Barring any serious causes to back pain like fracture, infection or cancer, physicians typically recommend conservative, non-pharmacologic and non-surgical treatment options to most patients.
Fortunately, there are safe and effective treatment options for back pain, spine disorders and injuries. Your doctor will assess your back problem and overall physical condition and work with you to find the best course of action for you, which may include more than one type of treatment.
When a more serious condition is diagnosed, your doctor may recommend surgery, radiation therapy, chemotherapy or a combination of treatments. If you are referred for any of these types of treatments, there may be many more experts throughout your treatment journey including rehabilitation specialists, neuropsychologists and psychiatrists, endocrinologists, ophthalmologists, dentists, pharmacists and nutritionists.
Treatment Options for Spine Conditions
Non-Surgical
There is a range of conservative, non-surgical options that can be effective in treating many spinal injuries and conditions. Your options may include pain medications, physical therapy, electrical stimulation, alternative therapies, and behavior modification.
Spinal Surgery / Image Guided Surgery
Depending upon your diagnosis, your doctor may recommend surgery
Surgery is typically considered when a number of factors favor this option.
You will meet with your surgical team of experts headed by your spinal neurosurgeon or spinal orthopedic surgeon to discuss the goals of your surgery, which may include symptom relief, removing primary spinal tumors or controlling metastatic tumors.
In 2011, more than 740,000 people underwent spinal surgery in the United States, with spinal fusion, discectomy, spinal device implantation and spinal decompression the most common of those procedures.1
The three basic types of back surgery:
There are many other types of surgical procedures used to treat the spine:
In order to support clinicians during these types of procedures, advanced surgical technologies and techniques are being continuously developed and improved upon. Some types of surgery are more invasive than others with longer hospital stays and healing periods. There are a lot of factors to discuss with your doctor including healing process, post-surgery function considerations, the type of surgery being recommended, e.g., open, minimally invasive or percutaneous as well as the technologies that may be used.
Surgical Approaches
In addition to discussing the way that the surgery will be approached, spine surgeons also review the type of technique that will be used:
Minimally Invasive Surgery Today, many spine surgeries are performed using minimally invasive spine surgery (MISS) techniques, allowing surgeons to limit the dissection and exposure during the procedure.Unlike open surgery where a five to six inch incision is created, MISS incisions are typically 50% smaller. This technique still allows the surgeon to access the location where the spine problem exists, but by limiting the size of the incision in the back, MISS helps avoid significant damage to the muscles surrounding the spine. This typically results in less bleeding, less pain after surgery, shorter stays in the hospital and faster recovery.2
Common minimally invasive spine procedures include lumbar discectomy and lumbar fusion. In these less invasive spine surgeries, doctors use specialized instruments to access the spine through small incisions.
Sophisticated surgical technologies, including precision navigation systems and intraoperative imaging, are available to help enable minimally invasive surgeries. These computer-based systems are designed to help assess a patient case, plan the surgery and actually mirror the real human anatomy on screen—helping to guide the surgeon through important surgical steps during the procedure.
Visit our Understand Image Guided Surgery for Spine Disorders to explore spinal surgery using image guidance, or surgical navigation.
Radiation Therapy
If you are diagnosed with a spinal tumor or metastasis—cancer that has spread to the spine from another area of the body—you may undergo surgery and/or radiation therapy. For this journey, you will have a cancer care team made up of different specialists such as neuro-oncology, neurosurgery, otolaryngology (head and neck surgery), neurology, radiology, radiation oncology and pathology.
Doctors use radiation to target cancer cells with the goal of stopping tumor growth and destroying the cancer cells, while causing minimal impact to the spinal cord and healthy surrounding tissue. The most common treatments for spinal tumors and spine metastases—cancer that has spread to the spine from another part of the body—are external beam radiation therapy and stereotactic radiosurgery, both of which are delivered from a machine outside the patient’s body. In some cases, intraoperative brachytherapy may be used as an adjunct therapy or alternative therapy when all others have been exhausted.3
External beam radiation therapy can be given in a single treatment or over several appointments, called fractions, or sessions. Stereotactic radiosurgery (SRS) and fractionated radiation therapy deliver targeted radiation to the tumor while protecting surrounding healthy tissue and critical structures.
Learn more about radiation therapy for spine tumors in Understand Radiation Therapy for Spine Disorders
Chemotherapy
Chemotherapy, or chemo, is the use of chemical substances, also called anti-cancer drugs and chemotherapeutic agents, to kill cancer cells. If you are prescribed chemotherapy, you may receive it in the form of pills that you take orally or it may be given intravenously.
Chemo is not as helpful for treating spinal cord tumors, so it is used less often for these tumors.4
If you have cancer that comes back (recurrent cancer) or spreads to another part of your body (metastatic cancer), chemotherapy may be prescribed to destroy these cells.
Immunotherapy
Newer therapies, like immunotherapy, use the immune system to help attack cancer from the inside. Many of these treatments are still experimental and may not work for specific spinal conditions.
Combination Therapies
Clinicians may elect to combine therapies in order to best remove a tumor or tumors from the spine. One example is the surgical removal of the tumor followed by radiation therapy to eradicate any cancerous cells left after the surgery is completed.
1 http://www.boneandjointburden.org/2014-report/iie0/spine-procedures
2 https://orthoinfo.aaos.org/en/treatment/minimally-invasive-spine-surgery/
3 Scott L. Zuckerman, Jaims Lim, Yoshiya Yamada, Mark H. Bilsky, Ilya Laufer, Brachytherapy in Spinal Tumors: A Systematic Review, World Neurosurgery, 2018.
4 American Cancer Society
