Back in Action: Interventional spine care

Tossing a 50-pound bag of chicken feed, Jack Goodwater felt a twinge that meant an old back injury was acting up. Despite frequently popping over-the-counter pain relievers, he was unable to sit, walk or work for more than 20 minutes at a time last spring and early summer. “I spent a lot of time lying down with an ice pack on my back,” says Goodwater, 77, a retired construction worker and truck driver from Augusta, West Virginia. “When I drove my wife to the grocery store, I’d lie in the back seat of the car until she was done.”

Unwilling to undergo an invasive back procedure, Goodwater turned to David Essaff, DO, physician with Valley Health Interventional Pain Specialists, formerly known as Valley Health Interventional Spine. A history and exam suggested a pinched nerve was causing Goodwater’s back and leg symptoms. Imaging revealed narrowing of the spine, or spinal stenosis, which can compress and inflame nerves in the back, causing back and leg pain.

“Our plan was to target it with steroids to calm down the inflammation, reduce his pain and get him more functional,” Dr. Essaff says.

Goodwater received two spine injections in July. He felt better right away and even drove himself home after the 20-minute outpatient procedure in Winchester. Dr. Essaff says the steroid injections can reduce or even eliminate back pain for months and even years. “My pain was gone,” Goodwater says. “I can cut my 5 acres of grass on my riding mower for two or three hours now, then jump down and use the weed whacker. And my wife and I are planning a road trip to Maine in our mobile home next year. I’ve got my life back again.”

Relief Without Surgery
Interventional spine medicine uses nonsurgical interventions (such as nerve blocks and
epidurals) to treat pain in the neck and back. “We aim to identify the pain generator and treat the source,” Dr. Essaff says. Interventional approaches can ease pain for months to years; they can often be safely repeated if pain returns in the future, and may put off or eliminate the need for more invasive surgical options. Minimally invasive interventional spine procedures are guided by live X-ray imaging, called fluoroscopy.

Dr. Essaff and colleague Edward Lam, MD, are both
fellowship-trained in their field. People with back pain may see them on the advice of their primary care physician or another doctor, or make an appointment directly (with referrals as needed for insurance coverage). “Spine care has really evolved in recent years,” Dr. Lam says. “A lot of conditions that two decades ago needed procedures like spinal fusion or inserting screws can now be improved without them. It’s a continuum—some people will require surgery right away or in the future. As spine specialists, we can help determine when the best time for that is."

Once the likely source of the patient’s pain has been identified, the first line of treatment often is conservative therapies such as physical therapy and/or nonopioid medications such as anti-inflammatory drugs. “For patients who don’t respond, we offer minimally invasive procedures guided by fluoroscopy,” Dr. Essaff says. “These include steroid injections, nerve blocks, radiofrequency ablation, and implanted spinal cord stimulators.” These are usually same-day outpatient procedures with little to no downtime for recovery needed. “People often drive themselves home after injections and, in some cases, even go back to work the same day,” he says.

Getting His Swing Back
Mitch Kaas, 65, is a retired Department of Homeland Security employee who golfs three to four times a week and skis during the winter close to his home in Basye, Virginia. When back pain flared two years ago, he took pain relievers and tried to stick with his routine. “I noticed I was limiting how much I turned my body during the backswing and follow-through,” he says. “The pain was in the center of my back, shooting down my right leg.”

When physical therapy didn’t help much, his family doctor suggested an appointment with the practice. “I was trying to avoid surgery, but I didn’t want to be laid up and miss out on things like skiing with my grandchildren,” he says. A physical exam, X-rays and magnetic resonance imaging confirmed he had arthritis and a narrowing of the cushiony discs of his spine. “Dr. Lam recommended radiofrequency ablation, but first he had to confirm where the pain originated,” Kaas says. “I came to the office in pain, and he injected a temporary nerve block. I was suddenly pain-free, and we knew it was the right spot.” After repeating the test two weeks later, Dr. Lam performed radiofrequency ablation at three points along Kaas’ spine.

“Radiofrequency ablation uses a probe to heat and denature the protein in a pain-sensing nerve so the pain signals cannot reach the brain,” Dr. Lam explains. It’s a scheduled procedure that usually takes less than an hour, with no recovery downtime except avoiding baths for a few days until the area where the needlelike probe enters the skin has healed.

Kaas says he no longer needs pain relievers, and his golf scores have improved as he swings with his old form. Another benefit: “I expect to be on the slopes for hours with my
grandchildren this winter,” he says.

To learn more, visit valleyhealthlink.com/interventionalspine.