Osteoarthritis is a gradual deterioration of the spinal column that occurs in everybody by the time they are 50 years of age. Fortunately, the majority of the people are not symptomatic from the arthritis. In contrast, however, for reasons we do not yet know, some patients may suffer severely. The deterioration causes a low-grade inflammation in the joints of the spinal column.
Each joint is composed of two surfaces of cartilage that are normally very smooth and lubricated by joint fluid. Normal joints move smoothly, similar to two pieces of glass with a little bit of water in between them. Gradual calcium build-up gets deposited into the soft tissue around the joints causing inflammation and the soft tissues to become very hard. This hardening is called spur formation because a small mound of bone develops. The spinal joint is very close to the nerve and is susceptible to this bony spur putting pressure on the nerve, causing significant pain in association with the arthritis.
Diagnosis
Patients with spur disease of the spine will have symptoms related to their arthritis such as pain in the neck or low back as well as pain secondary to nerve root irritation where the spinal cord starts to branch out. This will usually cause radiating pain down the arm or leg. A simple spine X-ray is usually adequate for diagnosis of spinal spurs. Spurs that are just forming can sometimes be diagnosed earlier with a CAT scan.
Treatment
There are essentially five treatment strategies for nerve irritation secondary to spurs.
Medications. A combination of anti-inflammatory drugs and mild narcotics can be used to reduce pain.
Physical therapy. Sometimes patients with spurs may benefit from mild traction, which reduces pressure on the nerve. In addition, keeping the joint from moving with a soft collar can help.
Epidural injection. During an epidural injection, medications are placed close to the nerve to relieve the inflammation associated with the arthritis. These injections consist of anti-inflammatory cortisone type steroids. They are usually given as a series of two to four injections over a period of weeks. Relief will usually begin within 72 hours and can last for many months.
Surgery. During surgery the spur is removed, relieving the pressure on the nerve. Unfortunately, the tendency to form arthritis still remains. The spur can regrow and pain may recur.
Transcutaneous electrical nerve stimulator, also known as a TENS unit. This device is worn externally and delivers a mild electrical stimulation over the nerve, interfering with the conduction of pain. While the TENS unit does not change the underlying condition, it can definitely reduce symptoms while it is being worn.
The Priority Health Spine Centers of Excellence program was created to ensure that all patients with persistent neck pain, back pain or other spine-related problems receive a comprehensive, non-surgical medical evaluation for their condition. For patients whose condition does not require urgent or emergent surgical intervention, an evaluation by a certified Priority Health Spine Center of Excellence is required prior to any referral to an orthopedic or neurosurgeon for back or neck care.
Tri-County Pain Consultants, PC is honored to be recognized by Priority Health as a Spine Center of Excellence for West Michigan. Our team of pain management specialists have a proven track record providing high quality medical care that meets and exceeds the strict criteria required by Priority Health for a Spine Center of Excellence designation.
Acupuncture
Acupuncture is the practice of using small needles inserted at very precise points on the body to promote natural healing and improve functioning. Acupuncture stimulates nerves, muscles and connective tissues, prompting increased blood flow to injured areas of the body, boosting the body’s natural healing process. Acupuncture provides a low risk treatment option that can be beneficial for pain syndromes due to an injury or associated with chronic degenerative diseases.
Cryoablation
Cryoablation is a procedure done in office that utilizes a specially equipped needle guided under fluoroscopy to freeze the area surrounding a nerve that is causing pain or discomfort. The goal of cryoablation is to interrupt the nerve’s ability to send pain signals to the brain and provide pain relief.
Discography
A discography is a diagnostic tool your pain management specialist may use to help determine the disc or discs that are the source of your pain. For this procedure, a contrast dye is injected into the gel like center of the suspected disc or discs, allowing your pain physician to see cracks or leaks in the disc membrane. Typically a patient receiving a discography will be given a local anesthetic or numbing agent. All discographies are performed by a certified pain management specialists under fluoroscopy.
IDET
IDET, or Intradiscal Electrothermal Therapy, is a procedure used to treat discogenic back pain. IDET involves the use a heated probe inserted into the gel like disc which heats up the inside of the affected disc. Heating the inside of the disc can destroy pain causing nerve fibers and seals any cracks or holes in the disc.
Intrathecal Pump Therapy
An intrathecal pump is an implanted medical device that delivers pain medication directly to the intrathecal space surrounding the spinal cord. An intrathecal pump is indicated in cases where patients have difficulty with oral medications or where previous pain interventions have been ineffective.
Kyphoplasty
Kyphoplasty is a procedure designed to help relieve pain caused by compression fractures of the spine. During a kyphoplasty procedure, a small tube is inserted into the fractured area. Once the tube is in place, the physician inflates a small balloon within the fractured area to raise the area, returning the broken pieces to a more normal position. The balloon is then deflated and the space is filled with a bone cement, effectively stabilizing the fractured area.
Manual Therapy
Manual therapy, or manipulative therapy, is a direct contact physical treatment used primarily to treat musculoskeletal pain and disability, intended to restore joint or soft tissue mobility. Treatment may include joint mobilization and manipulation, muscle stretching, and resistance therapy to advance muscle timing and activation.
Medication Management
Mecication Management is medical care provided by your pain management physician to optimize the use of prescribed medication to improve therapeutic outcomes for patients.
Nerve Block Technique
A procedure in which an anesthetic agent is injected directly near a nerve to block pain. A nerve block is a form of regional anesthesia.
Occupational Therapy
Occupational therapy is a task orientated treatment program designed to help patients regain their ability to perform daily living and work activities after serious illness injury or disability. Therapy focuses on the facilitation of daily tasks of self-care, work, and play/leisure activities, to help patients regain the ability to perform daily living and work activities.
Radiofrequency Lesioning
Radiofrequency lesioning is an advanced procedure using a specialized machine to interrupt nerve conduction on a semi-permanent basis. The nerves are usually blocked for 6–9 months. The procedure is typically most effective in treating joint pain in the spine.
Spinal Cord Stimulation
A spinal cord stimulator is a small electrical device implanted just under the skin in the lower back that delivers low level electrical signals to tiny electrodes implanted in the epidural space of your spine. These electrical pulses interrupt the pain signal from reaching your brain, replacing them with a mild tingling in the area where pain is felt. The device is controlled through a magnetic remote control, which allows patients the ability to turn the device on or off, and adjust the intensity as needed.
Stress Management
Stress management is clinical therapy designed to help individuals cope with or lessen the physical and emotional effects of strain and anxiety. Stress-management may include relaxation techniques, time-management skills, counseling or group therapy, exercise, and maintaining an overall healthy lifestyle.
