Advances in Back Pain
Do you suffer from chronic back pain? Relief may be around the bend with the latest in research and development.
If you’ve ever moaned in agony from back pain, rest assured-albeit uncomfortably-that you’re not alone. More than four out of five Canadians will suffer from it at some point in their lives.
Back pain can originate from many sources and treatments are just as varied, often only providing temporary relief. But the search for a silver bullet continues. Doctors and scientists are reporting success with the following new and impending treatments that can ease back pain for some sufferers while offering hope to all.
An implantable device called a “neurostimulator,” works by sending mild electrical impulses along the spinal cord. “The exact mechanism of action is not well understood,” says Lynda Pike of Medtronic of Canada, “but the device blocks the pain signal from getting to the brain.” The latest model, the RestoreUltra, can operate for nine years with a battery recharge every four to six weeks.
A surgeon makes a small incision in your back, then delicately feeds a neurostimulator lead with eight electrodes through the incision and into the space just outside the membrane covering the spine. Sedated but still responsive, you would answer the surgeon’s questions to pinpoint where the lead provided the most benefit.
A few days later, the neurostimulator is implanted through a five-centimetre incision in your abdomen. Two weeks after that, the device is activated.
Neurostimulator-implant surgery is available in every province, with the exception of Prince Edward Island and Newfoundland and Labrador.
Scientists estimate about 50,000 of the current cases of lower-back pain in Canada are caused by strain or injury to spinal disks. Treatment usually involves physical therapy or epidural steroid injections to reduce inflammation. For serious cases of herniated-or “slipped”-disks, patients typically resort to surgery, despite no guarantee of a cure.
While surgery will still be an option, doctors have been developing less-invasive methods of reducing painful disk pressure on adjacent nerves. One of the most advanced techniques, percutaneous diskectomy, involves removing a small amount of tissue from the disk nucleus through a tiny puncture in the skin. “The theory is that when the hydrostatic pressure inside the disk is removed, the pressure transferred to the nerves compressed by the herniated disk is also reduced,” says Dr. Steven Helper of the False Creek Surgical Centre in Vancouver. “It’s like taking a bit of water out of an overfilled balloon.”
Doctors can now opt for the Stryker Dekompressor, a probe that uses a tiny titanium blade and vacuum action to remove a small amount of disk material. This “decompression” alleviates some pressure on the pinched nerves caused by the herniated disk. The procedure lasts less than an hour, and patients go home with only a small bandage over the insertion site; they then wear a lumbar brace for a couple of weeks. Helper says that some 70 percent of patients experience a substantial reduction in pain.
The Dekompressor is available to surgeons across Canada-including Dr. Richard Dumais in Moncton, N.B., the first in the country to use the device.
Each year, thousands of Canadians with degenerative disk disease under go spinal-fusion surgery. The procedure stabilizes the vertebrae with metal rods and screws to allow a bone graft to fuse the vertebrae together. It can provide dramatic and long-term relief. But spinal fusions limit a patient’s range of motion and can require follow-up surgery to alleviate stress on the adjacent vertebrae.
A new device, the Dynesys Dynamic Stabilization System, uses bendable materials to provide support and greater movement. During surgery, doctors attach the device to both sides of the affected vertebrae. “The goal is to stabilize abnormal motion while allowing some degree of normal motion,” says Dr. Christopher Bailey, an orthopedic surgeon at the London Health Science Centre in London, Ont.
Bailey and his team are running a study on Dynesys patients, comparing their results to those of patients who have undergone traditional spinal fusion. He says the success rate for a degenerative spondylolisthesis with secondary stenosis-is higher than 80 percent. “I believe we can achieve that with the Dynesys,” he says.
Spine School for Stem Cells
Many therapies for degenerative disks treat only the symptoms, not the cause of the pain. But at the University of Calgary’s Centre for Bioengineering Research and Education, professor Christopher Hunter is working on a radical and promising approach: teaching the patient’s own stem cells how to create a healthy back.
Hunter’s proposed therapy uses notochordal cells, specialized embryonic cells that give stem cells the blueprint for building a spinal column. He believes that notochordal cells may hold the key to regenerating damaged disks. Doctors would extract a patient’s stem cells, then, in a lab, treat the cells with notochordal tissue. By the time they are reimplanted during minimally invasive surgery, the stem cells would have had a crash course on how to rebuild the back. “We give them a push,” says Hunter, “and hopefully that will get them moving down the right pathway.”
Hunter-an expert on notochordal cells-hopes to start clinical trials within five to ten years.