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ASK DR. SPINE: Work-related back pain, part 2: Surgical treatment

ASK DR. SPINE: Work-related back pain, part 2: Surgical treatment

Welder at work on dry dock

Based on the complaints of a worker with a back injury and on the findings of studies such as an MRI and X-rays, a treatment plan can be developed. For those injured workers without any damage to the bones, muscle, nerves or disc, continued physical therapy and medications are usually enough to resolve the symptoms and allow the worker to return to work. Normally, this process will take a few weeks.

For those patients with evidence of damage, such as a disc herniation or fracture, treatment often requires surgery. The goal of surgery in these circumstances is geared towards fixing the damaged structures, resolving the injured worker’s pain and restoring proper function, therefore allowing the injured worker to return to full function.

If there is a disc herniation, then an epidural injection is the next step. This is a procedure by which a steroid medication is injected close to the injured nerve. Most injured workers at this point will experience back and leg pain relief. These epidural injections can be repeated based on how well the injured responds.

Surgery, a micro-discectomy, is needed if there is no or little relief despite the epidural injections, medications and therapy. The goal of a lumbar micro-discectomy is to remove the portion of the lumbar disc which is compressing the lumbar nerve.

This is a procedure that is often done in an outpatient setting, which allows the patient to have the procedure and return home that day. This is possible due to the use of specialized instruments and the use of the microscope, which limits the extent of the surgical incision.

After the micro-discectomy, physical therapy is prescribed to allow the injured worker to regain full function and return to work.

For an injured worker with a vertebral compression fracture that does not heal, a procedure called a vertebroplasty is performed to stabilize the fracture. In this procedure, bone is injected into the fractured vertebrae therefore resolving the pain and allowing rehab.

Sometimes, the injury is more severe, leading to a disc injury and significant back pain. For these injured workers, a lumbar fusion is warranted to resolve the back pain. Lumbar fusion techniques have improved tremendously over the past few years. What used to be a very long surgical procedure with a long recovery and hospital stay is now being done in the selected patient in an outpatient setting.

These improvements have occurred due to advances in surgical technique, the use of the microscope as well as refinement of anesthesia protocols. The surgical technique is called Minimally Invasive Spine Surgery (MISS). In this surgical technique, the incision is limited and precise; there is no longer significant muscle damage nor blood loss. Specialized spine surgical screws are used. The main advantage of MISS is that the injured worker can start recovery earlier and therefore return to an active lifestyle and work faster due to the less invasive surgery.

Unlike the traditional lumbar fusion, the MISS fusion patient can often return to work within three months, and therefore MISS is the preferable method to treat this severe condition.

Physical therapy is used after the fusion to rehab the muscles and allow the injured to return to work.

In summary, the worker with back injury can be effectively diagnosed and treated.

Dr. Dwight S. Tyndall, FAAOS, is a minimally invasive spine surgeon practicing in the Region at His column, which appears every other week, covers a wide range of health and medical issues.


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