Non-Surgical Spine Treatments

Cervical Spondylosis

Physical therapy

Strengthening and stretching weakened or strained muscles is usually the first treatment that is advised. Your physical therapist may also use cervical (neck) traction and posture therapy. Physical therapy programs vary, but they generally last from 6 to 8 weeks. Sessions are scheduled 2 to 3 times a week.

Medications

Several medications may be used together during the first phase of treatment to address both pain and inflammation.

  • Acetaminophen. Mild pain is often relieved with acetaminophen.
  • Non-steroidal anti-inflammatory drugs (NSAIDs). Often prescribed with acetaminophen, drugs like ibuprofen and and naproxen are considered first-line medicines for neck pain. They address both pain and swelling, and may be prescribed for a number of weeks, depending on the specific problem. Other types of pain medicines can be considered if you have serious contraindications to NSAIDs, or your pain is not well controlled.

Muscle relaxants

Medications such as cyclobenzaprine or carisoprodol can also be used in the case of painful muscle spasms.

Soft Collars

These collars limit neck motion and allow the muscles of the neck to rest. Soft collars should only be worn for short periods of time because long-term wear can decrease the strength of neck muscles.

Ice, heat, other modalities

Careful use of ice, heat, massage, and other local therapies can help relieve symptoms.

Steroid-Based Injections

Many patients find short-term pain relief from steroid injections. Various types of these injections are routinely performed. The most common procedures for neck pain include:

Cervical epidural block

In this procedure, steroid and anesthetic medicine is injected into the space next to the covering of the spinal cord (“epidural” space). This procedure is typically used for neck and/ or arm pain that may be due to a cervical disk herniation, also known as radiculopathy or a “pinched nerve.”

Epidural injection in the cervical spine

Cervical facet joint block. Steroid and anesthetic medicine is injected into the capsule of the facet joint in this procedure. The facet joints are located in the back of the neck and provide stability and movement. These joints can develop arthritic changes that may contribute to neck pain.

Cervical facet joint

Medial branch block and radiofrequency ablation. This procedure is used in some cases of chronic neck pain. It can be used for both diagnosis and treatment of a potentially painful joint.

Facet joint injection in the cervical spine

During the diagnosis portion of the procedure, the nerve that supplies the facet joint is blocked with a local anesthetic (like the medicine used by your dentist). Your doctor will ask if your neck pain is completely gone. If so, then your doctor has pin-pointed the source of your neck pain. The next step is to block the pain more permanently. This is done by damaging the nerve with radiofrequency, a procedure called radiofrequency ablation.

Although less invasive than surgery, steroid-based injections are prescribed only after a complete evaluation by your doctor. Before considering these injections, discuss with your doctor the risks and benefits of these procedures for your specific condition.

Herniated Cervical Disc

Medications. Several medications may be used to help relieve your pain.

  • Aspirin or acetaminophen can relieve pain with few side effects.
  • Non-steroidal anti-inflammatory medicines like ibuprofen and naproxen reduce pain and swelling.
  • Narcotic pain medications, such as codeine or morphine, may help.
  • Steroids, taken either orally or injected into your spine, deliver a high dose of anti-inflammatory medicine.
  • Physical medicine. Low back pain can be disabling. Medications and therapeutic treatments combined often relieve pain enough for you to do all the things you want to do.

Physical therapy can include passive modalities such as heat, ice, massage, ultrasound, and electrical stimulation.

Active therapy consists of stretching, weight lifting, and cardiovascular exercises. Exercising to restore motion and strength to your lower back can be very helpful in relieving pain.

Braces

The most common brace is a corset-type that can be wrapped around the back and stomach. Braces are not always helpful, but some people report feeling more comfortable and stable while wearing them.

Kyphosis

Treatment will depend on the reason for the deformity. Most teens with postural kyphosis will do well throughout life. The posture of some patients with postural kyphosis may improve over time. An exercise program may help relieve any associated back pain.

Nonsurgical Treatment

An initial program of conservative treatment that includes exercises and anti-inflammatory medications (for discomfort) is recommended for patients with Scheuermann’s kyphosis. If the patient is still growing, the doctor may prescribe a brace. The patient typically wears the brace until skeletal maturity is reached.

Lower Back Pain

Medications

Several medications may be used to help relieve your pain.

  • Aspirin or acetaminophen can relieve pain with few side effects.
  • Non-steroidal anti-inflammatory medicines like ibuprofen and naproxen reduce pain and swelling.
  • Narcotic pain medications, such as codeine or morphine, may help.
  • Steroids, taken either orally or injected into your spine, deliver a high dose of anti-inflammatory medicine.

Scoliosis

Observation

This option is appropriate when the curve is mild (less than 20°) or if the child is near skeletal maturity. However, the doctor will want to recheck the curve on a regular basis to see that it is not progressively getting worse. You may be asked to return every 3 to 6 months for re-examination. Most instances of scoliosis identified by school screening will fall into this category.

Bracing

The goal of bracing is to prevent scoliotic curves from getting worse. Bracing can be effective if the child is still growing and has a spinal curvature between 25° and 45°. There are several types of braces, most being the underarm type.

Your orthopaedist will recommend a brace and tell you how long it should be worn each day. Wearing a brace does not affect participation in sporting activities. Time out of the brace is allowed for these activities.

Sciatica

The condition usually heals itself, given sufficient time and rest. Approximately 80% to 90% of patients with sciatica get better over time without surgery, typically within several weeks.

Nonsurgical treatment is aimed at helping you manage your pain without long-term use of medications.

Nonsteroidal anti-inflammatory drugs such as ibuprofen, aspirin, or muscle relaxants may also help.

In addition, you may find it soothing to put gentle heat or cold on your painful muscles.

It is important that you continue to move. Do not remain in bed, as too much rest may cause other parts of the body to feel discomfort.

Find positions that are comfortable, but be as active as possible. Motion helps to reduce inflammation. Most of the time, your condition will get better within a few weeks.

Sometimes, your doctor may inject your spinal area with a cortisone-like drug.

As soon as possible, start stretching exercises so you can resume your physical activities without sciatica pain. Your doctor may want you to take short walks and may prescribe physical therapy.

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