Typical symptoms in the neck can be headaches or an aching pain in the neck and shoulder worse with extension (tilting backwards) of the neck. In the lower back, pain is usually worsened with standing, transitioning from sit to stand, or leaning backwards. Usually, leaning backwards and tilting one side of the shoulder towards the floor, reproduces pain in the lower back, buttock or posterior thigh on the same side as the shoulder that is tilting back. This is because the facet joints are being "loaded" with the weight of extending the spine backwards.
Treatment Options
Physical therapy, ice or heat packs, and occasional use of over the counter medications (such as tylenol, ibuprofen or naproxen) are the first line treatment options. The goal of physical therapy is to strengthen the spine stabilizing muscles and to correct posture.
If a few weeks of therapy does not provide adequate pain reduction, a procedure called Radiofrequency Ablation (RFA) may offer significant relief. Radiofrequency Ablation is also typically called Rhizotomy or Neurotomy. There are even some spine clinics have even referred to this procedure as "Laser" spine surgery, although this is not an accurate description of how the procedure works.
With this procedure, a fine needle is inserted towards the spine, and radiofrequency waves are used to produce heat at the tip of the needle on specifically identified nerves surrounding the facet joint(s) on either side of the cervical or lumbar spine. By generating heat around the nerve, its ability to transmit pain signals to the brain is destroyed, thus ablating the nerve. The nerves to be ablated are identified through injections of local anesthesia (such as lidocaine) prior to the RFA procedure. If the local anesthetic injections provide temporary pain relief, then RFA is performed on the nerve(s) that responded well to the injections. RFA is a minimally invasive procedure which can usually be done in day-surgery clinics, going home shortly after completion of the procedure. The patient is awake during the procedure, so risks associated with general anesthesia are avoided. An intravenous line may be inserted so that mild sedatives can be administered.
The major drawback for this procedure is that nerves regenerate over time, so the pain relief achieved may last for only a short duration (6-24 months) in most patients. However, the procedure can always be repeated as necessary.
Documented benefits have led to RFA becoming widely used during the last 15 years. RFA procedures are performed under image guidance (such as using X-ray) by an interventional pain specialist. Because of the significant benefits and minimal risks involved, RFA is widely accepted by almost all insurance carriers including Medicare.
If you are having severe chronic neck or lower back pain, and would like to find out if you are a candidate for RFA, please call us at (253) 833-7750 to make an appointment with one of our spine specialists at Cascade Orthopaedics for a comprehensive evaluation.