Physiotherapy
- Programs concentrate on:
- Aerobic exercise - weight reduction & core strengthening
- Core stability – transversus abdominis, multifidus, lumbar muscles
- Flexion exercises – for those with stenotic symptoms
- Extension exercises – for those with flexion/sitting pain (disc generated)
- Spinal mobilisation – stretching of joints – release of contracture & synovium
Chiropractic Care
- Stretches joints beyond their physiologic range – hear pop
- Not in those with stenosis or radiculopathy
Evidence
- Both have reasonable evidence for acute pain
- Not of significant benefit in chronic back pain
Epidural Steroids
- Types:
- Translaminar
- Transforaminal
- Caudal
- Aim is to decrease inflammation around nerve roots – not for myelopathy
- May help in stenosis – temporary
- Diagnostic & therapeutic value
- Transforaminal shown to be most effective (nerve root injection)
Facet Joint Injection & Denervation
- For lumbar back pain where facets are main pain generator
- No good way of diagnosing this for sure
- Usually have pain on rotation & extension
- Rule out other causes of back pain
- MRI may show facet joint high signal or degeneration
- Injection with dye to confirm – dumbbell-shaped contrast confirmatory
- RF ablation if injections work
- Denervates nerve supplying facet (middle branch of dorsal rami)
Sacroiliac Injections
- Same principle as facet injections
- Rule out other spinal pathologies
- Faber test suggests SIJ pain
Spinal Cord Monitoring
- Can be useful intra-operatively for high-risk procedures
Somatosensory Evoked Potentials (SSEPs)
- Monitor peripheral nerves during surgery (median, ulnar, tibial, peroneal)
Transcranial Motor Evoked Potentials
- Monitor corticospinal tracts for motor tract changes
EMG
- Dynamic, continuous EMG is the most common method
- Continuous reading created
- Can be monitored during key phases e.g. pedicle screw insertion
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