The Spine Center at North Shore-LIJ Health System's Cushing Neuroscience Institute provides patients with an individualized comprehensive evaluation and spinal treatment plan, prepared by the institute's expertly trained clinicians.
Specific spinal treatment will be determined by your physician based on:
- Your age, overall health and medical history
- Extent of the condition
- Your tolerance for specific medications, procedures or therapies
- Expectations for the course of the condition
- Your opinion or preference
Spinal treatment may include:
- Activity modification
- Physical rehabilitation and/or therapy
- Occupational therapy
- Weight loss (if overweight)
- Prevention program (as directed by your physician)
- Pain management and injections
- Assistive devices, such as mechanical back supports
Pain Management Procedures used in the Spine Center
- Baclofen Pumps
Baclofen pumps are used to relieve both severe pain and muscle spasms by implanting a small pump and medicine-filled reservoir in the body. A thin tube, or catheter, goes from the pain pump to the spine where the medication is released into the fluid surrounding the spinal cord.
A technique that relieves pain by using cold to destroy nerve tissue
Discography uses a tiny scope to look at spinal damage, then annuloplasty uses a needle to produce heat and destroy disc defects that cause pain.
Using a special, small endoscope, the pain specialist can enter the spinal canal to remove scar tissue and take painful pressure off nerves.
- Epidural injections are a way of treating back pain caused by a herniated disk or pinched nerve. An anti-inflammatory medication, such as cortisone, is injected near the irritated nerve root, decreasing inflammation and, thus, decreasing pain. The procedure is done under X-ray guidance by a physician who is specifically trained to perform this technique.
- Facet injections target back pain as a result of arthritis in the small joints of the spine known as facet joints. Anti-inflammatory steroid medication is injected to diminish the pain that is being caused by inflammation along these joints. During this process, fluoroscopic guidance is used for accuracy by an interventionally trained physician.
- Sacroiliac joint injections treat low back pain that results from arthritis in the joint that connects the pelvis with the spinal column, the sacroiliac joint. To reduce the pain being caused by inflammation of these joints, anti-inflammatory medication, such as cortisone, is injected into the joint. The procedure is done under X-ray guidance by a physician who is specifically trained to perform these techniques.
- Nucleoplasty is an advanced treatment for spinal pain that reduces the size of a damaged disc to relieve pain-causing pressure on nerves.
- Radiofrequency Lesioning
With a probe that generates a microwave, pain specialists can destroy nerve tissue and relieve pain.
- Spinal Cord Stimulation
This technique can block the sensation of pain with an electrical device implanted in the body. It uses a mild current to replace the feeling of pain with a sensation similar to the feel of running water. Spinal cord stimulation is used when back surgery fails, for peripheral neuropathy (severe pain in the arms, legs, hands or feet), and when severe phantom limb pain follows amputations.
Specialized Surgical Techniques
- Anterior Cervical Discectomy and Fusion – Are spinal treatments that may be appropriate for patients who have a herniated disc in the cervical region of their spine that is causing their symptoms. The common approach is an anterior cervical discectomy. This is an operation under general anesthesia in which a small incision is made in the front of the neck to gain access to the front of the spine. The disc along with its herniated portion is then removed to relieve the pressure on the nerve and spinal cord.
- Baclofen Pumps – Are used to relieve both severe pain and muscle spasms by implanting a small pump and medicine-filled reservoir in the body. A thin tube, or catheter, goes from the pain pump to the spine where the medication is released into the fluid surrounding the spinal cord.
- Intradiscal Electrothermal Therapy (IDET) – Is a spinal treatment that is used on a select group of individuals with chronic back pain. The procedure involves the use of a sedative and local anesthetic and under X-ray imaging (fluoroscopy). The surgeon will then insert a needle containing a heating element into the spinal disc. The catheter is placed in the outer layer (the annulus) of the disc and is then slowly heated. The heat destroys the nerve fibers and causes the disc tissue to seal any small tears.
- Kyphoplasty – Provides pain relief related to vertebral compression fractures due to osteoporosis and metastatic disease. This procedure usually delivers pain relief within several days and the majority of people experience satisfactory results. Balloon kyphoplasty can significantly reduce back pain, often shortly after the procedure. In addition to pain reduction, patients often experience an increased ability to return to simple, everyday activities such as walking, reaching, bending and lifting. The procedure may also restore vertebral body height. Patients often report improved mental and emotional health, vitality and social function.
- Laparoscopic Spine Surgery – Is minimally invasive surgery (also known as laparoscopy), thst allows the surgeons to perform a spine operation without having to make a large incision. For the laparoscopic approach, small puncture holes are made in the skin instead of long incisions. A telescope is inserted through one of the puncture holes projecting a picture on a television screen which then allows the surgeon to see the spine. Additional puncture holes are created where specialize surgical instruments are placed allowing the work on the spine. The advantages of performing minimally invasive procedures like laparoscopic spine surgery are: small incisions, typically less blood loss than an open procedure, less pain, a shorter length of stay in the hospital and a quicker return to activities of daily living.
- Lumbar/Cervical Discectomy – Open discectomy is a procedure that removes the disc that is located between the vertebrae in the spine. The herniated portion of the disc is removed, as well as any additional abnormal portion of the intervertebral disc. This allows the nerve root to return to its normal position and orientation.
- Minimally Invasive Microdiscectomy – Patients whose pain is caused by a pinched nerve from a herniated lumbar disc are candidates for a microlumbar discectomy. This is an operation done under general anesthesia in which a small incision (typically less than one inch) is made in the lower part of the back or neck. A window is made in the bone (laminotomy) overlying the nerve root and herniated disc. The herniated portion of the disc is removed as well as any additional abnormal portion of the intervertebral disc. This allows the nerve root to return to its normal position and orientation.
- Spinal Cord Stimulation – Can block the sensation of pain with an electrical device implanted in the body. It uses a mild current to replace the feeling of pain with a sensation similar to the feel of running water. Spinal cord stimulation is often used when back surgery fails, for peripheral neuropathy (severe pain in the arms, legs, hands or feet) and when severe phantom limb pain follows amputations.
- Spinal Fusion – The stability of your spine is dependent upon the combined function of the muscles, tendons, ligaments and bones that make up the spinal column. Sometimes, either because of abnormalities involving one or several of these components, the spinal column becomes unstable. In these cases, stability can be provided through the use of bone grafts which fuse the spine into a stable position. This is known as a spinal fusion. Spinal instrumentation involves placing a set of rods, hooks or screws into the spine in order to provide immediate stability until the bone graft fuses. For people with instability, the surgeon fuses adjacent vertebrae. Matchstick-sized pieces of bone may be used as bone grafts on the facets, or, hockey puck-shaped plugs of bone may be placed between the vertebrae. Bones and bone grafts grow into one unit, stabilizesing the vertebrae at that point of the spine.
- Surgical Decompression – For patients whose symptoms are due to spinal stenosis, or narrowing of the spinal canal, a laminectomy is sometimes required in order to alleviate their pain. The operation is done under general anesthesia. The back part of the bone covering the spinal canal is removed over the area that is narrowed. This has the effect of relieving the compression on the nerve roots and allowing them to assume a freer, less irritating orientation. A laminectomy is also used when the disk is badly damaged and the surgeon needs greater access to perform a discectomy. If spinal stenosis is present, the surgeon may enlarge the foramen (opening between the vertebrae) to allow space for the nerve to exit.
The goals of managing osteoporosis are to decrease pain, prevent fractures and minimize further bone loss. Some of the methods used to treat osteoporosis are also the methods to help prevent it from developing, including:
- Maintain an appropriate body weight
- Increase walking and other weight-bearing exercises
- Minimize caffeine and alcohol consumption
- Stop smoking
- Maintain an adequate intake of calcium through diet and supplements.
- Prevent falls in to prevent fractures (i.e., install hand railings, or assistive devices in the bathroom, shower, etc.)
- Consult your physician regarding a medication regimen
For postmenopausal osteoporosis in women, the Food and Drug Administration has approved a number of medications to maintain bone health. Your physician will discuss what is right for you.
The goal of spondylosis treatment is relief of pain and prevention of permanent spinal cord and nerve root injury.
In mild cases, treatment is usually not required. Symptoms from cervical spondylosis usually stabilize or regress with simple, conservative therapy, including a cervical collar (neck brace) to restrict motion and non-steroidal anti-inflammatory medications (NSAIDs). Cortisone injections to specific areas of irritation may also be helpful.
For severe cases, narcotic medicine or muscle relaxants may help to reduce pain. Surgical decompression of the spinal cord in the neck may be recommended for severe back pain or for significant loss of movement, sensation or function.
Surgical procedures may involve removal of bone and disc tissue impinging on the nerves of the spinal cord and stabilization of the neck by fusing the cervical vertebrae.
Most patients with cervical spondylosis will have some chronic symptoms, but they respond to non-operative interventions and do not require back surgery.
To make an appointment at the Spine Center:
Cushing Neuroscience Institute’s Spine Center makes it easy for you to take the first steps in ensuring the best neurological and neurosurgical care for yourself or your family. Simply fill out our Request an Appointment form, email us at firstname.lastname@example.org or contact one of our locations.