I want to find the least-invasive surgery to relieve my back pain. What’s my best option?

For many of the most common sources of chronic back pain, including spinal stenosis and herniated discs, a minimally invasive laminotomy can provide effective pain relief with very low risk of complications. This procedure frees a trapped spinal nerve from painful pressure.

The back pain specialists at the OHSU Spine Center are experts at radiofrequency facet denervation, or RFD. This treatment can relieve or greatly reduce pain without long-term medication or surgery.

Your doctor gives you an injection to stop pain signals in the nerve causing your pain, relieving pain for 12 to 18 months. After RFD, your doctor prescribes a physical therapy program to help reduce pain and increase flexibility.

I have chronic back pain. How can I be sure my rehabilitation program is working?

The healing process for back pain takes time, and you might not see results right away. That’s because with the right treatment, your spine can begin to heal and gain strength before your pain is gone. The specialists at the OHSU Spine Center can track your strength and other physical abilities to measure how well you are healing, enabling them to offer reassurance that your treatment is working.

My back recently started hurting.  Should I stop exercising and take it easy while my back heals?

When you have back pain, you might think you should stop strenuous exercise or completely stop exercising. It’s vital, however, to keep exercising and moving your back. Inactivity causes muscles to shrink (atrophy) and to become less flexible and strong.

To determine the source of your back pain and the best exercises for you, consult a spine specialist who will show you how to  exercise properly. Your doctor will probably prescribe exercise that combines stretching, strengthening and aerobic activity. This can relieve back pain and help prevent back injury.

Could a back injury cause me to  have leg pain?

Leg and back pain can be related, especially if you have a lower back injury. The lower back is a common spot for sprains, strains or a herniated (bulging) disc. You can also have disc or spine problems in your lower back as you get older.

A lower-back injury or problem can pinch spinal nerves, sending pain signals down into one or both legs. This type of leg pain often gets better with treatments such as ice, pain medication and stretching or strengthening exercises. If your pain lasts longer than a few weeks, or your leg or foot starts feeling weak, see your doctor or spine specialist.

I strained my back. Could it be a herniated disc that requires surgery?

Low-back strain causes pain mainly in the back, sometimes in the buttocks and occasionally up and down the entire spine. Strains can heal over time with rest and physical therapy. If you have a herniated (bulging) disc, you might have pain from your back into one or both legs. Pain can be severe but usually starts to get better within a few weeks.

If medication, heat and cold treatment, electrical stimulation, hydrotherapy and stretching don’t help your pain, your doctor might recommend surgery. Surgery also might be recommended if your muscles get weaker or you can’t control your bladder or bowels.

I have shooting pain starting in my lower back and going all the way down my leg. Nothing I do seems to help. What should I do?

You might have sciatica, or pain that travels down your sciatic nerve. This nerve runs down the back of your thigh. Most people simply describe it as leg pain. Pressure on the sciatic nerve can cause pain. The cause is usually a herniated (bulging) disc in your lower back.

You can help the pain by putting hot or cold packs on your back and taking anti-inflammatory medications. Physical therapy can also help. Sciatica usually gets better on its own, but if your pain doesn’t go away or gets worse, your doctor might recommend steroid injections or surgery.

Since my back surgery three years ago, I have had nerve pain in my leg, and nothing seems to help. Do I just need to learn to live with the pain?

Spine surgery might not relieve all your pain for many reasons. Your doctor can examine you, ask questions and do more tests, including MRI and CT scans, an EMG or diagnostic injections. If your doctor still can’t find the cause of your pain and other treatments don’t help, your doctor might recommend another surgery.

My lower back has been aching for months, but I’m afraid of surgery so I have not seen a doctor. What should I do?

Back pain is one of the most common medical concerns for people ages 45 to 64. It's also one of the most common reasons to miss work. Most people find pain relief and improved function with physical therapy, medications and other nonsurgical treatments. If your back hurts most of the time, making it hard to do everyday activities, it’s a good idea to see a spine specialist.

I’ve been diagnosed with degenerative disc disease. How did I get it, and what can I do to minimize symptoms?

Degenerative disc disease is very common as we get older. The most common symptom is back pain. As we age, the spinal discs become less flexible. They don’t spring back as well from impact or protect your spinal bones and nerves as effectively as they once did. Spinal ligaments can become brittle and tear more easily.

Exercise is the best way to keep your back healthy and limit pain. Stretching and moderate strength-building exercise should be part of your daily routine. Consult a spine specialist who can show you exercises and how to do them properly.

What should I do if I have a herniated disc in my lower back?

Stay off your feet for two to three days and rest on a firm mattress. You can place a board under your mattress to make it more supportive.

Medication that relaxes your muscles, reduces inflammation or relieves pain can help. Alternate applying cold and hot packs to help relieve inflammation. Your doctor also might recommend a steroid injection to control pain and inflammation. When your pain decreases, physical therapy can help you strengthen your back muscles.

If these treatments don’t help and you have muscle weakness or confusion, your doctor might recommend surgery.  At the OHSU Spine Center, your doctor will try the least-invasive options first.

What are treatment options for flatback syndrome, also known as loss of lumbar lordosis or kyphosis? I understand the syndrome falls under the category of spinal stenosis.

The spine’s two curves help us carry our upper bodies in a balanced way. An imbalance can cause pain and changes in posture that greatly affect day-to-day living. Flatback syndrome, which happens when one or both of the spinal curves straightens out, is one kind of spinal imbalance.

If you have flatback syndrome, you might have trouble standing up straight, or you might look like you are crouching. Other symptoms are low-back, thigh and groin pain.

Flatback syndrome can be caused by degenerative arthritis (joint damage) of the spine, spinal fractures (broken bones) or scoliosis (curved spine). You might also have flatback syndrome if you have had spinal fusion surgery for arthritis.

It’s a good idea to see your health care provider as soon as you notice symptoms. A spine specialist can confirm the diagnosis with a medical history and examination. Treatments may include:

• Using a cane or walker to reduce pain and help with balance
• Physical therapy and a home exercise program
• Anti-inflammatory medication
• Surgery

I have osteoporosis, and now my back has a more rounded look. What is this, and how can I prevent further damage?

You might have started to develop something called a “dowager’s hump.” This is an abnormal outward curve of the spinal  bones (vertebrae) in your upper back. It happens because osteoporosis makes bones thin and brittle. You also lose a little bone each year. As your bones become smaller and more brittle, the upper vertebrae can collapse on each other, causing the rounded appearance.

It’s never too late to stop bone loss or even reverse it, however. Exercise can help strengthen bones, develop good body  mechanics (posture and movement), and make your back look less rounded.

Talk with a doctor to learn exercises you can do safely, and make sure to eat a diet rich in calcium and vitamin D. Your doctor also might prescribe medication to help prevent further bone loss. Consult a spine doctor if the curve of your upper back causes pain or discomfort.

What’s the difference between a laminotomy and a laminectomy?

Laminotomy and laminectomy are both surgeries done to relieve back, leg or arm pain. A laminotomy can take pressure off a spinal nerve. It can also let your doctor treat a herniated (bulging) disc or bone spur causing pain by pressing on a nerve.

A laminectomy can create more space for spinal nerves or allow your doctor to remove bone spurs or ruptured (leaking) discs. A laminotomy removes only part of the layer of bone that covers your spinal cord. A laminectomy removes all the bone in certain areas.

How effective is spinal cord stimulation in treating chronic back and leg pain?

For some people, spinal cord stimulation effectively reduces back or leg pain caused by nerve damage. Your doctor puts two small wires near your spinal cord and spinal nerves. The wires are connected to a small generator programmed to send a mild electrical current to the nerves causing pain. This blocks the pain signals to your brain.

This outpatient procedure isn’t right for everyone. To find out if it’s the best treatment for you, you’ll need a medical exam and a discussion with your doctor.

My steroid injections seem less effective than when I started receiving them. What should I do?

Epidural steroid injections are often used to treat pain in the arms or legs caused by pinched nerves in the spine. If something is pressing on a spinal nerve, this causes inflammation and pain. The steroids decrease inflammation and reduce pain but don’t fix the problem.

If your pain comes back, you might feel better after additional injections. Most doctors won’t give you more than a few injections each year in the same area, however. If your pain keeps coming back and the relief seems to wear off faster each time, your doctor might recommend surgery to relieve pressure on the spinal nerve. Several procedures are minimally invasive and are done on an outpatient basis.

My doctor recommended spinal fusion to relieve my arthritis pain. Are there nonsurgical treatments I should  consider?

Yes. Studies show most patients with spinal arthritis can manage pain without surgery. Nonsurgical treatments include  anti-inflammatory medication, physical therapy and exercise. Temporarily wearing a brace, or receiving an injection of local  anesthetic and steroid medication can also be effective.

I am looking into open-back surgery. What can you tell me about minimally invasive laminotomy?

A laminotomy can relieve pain from a variety of spine conditions, including spinal stenosis (narrowing of the spinal canal), herniated (bulging) discs, and overgrown bone or ligaments. All these can press on spinal nerves, causing neck or back pain.

In a laminotomy, your doctor removes part of the thin layer of bone (lamina) that covers your spinal cord, relieving pain by removing pressure on spinal nerves. Laminotomy has a very low risk of complications. After surgery, you spend one night in the hospital.

I am a golfer. What do you recommend I do to avoid a back injury?

Golfing again after a break, such as winter, can increase your risk of back injuries and other problems. Your best protection is to start a daily program of stretching and core strengthening exercises as early as possible before you start golfing again. Choose stretches for your lower back, hips, gluteal muscles (buttocks) and hamstrings (back of the legs). Then add exercises that strengthen your abdominal and back muscles.

Call the OHSU Spine Center at 503-418-1988 for a free brochure on recommended stretches and exercises for golfers. If any of your exercises causes pain or you have an injury, call the back and spine experts at the OHSU Spine Center.

Could my golf swing hurt my back?

It’s possible. If you play golf or racquet sports, you are more likely to be injured from bending and twisting. Your risk increases if you play infrequently.

If you regularly do stretching and strengthening exercises, you’re less likely to injure your back because supporting muscles — including your stomach muscles, hamstrings (back of the legs) and gluteals (buttocks) — become stronger and more flexible.

If you’re worried about possible injury, a sports medicine doctor can show you proper conditioning. The doctor can also  recommend treatment for golf injuries you might already have.

What can I do now to help prevent a back injury during spring golf season?

During rainy Oregon winters, many golfers go months without swinging a club. That can increase your risk of back injuries or  other problems. 

A stretching program for your lower back, hips, gluteal muscles (buttocks) and hamstrings (back of the legs) can help  strengthen the areas you use most in golf. Exercises that strengthen your abdominal (stomach) and back muscles can also help protect your back and  improve your game.