New procedure brings relief to some back pain sufferers
Low back pain can be as simple as bending over and feeling a pinch in your back that goes away as you straighten up or as complicated as constant pain with most movement almost every day.
While those with constant or chronic pain often find diagnosis and treatment complicated, lengthy, and not always successful, there is hope on the horizon with a new procedure that shows promise in eliminating low back pain.
“Intracept® is a new surgical procedure designed to treat the pain caused by irritation of the basivertebral nerve as a result of stress-induced degeneration of the disc,” said Paul Houle, MD, FAANS, a neurosurgeon with Cape Cod Healthcare. “It is a very minimally invasive procedure that takes less than an hour to perform and is done as an outpatient, and you can go home the same day.”
The procedure involves inserting a small probe into the portion of the vertebrae where the nerve fibers are. The tip of the probe is heated with radio frequency waves to a specific temperature for a specific amount of time, which destroys the nerve.
“The important part of this procedure is that the nerve is within the vertebrae, not the disc,” said Dr. Houle. “For so long, we’ve been focusing on the disc as the generator of pain, and by fusing the disc, we assumed patients would get better. That didn’t always turn out to be the case.”
Multiple studies have demonstrated significant pain relief for up to five years after the Intracept procedure, said Dr. Houle. “Pain relief is not immediate because there is some inflammation following the procedure, so it takes a couple of weeks for the pain to go away,” he said.
Eligibility for the Procedure
There are many reasons for low back pain and many diagnoses involving the spine, vertebrae, discs, and nerves that can lead to various forms of treatment, such as physical therapy, injections and surgeries. Often, results are 50/50, said Dr. Houle.
“We try to hone in on the causes of the low back pain,” he said. “Every type of procedure we do is a balance between the risk and the benefits. Keep in mind, back pain is so multifactorial and the expectation that one procedure will eliminate all causes of back pain all the time is often times unreasonable.”
One of the qualifiers for candidates for the Intracept® procedure is the absence of radiating pain to the legs.
“The difficulty is identifying those patients who just have low back pain, which we call axial pain, that doesn’t radiate into the legs,” said Dr. Houle. “Right off the bat, with our treatment algorithm, that puts you down the path of the possibility of being a candidate for the Intracept procedure.”
Another is Modic changes on an MRI, which are alterations in signal intensity of bone marrow adjacent to a degenerated disc. Modic type 1 has been specifically linked to low back pain.
Dr. Houle said an important aspect of meeting criteria for this treatment is a good medical history and listening to the patient.
“One of my professors used to say, ‘if you just listen to the patient and ask the right questions, the patient is going to tell you what their diagnosis is,’” Dr. Houle said.
The Intracept® procedure has the potential to help a lot of people, he said. “For the younger population, it holds a lot of promise because it can potentially eliminate a lumbar fusion, which was the only treatment we had in our toolbox, and had consequences down the road,” he said.
“I tell my patients I may not be able to make you completely pain-free but I’m going to try to make you pain better, so if you do have pain, especially as you get older, it doesn’t bother you or prevent you from doing the things you want to do.”