We’ve all experienced it before.
Robert A. Hirschl, M.D.
Back pain is one of the most common ailments in the country — 80 percent of adults will experience it at some point.
While most back pain can improve or go away with conservative treatment, medication and time, surgical approaches — especially minimally invasive methods — have evolved over the years to treat back pain caused by more serious underlying health conditions.
Etiologies of Back Pain
There are many different causes of back pain. While some people may have a soft tissue injury, like a muscle strain or ligament tear, others may have arthritis that affects the joints in their back or neck. Disc degeneration, in which the spinal discs change as we age, also is a culprit. It can lead to more serious health conditions like a herniated disc and spinal stenosis, which causes the spinal canal to narrow and leads to pain and numbness in the neck, arms, lower back, and legs.
In my practice I see a range of patients, from people with vertebral fractures after major trauma to those with neoplastic conditions involving spinal cord tumors. In neurosurgery, many patients also may have nerve root or spinal cord compression or other degenerative changes that affect the spine, like hypertrophied ligaments or facet joint degeneration.
It’s important to understand the cause of back pain in order to treat it. With certain conditions, like arthritis or a muscle strain, anti-inflammatory medication and some rest may help ease a person’s discomfort. However, when the underlying cause is a spinal cord or neurological issue, surgical intervention often is the best option for treating patients.
Advances in Back Pain Treatment
Many people often are leery about back or spinal surgery because of the perceived risks. There’s a misconception that nerve damage — and potential, long-term muscle weakness and paralysis — are major risks when you undergo back or spinal surgery. However, each patient is different, and the risks won’t be the same for everyone. I also can tell you that the risks of these complications are minimal, especially if a highly qualified and trained surgeon performs the procedure.
Back and spinal surgery is usually the last and best option for people who have tried other remedies to cure their back pain. Patients who do not improve with conservative treatment or have neurological deficits due to nerve root or spinal cord impingement may benefit from surgical intervention.
Spinal surgery has improved dramatically in recent years. New minimally invasive techniques and instrumentation have made spinal surgery much safer, with less blood loss, less normal tissue disruption and faster healing times.
The advantages of minimally invasive spinal surgery aren’t just a smaller incision. These new techniques provide options to patients who once would have been considered “poor surgical candidates” because of medical comorbidities or age. Because these procedures aren’t open, there’s less blood loss. Take degenerative scoliosis surgery, for example. The traditional procedure required a long midline incision, dissecting all muscle and soft tissue from the bones of the spine, removing several areas of bone, placing hardware and manually reducing the deformity. This technique usually causes about a liter or more of blood loss, and more times than not requires blood transfusions. For a high-risk patient, a surgery of this nature was out of the question. However, with new minimally invasive techniques, we can now make a small one-inch incision on the side, not disrupt any back muscles or soft tissue and correct the deformity — typically with less than 5cc of blood loss.
Minimally invasive spinal surgery has other benefits, as well. These techniques don’t cause as much disruption to normal soft tissue, which reduces healing time for patients. The hospital stay also is much shorter compared to the traditional procedure. Patients are up and walking the same day and often go home that day or the following day after surgery.
Aside from degenerative scoliosis surgery, there are several other minimally invasive surgical techniques that are successful in treating back pain. These include decompressive procedures such as microdiscectomy, a procedure that reduces nerve pressure to relieve back pain and leg pain; minimally invasive laminectomy, a surgery that removes a section of the bone in the back of the spine and overgrown ligaments to provide relief for spinal stenosis; and foraminotomy, which decompresses nerve roots to relieve inflammation and pain.
There’s also minimally invasive decompressive and stabilization procedures such as transforaminal lumbar interbody fusion (TLIF) and Direct lateral interbody fusion (DLIF), both of which are spinal fusion surgeries that correct anatomical issues and health conditions (like degenerative disc disease) that cause back pain.
New biologic agents and biomaterials also are available to help with recovery after spinal surgery. These agents and materials help the patient heal more effectively. I’ve been fortunate to be personally involved in the development of new technology and biomaterials for minimally invasive spinal surgery. I’ve worked with many companies to help them develop spinal instrumentation and am currently involved in the development of biological agents and new biomaterials to promote bone growth and healing. These things also have informed my own work. I’ve created multiple patents on spinal instrumentation that have been developed or that are currently in development, and I’ve produced new biomaterials to improve the efficacy of spinal fusions. One of my current passions is working on new implants that have bone-stimulating properties. These implants are currently being tested and show great promise.
Millions of Americans will experience back pain at some point in their lives. While underlying causes may range from something as treatable as a soft tissue injury to more serious conditions like degenerative scoliosis, advances in minimally invasive surgery have expanded the possibility that more patients can get relief and have a better quality of life. We’ve come a long way in the last decade, and I’m incredibly hopeful about where we’ll be in the next.
By Robert A. Hirschl, M.D.
Robert A. Hirschl, M.D., earned his medical degree from The Ohio State University College of Medicine, where he also served his residency in neurological surgery and completed a fellowship in endovascular neurosurgery/interventional neuroradiology. He served on the faculty at Ohio State as a clinical instructor and director of endovascular neurosurgery. In 2010, he was awarded the clinical excellence award.
Prior to joining Orlando Health, Dr. Hirschl was medical director and chairman at Mercy Neurosurgery in Des Moines, Iowa. In this role, he earned the 2013 Angel of Mercy award for exceptional patient care. Additionally, he was named “One of the 62 Spine Surgeon Inventors to Know” by Becker’s Spine Review in 2012 for inventing several surgical instrumentation devices.
Dr. Hirschl has been published in multiple journals, including the Journal of Pediatric Neurology, the Journal of Neurosurgery, and the Journal of Robotic Surgery. He has also authored several book chapters, including Endovascular Surgical Neuroradiology published in 2015 and Endovascular Technique for Tumor Embolization in Youmans Neurological Surgery.
To schedule an appointment with Dr. Hirschl please call 321.841.7550.
