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Praxis für Neurochirurgie
Dr. Elmar Patz
Dr. Patz with CT scan

Chronic backache

Every year an increasing number of people are suffering from pain in the back and/or neck. Although most see an improvement in their condition again, very many are affected by chronic pain. Such pain may have a number of causes (see above), with there often being more than one reason in each case. The most common cause is pain in the joints (zygapophyseal / facet joints). These joints, which connect and stabilise the spine, are known as facet joints. Another cause of chronic backache can be wear and tear of the intervertebral discs themselves. Tears or fissures may occur in the tough ring of fibre in the disc following injury or as we age. Such tears are filled with nerve endings and blood vessels.

How do we know what disease is responsible for your pain?

Pain from the facet joints (facet syndrome) is frequently described as back or neck pain, which becomes worse whenever you bend backwards or turn. Another typical sign is an increase in pain when the patient stands up from a sitting position or when "getting going" after resting for a while. The pain may take the form of a dull ache or a stabbing pain, a continuous or throbbing sensation and may be associated with muscle cramp. It can radiate into the arms or legs. In the upper neck region pain from the facet joints may result in headaches. Pain that primarily originates from the intervertebral disc itself (discogenic pain) is also perceived as backache but increases when bending over and is not so likely to radiate into the arms or legs. An MRI scan of the spine and/or an X-ray of the disc using a contrast medium will be necessary to confirm this diagnosis.

Facet denervation (coagulation of facet joints):

Facet denervation involves the application of RF current to the nerves responsible for transmitting pain signals from the facet joint to either destroy or block them temporarily. These nerves are known as medial branches and extend from the nerve roots which pass through an opening to exit the spinal cord. During the procedure you will lie facing down on an X-ray table. Your back will be washed with a disinfectant and sterile coverings placed on it. Under X-ray guidance a little needle will be positioned at the facet joint and used to insert a high-frequency probe. Sensory stimulation tests are then carried out to check that the needle is positioned at the small medial branch and not inadvertently at the nerve root. The medial branch is then destroyed by applying RF current. This is an outpatient procedure. You will have to wait between two and four weeks to enjoy the full effect. Should you still be experiencing high levels of pain until then, the facet joint can be numbed again with cortisone.

IDET (intradiscal electrothermal therapy):

The IDET procedure only involves the tissue of the intervertebral disc itself, or to be more precise, its outer ring of fibre and the posterior longitudinal ligament. This is a minimally invasive treatment, in which a little wire is used to apply heat to this specific area of the disc. The aim here is to shrink and close off fissures in the ring of fibre. The IDET technique is generally an inpatient procedure. During the procedure you will lie on your side on an X-ray table. Your back will be washed with a disinfectant and sterile coverings placed on it. A local anaesthetic will be applied to your skin and muscle tissue to make them numb. Under X-ray guidance a needle will be positioned at the intervertebral disc and used to insert a heat probe. Once the position of the probe has been checked by X-ray, the heating element is activated and slowly heated up to 80°C over a period of 15 minutes. Many patients find their symptoms temporarily worsen after the procedure, but this wears off after a week. Healing may take 12-16 weeks until final alleviation of their symptoms.

Want to learn more?
Here you will find information on intradiscal therapies
of NeuroTherm in English:

» NeuroTherm Intradiscal Therapies

Also see:

» Slipped disc
» Bony narrowing of the spinal canal
» Nerve compression syndrome of the hand
» Nerve compression syndrome of the elbow

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Praxis für Neurochirurgie · Dr. Elmar Patz · Boxgraben 95 · 52064 Aachen