You must screen patients carefully

Ensuring good outcomes for any procedure means making sure that the procedure is the right treatment for the patient's condition, and patient screening for back pain treatments is essential for success, says Didier Demesmin, MD, a pain management specialist in Milltown, NJ.

When using hydrodiscectomy to treat back pain, make sure that the patient's back pain is caused by a herniated disc and not spinal stenosis or fractures, he emphasizes. Good candidates for the procedure also must have at least 50% of their disc height, no infections, and no slippage of discs. "Once these other causes and conditions have been ruled out, hydrodiscectomy is a good choice," Demesmin says.

Most patients who are candidates for X Stop Interspinous Process Decompression System are older than the age of 50 with pain in the buttocks and legs that makes it difficult to stand and walk, says Arya Shamie, MD, a spine surgeon at Santa Monica-University of California at Los Angeles Medical Center. Not all patients with these symptoms are appropriate for the procedure, he explains. Patients with severe osteoporosis are not candidates for X Stop because the implant can cause a fracture when placed against weakened bones, and patients with more than two levels affected by lumbar spinal stenosis are not candidates, either, Shamie says. "Also, if the patient does not get relief from the pain when sitting, he or she is not a candidate," he adds.

While balloon kyphoplasty is a very successful treatment for patients with spinal fractures as a result of osteoporosis, there are some patients who should not undergo the procedure, says B. Christoph Meyer, MD, an orthopedic surgeon in Houston. Patients who are not good candidates for balloon kyphoplasty have underlying infections that can spread into the area in which you inject the cement, or they have medical conditions that increase the risk of anesthesia, he says.