedure with your provider before undergoing treatment. The risks of these injections are all quite rare, but may include:
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Infection
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Nerve damage
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"Spinal headache" or "Spinal fluid leak"
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A rise in blood glucose levels
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Worsening of leg or arm pain
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Failure to relieve symptoms
Some spine surgeons may also perform spinal injections. Dr. Bjerke has trained in this area and understands the role and importance of spinal injections very well. However, he works closely with pain specialists and interventional radiologists who have performed thousands of these procedures, with much greater proficiency and effectiveness. For this reason, Dr. Bjerke does not offer to perform spinal injections and recommends that these should only be administered by specialists who perform a large number of injections per year. He works with spinal injection specialists regularly and will gladly recommend one who is an expert at the type of injection each patient needs.