Explore nonsurgical options for back pain
DEAR DR. GOTT: My 79-year-old mother has lumbar spinal stenosis that leads to hip pain. She has seen ads and articles about minimally invasive procedures to relieve this problem. In a recent column, you stated that laser spine surgery “has not undergone controlled clinical trials.” What does this mean? Hasn’t it been tested for safety or effectiveness?
Also, are you familiar with MILD (minimally invasive lumbar decompression), which is an image-guided procedure to remove bits of bone and tissue that impact the spinal cord?
My mother has had a couple of steroid shots and has seen a chiropractor for this and other concerns. She is wondering about these minimally invasive procedures in the future rather than the major open surgery.
DEAR READER: Spinal stenosis is a common condition that results in the narrowing of the opening in one or more of the vertebrae (typically in the neck or lower back) through which the spinal cord runs or where a portion of the nerve exits the vertebrae. This puts pressure on the nerves. Mild degrees of stenosis are often found during X-rays for unrelated causes, and the patient may not have any symptoms.
In the cervical spine (neck), this can lead to numbness, weakness or tingling of one or both arms, legs, hands or feet. It can also cause neck or shoulder pain. In severe cases, urinary and/or fecal incontinence may occur.
In the lumbar spine (lower back), this can lead to numbness, weakness or tingling of one or both legs or feet. As with cervical stenosis, in severe cases urinary and/or fecal incontinence may occur. Cramping or pain of the legs after long periods of standing or walking may also result. This can usually be eased or relieved by sitting down or bending forward.
The most common causes of spinal stenosis are arthritis and degenerative changes due to the aging process. Paget’s disease of the bone and spinal injuries or tumors may also be to blame; however, they are uncommon.
Surgery, even minimally invasive techniques, should be considered only as a last resort in most cases. I urge your mother (and you) to sit down with an orthopedist or neurosurgeon to review her situation and discuss what treatment options are available to her. These can include non-steroidal anti-inflammatory drugs (NSAIDs), narcotic/opioid pain relievers, anti-depressants, anti-seizure drugs or steroid injections. Physical therapy may also be beneficial.
If she is overweight, a weight reduction plan can help, as will a cane or walker.
Now on to your questions. First, “has not undergone controlled clinical trials” means that the techniques and procedures have not been thoroughly tested for effectiveness and safety. Controlled clinical trials compare the results of one technique, procedure, therapy or medication to others, as well as to a control group to determine what the risks, side effects and efficacy are from one to the other and which is most likely to be successful for the majority of patients needing that particular treatment.
As to MILD, I am unfamiliar with it. I did find an article printed in January 2010. The authors reviewed surveys completed by the treating physician of 90 patients who underwent the MILD procedure. No adverse events or complications were noticed; however, efficacy parameters were not collected. Essentially the authors were given information by the physicians and attempted to put together an overall view of the how the procedure went. This is a fairly new procedure, and at this point appears to be safe; however, more reviews and studies are needed (some are currently being conducted) before any final conclusions can be made.
In summary, your mother needs to talk to her physician about her options. Even if she is a candidate for surgery, this shouldn’t be considered until she has exhausted other, more conservative approaches first.