Download CONSERVATIVE CARE

CONSERVATIVE CARE
Douglas Koontz, M.D.
Neurosurgery Specialists
What does conservative care
entail?
• In neurosurgery, conservative treatment is
treatment for neck or back pain with
therapies other than surgery
• Often utilizes medication, physical therapy
and/or injections
First Evaluation
• Physical exam of the patient
- many times, the patient comes to us after
they have seen one or two other physicians
such as primary care
• History taken of pain and all complaints
- ie: numbness, tingling, etc.
• Discussion of options with the patient
Medications
• Many times the patient can be treated with
anti-inflammatory medication, steroids and
muscle relaxers.
• Take into account patients complaints,
history and medications they are already
taking
Medications
• NSAID’s or anti-inflammatories reduce
inflammation in and around the spinal area
• Steroids may be prescribed for a SHORT
amount of time. This is often known as a
Medrol Dose pack.
Medications
• Muscle relaxers can be prescribed when the
patient is experiencing spasms.
• Common forms of muscles relaxers are:
Flexeril, SOMA, Valium, Skelaxin and
Robaxin
• Side effects can include drowsiness and
dependence so these should be prescribed
with caution
Medications
• Gabapentin
• Lyrica,
• Cymbalta
• All used to treat neuropathic pain
Physical Therapy
• This should be considered if back pain has
lasted from between 2-6 weeks and the
patient has experienced no relief
• Physical therapy evaluation is the first step
- The therapist can then develop a specific
treatment plan for the patient including
many different modalities
Physical Therapy
• Aquatic therapy
- low impact exercises for patients who are in
severe pain or might have a disability that
precludes them from participating in land
based physical therapy
Physical Therapy
• TENS Unit
-involves high or low frequency stimulation
-placement of electrodes on or around the
painful area
- trials are available to see if patient
responds well to the TENS unit
Physical Therapy
• Land based, or traditional physical therapy
involves exercises meant to reduce pain.
• This can involve strengthening certain
muscle groups
• The therapist is also able to instruct the
patient with home exercises to improve
their outcome
Other Modalities
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Acupuncture
Biofeedback
Massage
Manipulation
Ultrasound
Diagnostic Testing
• Xray
-used to investigate if there is a fracture
• CT
-more in depth test to investigate any bone injuries
• MRI
-more common to order in neurosurgery
-used to diagnose soft tissue injury
Diagnostic Testing
• MRI cont.
- this diagnostic test most often helps
neurosurgeons diagnose things like herniated
disks
Diagnostic Testing
• Discogram
- This is used to locate the disk that is
generating the pain
- Performed by a pain management doctor
- Usually involves the disk above and below
the suspected “problem disk”
- Controversial
Diagnostic Testing
• CT Myelogram
- used to diagnose herniated disk, tumor,
spinal stenosis and infection
- Many times this is used after an MRI is
performed for a more detailed study
Diagnostic Testing
• EMG
- Performed by a neurologist
- Used to record activity by the muscles
- An order is an EMG of the left/right upper
extremities or the left/right lower extremities
- EXAMPLE: A patient with negative MRI but
persistent leg numbess
Epidural Steroid Injections
• Performed by a pain management
physician, usually in the hospital
• Outpatient procedure that should not
interfere with patient’s daily activities
• Using x-ray guidance, a thin needle is
inserted into the epidural space and a steroid
(cortisone) is injected
Epidural Steroid Injections
• Can be ordered in a series
• Patient will come back to see his or her
neurosurgeon approximately 2 weeks after
the procedure to gauge whether it was a
success
• Injections are considered safe and effective
as treatment for pain
Injections: Continued
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Selective Nerve Root Block
Trigger Point Injections
Facet Injections
Rhizotomy
Surgery
• Surgery is indicated if:
- Patient fails conservative treatment
- Their condition interferes with their ability to
function
- The benefits of the procedure outweigh the risks
- In some cases, the symptoms may be so severe
that conservative treatment is not an option and
surgery must be performed immediately.
Questions?