Spinal surgery for osteoporosis no better for pain relief than injections

Surgery to repair spinal fractures is no more effective for pain relief than a sham (placebo) procedure in older patients with osteoporosis, finds a trial published by The BMJ in May 2018.

Vertebroplasty (Surgery to repair spinal fractures) involves injecting a special cement into the fractured bone to stabilise it and to relieve pain. But previous studies have reported conflicting results and there is ongoing debate about its benefits, risks, and cost-effectiveness.

To try to resolve this uncertainty, researchers in the Netherlands and the USA compared pain relief in patients undergoing vertebroplasty or a ‘sham’ procedure, where patients are given local anaesthetic injections, but no bone cement.

“Percutaneous vertebroplasty to treat patients with acute osteoporotic vertebral compression fractures did not result in statistically significant more pain relief than a sham procedure during 12 months’ follow-up,” say the researchers.


Source and additional details


Reduced Opioids After Spinal Surgery With ERAS Protocol

ERAS is a comprehensive perioperative surgical pathway protocol that involves multidisciplinary, collaborative management of patients. While ERAS protocols are gaining favor around the country, the report by this group of researchers here at the American Association of Neurological Surgeons (AANS) 2018 Annual Meeting, is among the first to show its benefit in elective spine and nerve surgery.

Postoperative pain management is achieved by a robust opioid-sparing multimodality regimen,” she said. This includes epidural analgesia and short-acting anesthetics along with implementation of nonopioid medications: standing orders for acetaminophen, gabapentin, and local anesthetics. PCA is generally not used.

At 1 month, patients undergoing spinal and peripheral nerve surgery who were managed under the ERAS protocol had less need for opioids but achieved pain relief that was as good as that provided by opioids in the control group, the study showed.




Robotic surgery at Norton Healthcare doing more than fixing back pain

Mazor X machine cuts back surgery time nearly in half.  Along with cutting down surgery time, the new technology also saves the hospital money. Gum said patients who have had non-robotic surgery typically stay in the hospital for three to five days after a surgery. With the new machine, patients only stay overnight. The machine is also tackling a bigger issue with the opioid epidemic.

“The robot allows us to minimize incision. We strip less muscle when we’re doing a surgery in the back of the spine,” Gum said. “It allows us to place the screws a little more precise, so it takes more of the human error out of it.

“One of the goals of utilizing this technology is to be able to decrease post-op pain, which in turn helps decrease post-op narcotic use.”  Gum said a patient who has had a non-robotic surgery typically will take opiate narcotics for three to four weeks, but with less muscle being stripped and smaller incisions from a robotic surgery, he said patients only need painkillers for one to two weeks.




Effectiveness of three interventions for low back pain – results of controlled trial

I found a rather technical and dry article about  the effectiveness of three interventions that were aimed to reduce non-acute low back pain in the occupational health setting.  If you can put up with the dryness of the article it present interesting data from a scientific assessment.

The conclusion of the study is that Rehab and Physio interventions improved health related quality of life, decreased low back pain and physical impairment in non-acute, moderate LBP, but we found no differences between the Advice and Control group results. No effectiveness on sickness absence was observed.

The details of the study are here


A brand new set of recommendations for treating low back pain

A brand new set of recommendations for treating low back pain was published in The Lancet in March. It was compiled by a multi-disciplinary, international panel of low back pain experts.

A low back pain patient needs to understand they are not suffering a disease and that low back pain commonly resolves in time.

Some tips from Dr. Williams include:

  • Must understand that bed rest is a terrible idea.
  • Resume daily exercise
  • Resume daily activities as soon as possible
  • Limited or non-use of medication
  • Limited or non-use of imaging
  • Limited or non-use of surgery
  • Self-management at home is a big deal

There is an inappropriate high usage of:

1. Spinal injections

2. Imaging

3. Opioids

4. Surgery

5. Bed Rest

A healthy weight and regular physical activity will decrease the incidence of low back pain. Alternative care like chiropractic can go a long way toward helping low back pain while reducing the overall cost of dealing with low back pain.



Laser Spine Table Provides Relief For Back Pain Sufferers

Dr. Godrej Engineer is a chiropractor and the owner/Clinic Director of Physiomed, a physiotherapy clinic based in Toronto with 30 locations across Canada, is seeing impressive results for his patients after purchasing a spinal decompression table for his clinics just a few years ago.

“We have seen fantastic results overall,” Dr. Engineer said. “We see about 85 percent of our patient’s get significant relief from their pain. I would think anecdotally, treating the same conditions through traditional means like chiro, physio, massage, and acupuncture, we would only see 50 per cent of our patient’s report the same satisfaction as they would from the table.”

The 2010 BMC study — Restoration of disk height through non-surgical spinal decompression is associated with decreased discogenic low back pain — has supported the high level of satisfaction among patients that continues to be seen in 2018.

For more information refer to this source


Busting myths about back pain

Back pain is one of the most common ailments, with four in five people suffering from low back pain at some stage in their lives.  The most effective treatment for back pain is often exercise and physical activity – and not bed rest. Research shows that there isn’t one form of exercise that is superior to another. What we want is people doing the exercise that they enjoy – whether it’s walking, swimming, pilates or yoga. It has to be something that’s available for people to do.  The key is to get moving again and not to focus too much on the source of the back pain. “Often, it’s hard to pinpoint the exact ligament or muscle that’s causing the pain. It can be a combination of muscle, ligament and joint pain and resuming normal activities gently and gradually is more important than seeking out a precise diagnosis”.


Source and more details are here

Challenging hamstrings to deal with back pain

1. Set up a BOSU ball with the ball side up. Select a very light barbell (10 to 20 pounds to start) and place it across your shoulders behind your head.

2. Stand on the BOSU with your feet 12 to 18 inches apart. Tighten your abdominals and press your hips backward.

3. Lean forward with your back straight and without bending the knees. Continue lowering your torso until your upper body and lower body form an L shape.

4. Your chest should be facing the floor at the bottom of this motion.

5. Keeping the abdominals tight and feeling the effort in your hamstrings, raise the torso back up until you are in a full standing position.

6. Do two or three sets of 12 repetitions