Treatments

The URMC Spine Center offers a full range of progressive treatment options -- from education and conservative rehabilitation measures to minimally invasive procedures to the most complex of surgeries. Our philosophy is to carefully work through the pros and cons of alternative treatments with you. We’ll always recommend the least invasive procedure that can still deliver optimal mobility and pain relief over the long term.

Conservative Treatments

The vast majority of symptoms related to spinal conditions can be treated conservatively with relative rest, education, activity, and/or work modification, bracing, medication, and/or active physical rehabilitation. These measures are almost always incorporated into the treatment program of spinal conditions as they empower patients to be proactive with acute management and can be crucial in achieving long-term success.

Activity Modification

Short periods of relative rest and/or restriction or modification of certain activities may be prescribed depending on any given patient's diagnosis and unique work or lifestyle.

Orthotics (Braces)

Neck, mid back or low back bracing may be required for certain types of spinal conditions, most commonly to stabilize spinal fractures post-operatively.

Passive Rehabilitation

The utilization of heat, ice, mild electrical stimulation, ultrasound, relaxation techniques, pool therapy, etc. may be recommended for certain spinal conditions and commonly associated adjuvant conditions.

Medication

Medication may be utilized to assist in pain tolerance, muscle spasm control, and sleep deprivation in order to facilitate physical rehabilitation and functioning.

Physical Rehabilitation

Diagnosis-specific physical therapy programs are commonly prescribed with a physical therapist who has expertise in the rehabilitation of spinal conditions to help maximize patient function and return to an active lifestyle.

Non-surgical and Minimally Invasive Spinal Procedures

X-ray guided diagnosis-specific spine injections may be performed to resolve inflammation and swelling on a specific spine structure and allow some of the body's own healing mechanisms to repair structural abnormalities. X-ray guided and/or minimally invasive surgical procedures can be performed to remove portions of herniated discs, cement fractures, and heat internally torn and disrupted discs.

Image-Guided Spine-Specific Injections

Our interventional spine specialists are experts at utilizing x-ray guidance to deliver powerful anti-inflammatory medication (cortisone) safely and precisely to the potentially inflamed swollen spinal structure responsible for your symptoms. This more specific approach replaces the more traditional method of general blind epidural injections, which are non-specific and performed without x-ray guidance.

Guide to Spine Injection Procedures.

Facet Join Injections

Sacroiliac Joint Steroid Injection

Intradiscal Electrothermal Therapy/Annuloplasty (IDET)

This minimally invasive outpatient spinal procedure is utilized to relieve low back pain emanating from structural lesions within an internally compromised painful disc. A catheter is inserted into the outer portion of the painful disc under X-ray guidance. Then, a wire is guided through the catheter around the outer rim of the disc positioned to cover any cracks or tears within the disc. Once in position, the wire is heated to 90 degrees C over 16.5 minutes. This process can potentially tighten the loose protein molecules of the disk, seal painful cuts and tears in the outer portion of the disk, and cauterize small pain producing nerve fibers within the outer rim of the disc resulting in a firmer and less painful disk. IV pain medication is given throughout the procedure to control discomfort.

Percutaneous Disc Decompression via Nucleoplasty

This minimally invasive outpatient spinal procedure is utilized to decompress or relieve pressure on a spinal nerve from a small to medium sized herniated disc. A catheter is inserted into the herniated disc under x-ray guidance and a special type of radiofrequency energy field called coblation, or controlled ablation, creates channels within the center of the herniated disc allowing for the herniated portion to resorb back to fill the channel via a negative pressure effect and relieve the pressure on the spinal nerve. IV pain medication is given throughout the procedure to control discomfort.

Radiofrequency Ablation

Spinal Surgery

90% of patients with back and neck problems will improve significantly without surgery. However, when non-surgical methods prove unhelpful, surgery may be your best alternative. The URMC Spine Center has an expert team of orthopaedic surgeons who perform a full range of surgical procedures. Before surgery, each patient meets with a surgeon to explore all options, discuss pre-operative and post-operative procedures and any questions or concerns.

Discectomy

A discectomy involves the removal of a portion of a disk to relieve pressure on a nerve. It can be done as an endoscopic discectomy (or percutaneous arthroscopic discectomy), a microdiscectomy or an open discectomy. An incision is made, and the herniated disk and any loose pieces are removed. Ideally, just the fragment of disk that is pinching the nerve will be removed, leaving some of the disk intact.

Foraminotomy and Foraminectomy

These procedures are commonly done to treat narrowing of the spinal canal (spinal stenosis), lateral disk herniations or facet arthritis. The foramen is the space in the vertebrae where the nerve roots exit on their path to a specific tissue or organ. In both surgeries, this opening is expanded by removing bone and soft tissue to provide more space for the exiting nerve roots. When surgery involves removing a large amount of bone and other tissue, it is called a foraminectomy.

Kyphoplasty

Kyphoplasty is a minimally invasive procedure used for the treatment of compression fractures of the spine, usually due to osteoporosis. A person with multiple compression fractures might appear hunched, with a rounded back. With kyphoplasty, a surgeon inserts and then inflates a balloon into the fractured vertebrae to create a cavity within the bone. The cavity is then filled with bone cement to strengthen the bone. After the procedure, most patients report a dramatic improvement in pain, quality of life, and the ability to participate in everyday activities.

Kyphoplasty

Laminotomy and laminectomy

Both of these procedures involve removing a small amount of the bone over the spinal canal (lamina) to eliminate a source of compression on the spinal cord or nerve root in any part of the back. This source of compression may be part of a herniated disk, vertebra fragment, spinal cord tumor, aneurysm, narrowing of the spinal canal (spinal stenosis) or rough protrusion of bone called a bone spur. During a laminotomy just a portion of lamina is removed to, relieve pressure on a nerve or allow the surgeon access to a disk that's pressing on a nerve. A laminectomy involves removal of the entire lamina.

Laminectomy