Recent Advances in Back and Neck Pain Management

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Recent Advances in Back and Neck Pain Management
WWW.SPINE-UNIT.COM

• Manoj Krishna, FRCS, MCh(Orth)
• Consultant Orthopedic and Spine Surgeon

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Importance of spinal muscles

• 2 patients with identical severe degeneration on
  MRI scans
• One has no pain
• The other is crippled with pain
• WHY?

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Continuing mysteries

• Mechanism of back pain production
• Interaction with Psyche
• Correlation of pain and MRI scans

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Psychology and Pain

• Now accepted that pain causes psychological
  distress
• Pain can also be the first symptom of clinical
  depression

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Back Pain Rx Whats New?

• Spinal Rehabilitation Program
• Interbody Fusion
• Disc Replacement
• Intra-Discal Electrothermal Therapy
• Biological Solutions

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Disc Replacement

• Plastic spacer between 2 metallic plates
• Since 1980s
• Technical problems still exist
• Use not widespread
• Indicated in young people - lt 30
• Will mature in next 5-10 years
• 70 good or excellent results

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IDET Intradiscal thermal annuloplasty

• Insert catheter into disc
• Heat it to 70º
• Burns nerve endings
• Annulus fibres break up and re-form on cooling -
  ? Repairs tears
• 50 chance of being 50 better
• Still experimental

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Biological Solutions

• Disc cell aspiration
• Disc cell culture
• Injection of these cells back into disc
• Experimental

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BMP

• Proteins involved in bone healing isolated
• Duplicated using genetic techniques
• In future we will not need to harvest bone
  grafts for fusion. Reduce morbidity.

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• Most patients feel frustrated that their
  doctors do not take their pain seriously enough
• Enormous delays in the system increases their
  distress

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IDET - indications

• Good disc height
• Positive Discography

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Neck Pain whats new?

• Disc as pain source
• Discography to identify painful disc
• Fusion of painful disc
• Disc replacement experimental

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Litigation and Pain

• Very few true malingerers
• May exaggerate extent of pain and disability
• Pain can continue after case settles
• Most improve after successful surgery

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• For too long clinicians have used excuses to
  hide their lack of understanding of the problem
  and the consequent failure of treatment
• These include
• Patient is mad
• Its all caused by the depression
• Hes making it up for secondary gain

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• If being disabled pays more than being
  unemployed and as much as the minimum wage its
  easy to understand the temptation to use back
  pain as an easy way out
• Back pain disability in Sweden fell
  proportionately to the drop in disability
  benefits for it