Back pain can be treated without surgery

Valerie (“Val”) Berzinis Mahtesian, 58, a high school computer science teacher, has always been extremely active and in good shape. A former avid runner, she travels, dances, and rides her bike in her spare time.

About five years ago, Val began experiencing severe pain in her lower back.

“Low back pain might feel like a continuous dull ache or a sudden sharp sensation that could make it difficult for some to move at all,” explains Dr. Efstathios “Steve” Papavassiliou, neurosurgeon and Co-Director of the Spine Center at Beth Israel Deaconess Medical Center. “The pain, we often call it ‘acute’ back pain, can be felt in the lower back, buttocks and/or the upper thigh areas.”

After visiting her primary care physician, Val started seeing a chiropractor and going to physical therapy. The combination of treatments helped keep her pain to a minimum for a few years.

“Eventually, the pain returned, and it was so bad that I couldn’t move or sleep at night,” recalls Val. “I was miserable and knew this was no way to live.”

The Spine Center was her next step. The Spine Center at BIDMC includes experts in neurosurgery, orthopedic surgery, pain management, physiatry, and physical therapy.

“Because Val’s back pain had been going on for a long period of time, we ordered an imaging test, an MRI, to help us determine the cause and figure out a treatment plan,” says Dr. Renee Moran, pain management specialist and anesthesiologist at the Spine Center.

Dr. Moran points out that imaging tests (X-rays, MRIs, CT scans) are not usually recommended for patients within the first month of low back pain. Most people feel better with or without any imaging tests within six weeks. The tests can be costly and usually do not change the treatment of the problem.

Val’s MRI revealed common problems due to age-related wear and tear of the spine: lumbar generation, multiple disc bulges, facet arthopathy, and severe narrowing of the spine. After thoroughly examining Val and going through her medical history, Dr. Moran recommended a lumbar epidural steroid injection as the best way to relieve her pain. She carefully explained the procedure to her.

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THE SPINAL INJECTION PROCEDURE

First, a local anesthetic is used to numb the skin. Using a fluoroscope—an instrument with a screen that shows real-time moving images in X-ray form—the lumbar vertebra and epidural space are located. Then, an anti-inflammatory steroid—a synthetic version of what your body makes naturally, only stronger—is injected with a small needle. A contrast dye or solution is also injected to confirm the correct location.

The results of the procedure are different for everyone and any decrease in pain may be only temporary. Val realized a spinal injection was her best option at this point, and she booked the procedure.

Since her first injection, Val has had a series of spinal injections. At the beginning, she had the procedure every other month. By the third injection, she felt significant relief. Each time, she felt increasingly better for a longer period of time.

Most recently, Dr. Moran concluded that Val’s sacroiliac joint (the area where the spine and pelvis bone meet) would benefit from steroid injections. Val felt good enough to wait about seven months between the last two injections, and she is hopeful about increasing that number to a year. 

“It’s working for me as a temporary solution,” says Val. “It’s not fixing the problem, but it’s getting rid of the pain.”

Val has been busy frequenting the beach, traveling every weekend, and vows to dance to live music at least once a month.

“For however long this lasts, I will enjoy it,” says Val.

A BACK INJURY

Unlike Val, Peter Donaghey, 61, had a specific incident in which he injured his back.  An electrician for a large university in Boston, Peter slipped while walking down a flight of stairs.

“The pain I felt after my fall was so severe,” Peter recalls.

His medical provider prescribed a combination of pain medication and a vigorous physical therapy regimen. But the pain didn’t go away.

Several months later, Peter was also referred to the Spine Center at BIDMC. Dr. Stefan Muzin, a physiatrist, ordered an MRI on Peter’s back.

The MRI revealed several problematic areas due to the normal aging process, as well as herniated discs made worse by his injury. Dr. Muzin recommended a transforaminal epidural spinal injection to help relieve Peter’s back pain. This injection procedure is similar to the procedure Val had, except it targets a space closer to the nerve root.

Dr. Muzin gave Peter two injections in different locations, one immediately after the other. The procedure lasted about 25 minutes.

“Everybody responds differently to injections, and on average, a patient will receive one to three injections over a period of time,” explains Dr. Muzin.

Peter felt pain relief immediately, and so far it’s lasting. He is off pain medications and doing his physical therapy exercises at home.

“I’m able to kayak again and getting ready to ready to ride a bike soon,” says Peter. “My pain is not completely gone, but it’s a lot better.”

According to Dr. Muzin, approximately 80 percent of the Spine Center’s patients benefit from conservative treatments, such as spinal injections.

“When a patient has been receiving injections for a long time, the condition worsens or the injection isn’t relieving the pain anymore, I just step out into the hall to speak with one of our spine surgeons on the Spine Center team about evaluating my patient.”

For further information about surgical and nonsurgical spine conditions and treatments—including a video series for patients about spinal injections—please visit the Spine Center.