New procedures can help people suffering from back pain

Relief may be just around the corner for those suffering from back pain in the two Virginias. Dr. Abed Koja is among the nation's first neurosurgeons to offer two new minimally invasive spinal surgery procedures at St. Luke's Hospital.

These surgical techniques, lumbar discectomy and lumbar microlaminectomy, offer relief from pain and return to normal activity for many patients suffering from sciatica, or pain in the back and leg, caused by a herniated disc. Performed using tiny incisions and a microscope to relieve pressure on the lumbar nerve, both procedures are usually performed on an outpatient basis. Patients return home the same day and resume most normal activities soon after.

Koja has introduced these procedures at St. Luke's Hospital with very positive outcomes.

"Both procedures use an incision that is usually no longer than one inch," Koja said. "The back muscles are stretched, not cut, and they easily return to their normal position so that the patient experiences much less pain than with traditional back surgery."

Herniated disc is one of the most common causes of chronic back pain that persists after physical therapy, rest and anti-inflammatory medication. It is usually the result of a degenerative process in the back that causes joints to enlarge and the disc to bulge, reducing the amount of space for the lumbar nerve.

Another procedure, kyphoplasty, can be extremely beneficial to elderly patients with compression fractures from osteoporosis. This technique, also performed by Koja at St. Luke's Hospital, uses balloon catheter technology to inflate collapsed vertebra, restoring the bone's original height and creating a cavity within the bone. The cavity is filled with bone cement, which stabilizes and strengthens the spine. Kyphoplasty reduces fracture pain and helps patients return to mobility while preventing further collapse and bone loss caused by bed rest. It can significantly prolong and enhance the quality of life for elderly patients with osteoporosis.


Procedures for back woes popular, but unproven

It used to be a patient with osteoporosis who broke a vertebra was pretty much out of luck.

The only recourse was wearing a back brace and waiting to heal. If the searing pain was unbearable, it could be blunted with powerful narcotics.

But in the past few years, doctors have been offering and patients have been demanding what some call a miraculous treatment: vertebroplasty, in which a kind of cement is injected into the broken spinal bone.

No one is sure why it helps, or even if it does. The hot cement may shore up the spine or merely destroy the nerve endings that transmit pain. Or the procedure may simply have a placebo effect.

But vertebroplasty and a similar procedure, kyphoplasty, are fast becoming the treatments of choice for patients with bones so weak their vertebrae break.

In three years, the number of vertebroplasties nearly doubled, to more than 27,000 in 2004 from 14,000 in 2001. Despite the lack of rigorous evidence the procedures work, most were covered by Medicare, at a cost of $21 million last year.

There is even less data on the effects of kyphoplasty, which involves pumping open the broken area in the vertebra with a balloon to restore its shape before injecting cement.