Back pain

Back pain raises a number of questions among patients.

I have sciatica (or lumbago) but I have been told that it does not require surgery. What can be done?

Nervio ciático

Only 10% of lower back pain cases require surgical treatment. Conservative treatment cures 85% within 2-3 weeks. Furthermore, a divergence of up to 30% exists between reported symptoms and what imaging tests (like CT and MRI scans) reveal, meaning that some individuals with normal scans still experience pain, and conversely, some with abnormal scans feel no pain. Therefore, it is important to be cautious before deciding to undergo surgery without first trying other therapies (physiotherapy, postural education, epidural injections, etc.) or seeking a second opinion.

I have had back surgery, but I am still in pain. What other options do I have?

As we mentioned, evidence that certain individuals who have undergone back surgery continue to experience pain has led to greater caution in recommending surgical solutions. There are currently minimally invasive techniques that allow for the removal or remodelling of an intervertebral disc that is compressing a nerve root (discolysis) or the burning of said root (radiofrequency) to eliminate or reduce pain.

What is epidural infiltration?

It consists of administering medication into the epidural space. This space is the one between two thin layers that protect the spinal cord. Cortisone and local anaesthetics are usually administered. Its usefulness lies in the fact that the medication is closer to the problem (next to the painful nerve root) and such high doses of medication do not need to be administered. This is an outpatient procedure, so it is performed during the day and then the patient goes home. It tends to have greater effectiveness when repeated several times (2-3).

What is radiofrequency?

It consists of altering the transmission of pain to the brain by a peripheral nerve through the application of heat. To do this, a needle with a special tip that generates heat is used. Depending on the amount of heat and the frequency with which it is applied (continuous or pulsed), the phenomenon caused will be the destruction of the nerve (neurolysis) or a change in its signal (neuromodulation).

What is spinal cord neurostimulation?

It is a type of neuromodulation that consists of interrupting the transmission of pain signals through the spinal cord to the brain by applying electrodes that are placed close to the spinal cord and generate an electrical signal that can be programmed and regulated by the doctor and patient.

Given that it is an invasive and costly technique, it is reserved for pain that is resistant to other types of treatment.