Non-Surgical Diagnostics and Therapy

Physiotherapy

• Programs concentrate on:
  • Aerobic exercise - weight reduction & core strengthening
  • Core stability – transversus abdominis, multifidus, lumbar muscles
  • Flexion exercises – for those with stenotic symptoms
  • Extension exercises – for those with flexion/sitting pain (disc generated)
  • Spinal mobilisation – stretching of joints – release of contracture & synovium

Chiropractic Care

• Stretches joints beyond their physiologic range – hear pop
• Not in those with stenosis or radiculopathy

Evidence

• Both have reasonable evidence for acute pain
• Not of significant benefit in chronic back pain

Epidural Steroids

• Types:
  • Translaminar
  • Transforaminal
  • Caudal
• Aim is to decrease inflammation around nerve roots – not for myelopathy
• May help in stenosis – temporary
• Diagnostic & therapeutic value
• Transforaminal shown to be most effective (nerve root injection)

Facet Joint Injection & Denervation

• For lumbar back pain where facets are main pain generator
• No good way of diagnosing this for sure
• Usually have pain on rotation & extension
• Rule out other causes of back pain
• MRI may show facet joint high signal or degeneration
• Injection with dye to confirm – dumbbell-shaped contrast confirmatory
• RF ablation if injections work
• Denervates nerve supplying facet (middle branch of dorsal rami)

Sacroiliac Injections

• Same principle as facet injections
• Rule out other spinal pathologies
• Faber test suggests SIJ pain

Spinal Cord Monitoring

• Can be useful intra-operatively for high-risk procedures

Somatosensory Evoked Potentials (SSEPs)

• Monitor peripheral nerves during surgery (median, ulnar, tibial, peroneal)

Transcranial Motor Evoked Potentials

• Monitor corticospinal tracts for motor tract changes

EMG

• Dynamic, continuous EMG is the most common method
• Continuous reading created
• Can be monitored during key phases e.g. pedicle screw insertion