New back pain procedure

August 22, 2011 2:31:21 PM PDT
Back pain in the elderly can have many causes. One type of pain is caused by spinal stenosis, a narrowing of the spinal canal.

It has very typical symptoms and may need major surgery to cure, but a new procedure shows promise.

Spinal stenosis can pinch nerves and cause back and leg pain. Patients are often in their seventies or eighties, not a good age for major back surgery to improve pain. Now, a simpler procedure that's been available for less than two years may be an option.

Tony Gulli, 66, had just retired to a house near the beach. The problem was that he could barely get to the water.

"The beach is like three hundred yards from the house. The walk down to the beach was painful and I said we need to do something," Gulli said.

Tony had lumbar, or lower back stenosis. This new procedure was the something Tony did to relieve his symptoms.

"The classic symptom of lumber stenosis is pain in the back or legs that is not present on lying or sitting, but pain that gets worse when patients get up and walk," said Dr. Alan Mogilner of North Shore-LIJ Health System.

When physical therapy or injections fail, major back surgery can work.

But the new procedure doesn't even have a skin incision, just tiny holes where surgeons insert tools to shave down the bone and soft tissue pressing on the nerves. They watch on a tv monitor.

"You're hoping that the small amount that you can remove through the small opening are enough," Mogilner said.

He says the procedure is simple compared to standard surgery. Even pain management doctors are doing it as well as surgeons. It's done as an outpatient.

This is a really great idea, but the problem is that patients have only been followed for a year and a half.

Will improvement last a lifetime, as it does in many of the standard surgery patients? Will it last even five years? No one knows. Seventy percent of patients get better at least for eighteen months since the method has been used. Tony is one of them.

"I was able to walk home without pain," he said.

The good news is that even if the procedure doesn't work or the benefits don't last long, patients can still have the major back surgery. But again, elderly patients with other medical issues may not be candidates for the major surgery.