e-book Non-Operative Treatment of the Lumbar Spine

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This study was significant in determining the effectiveness of bracing, as compared with observation, in prevention of curve progression to 50 degrees or a recommendation for surgery. Twenty five institutions throughout the US and Canada collected data on patients who had curves for which bracing was indicated degrees.


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The participants were aged years old, and had Risser scores of indicating growth was not yet complete. One hundred forty six patients wore braces for the study, while 96 were observed only for curve progression. Patients were evaluated, including x-ray, every 6 months during the study. Bracing success was defined as reaching skeletal maturity the end of growth without progression to a 50 degree curve. Additionally, the amount of time the patient wore a brace correlated with the rate of success. This was similar to the results of those who were observed without wearing a brace.

The BRAIST study provides strong support for the conclusion that bracing reduces the risk of curve progression and need for surgery. It also shows the importance of wearing a brace for the prescribed number of hours per day. The Schrot h Method. Yoga and Pilates are great ways to stretch and strengthen your back. They improve core strength, which supports the spine and assists in posture. Practice either activity to your comfort level. In many cases, informing the instructor that you have a spinal condition will prompt him or her to offer variations of the postures.

Additionally, we have resources in our office for scoliosis-specific yoga instruction. Swimming is an exceptional form of exercise that allows you to obtain physical activity with reduced effects of gravity. We may instruct additional exercises or individualized therapy to compliment your condition. Combining Vitamin D with calcium is a promising therapy capable of preventing the progression of scoliosis curvature.

Subjects in the study with a curvature of 15 degrees or more who were also suffering from reduced bone mass, responded favorably to supplementation. There is hope that this therapeutic approach will revolutionize the treatment of AIS. Halting progression worsening of a curve.

How long is a brace worn? Time in brace:.

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Time out of brace:. The Boston Brace has been the standard for bracing care over many years. Our patients using this brace have had considerable success in their treatment. The Charleston and the Providence Bending Brace have allowed patients to receive correction during nighttime wear.


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It is especially customized to the patient, lightweight, breathable and provides personalized scoliosis treatment. Our expert surgeons will chart the best course of treatment for whatever condition you are suffering from. Physical therapy helps build strength, flexibility, and endurance while providing an opportunity to learn proper body mechanics to keep the spine stable and prevent injuries.

Physical therapy includes therapeutic exercises, orthopedic manipulation and mobilization, Transcutaneous Electrical Nerve Stimulation TENS , and myofascial release techniques. Physical therapy may include ultrasound, ice and heat therapies to improve or maintain functional abilities associated with the activities of daily living. Healing through physical therapy, or functional rehabilitation , is one of our preferred non-operative treatment solutions that involve passive therapies, including Orthopaedic Manipulation, Aquatic Therapy and Exercise, and Biomechanics.

Interventional pain management includes nerve block medications, epidural steroid injections, and radiofrequency nerve ablation. The Interventional Pain management option, or injection therapy, may be used to control pain from spine disorders. In conjunction with Interventional Pain management, patients may be prescribed pain medication, or Pharmacological pain management , to relieve discomfort due to back and neck pain.

Pharmacological pain management techniques feature the use of medications, such as opioids, muscle relaxants, and non-steroidal anti-inflammatory drugs to alleviate pain. Spinal bracing uses stiff plastic braces to mobilize and support the spine.


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Depending on the severity of the condition, either soft or rigid braces may be supplemented to any treatment plan. Contact us today to learn more. Main Menu. Physical Therapy Physical therapy helps build strength, flexibility, and endurance while providing an opportunity to learn proper body mechanics to keep the spine stable and prevent injuries.

Despite this, patients who do not tolerate the transition to exercise may benefit from limited passive treatments such as therapeutic modalities of heat, ultrasound, and soft tissue mobilization. Patients who achieve a longer state of remission of pain symptoms can participate in cardiovascular conditioning exercise. Although maintaining flexibility and some degree of trunk strength through a program of daily exercise seems to make sense, only fitness has been implied as preventative for lower back pain.

Progressive neurologic deficit or cauda equina syndrome in association with lumbar spinal stenosis are indications for urgent operative intervention. One study revealed that nonprogressive neurologic deficit pin prick, vibration, reflexes, leg muscle power correlated poorly with patients pain and physical disability, 32 and therefore should not be a reason for operative intervention.

Back pain, leg pain, and myofacial pain can be addressed as three separate conditions that require proportional treatment. Most patients will have some component of all three conditions. Leg pain must be evaluated carefully by the clinician. Leg pain not directly attributable to radiculopathy may result from hip bursitis, osteoarthritis of the hip or knee, or myofacial pain.

Oral analgesic medication can be divided into several categories. Most patients should undergo a trial of antiinflammatory medication. Pain-altering medications include tricyclic antidepressants and anticonvulsants. The mechanism for gabapentin has yet to be elucidated. One recent study suggested the efficacy for gabapentin in the treatment of patients with neuropathic or myofacial pain. Besides blockade of norepinephrine uptake, the antagonist action on the N-methyl D-aspartate receptor has been implied. Epidural steroid injection is warranted before initiating physical therapy in patients with persistent moderate to severe leg pain.

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Patients with proportionally more back pain and myofacial pain or only mild leg pain can begin a trial of therapy immediately. If they fail to respond after a numerous weeks of physical therapy, epidural steroid injection can be suggested with the provisory that chances of success are less than for leg pain treatment. Patients with unresponsive back and myofacial pain may undergo trigger point or flouroscopically guided lumbar facet joint injection.

Facet injections may be more beneficial for patients with conditions complicated by severe facet joint osteoarthritis, facet cyst formation, degenerative spondylolisthesis, scoliosis, or hyperlordosis. However, none of these structural factors has been shown to correlate with facet joint injection outcome. The author recently analyzed results of his patients undergoing aggressive nonsurgical treatment using a previously validated outcome measure for lumbar spinal stenosis. Patients had to have undergone at least 6 weeks of conservative treatment consisting of therapeutic exercise, epidural steroid injection, or both.

Patients with previous spinal surgery were excluded. Some data were collected in a prospective fashion. On the initial visit, patients rated back and leg pain on a scale of 0 to 10, and rated overall daily anxiety and depression levels on a scale of 0 to Patients also completed a Roland-Morris disability scale. The worst manual muscle scores at each root level L4, L5, S1 from both sides were added. Radiographic central stenosis was rated as mild, moderate, or severe. The number of moderate to severe levels was counted. The outcome questionnaire was adopted from Stucki et al. The severity was rated as none, mild, moderate, severe, and very severe.

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The two questions regarding function asked how far the patient could walk and whether he or she could walk outdoors or in malls for pleasure. A final question was added to determine whether overall patients sustained improvement, mild improvement, no change, probably worse, or definitely worse. To summarize the 13 questions, three summary variables were created: a summary pain score equal to the sum of the six questions regarding pain, a summary function score equal to the sum of the two questions regarding function, and a summary satisfaction score equal to the sum of the five questions regarding satisfaction.

A global outcome score, the sum of all 13 questions, also was created. Relationships between the Likert questions were analyzed using the nonparametric signed rank and rank sum tests. Outcome scores including comparisons before and after treatment also were analyzed for patients who underwent surgery and patients who did not undergo surgery.

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Fifty-five patients satisfied the criteria for the study. Six patients were not included one patient died of cardiac arrest, two had severe strokes, one had many compression fractures, one of the patients with stroke also had diabetic leg ulcers, and two were lost to followup , leaving 49 patients 15 men, 34 women. The average age of the patients was 69 years range, 53—87 years , and the mean followup was 33 months range, 16—55 months.

The baseline status of the patients was assessed Table 1. Nine patients required surgical treatment after unsatisfactory nonoperative results at a mean time of 13 months range, 2—41 months. Two of 40 patients who were treated nonoperatively had significant motor deterioration two points or more decreased motor score.

These two patients opted against surgery because of their age and incipient risks. No significant change occurred for the two questions regarding function.

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Non-Surgical Treatment for a Lumbar Herniated Disc

Overall patent satisfaction was related to the pain scores but not to the numbness, weakness, or functional score. Older patients seemed to have worse outcomes global score, overall satisfaction, improvement. No other feature of radiographic severity was correlated with nonoperative outcome. Depression scores were not correlated with worse pain scores. Numerous other nonoperative outcome studies for lumbar spinal stenosis have been published.

The patients received no specific nonoperative therapy.

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