According to Dr. Daniel Nemeth, owner and interventional spine specialist at Signe Spine & Rehab LLC in Mount Pleasant, there has .been a shift to put greater focus on conservative treatments of spinal issues. These approaches, he said, include core strengthening exercises and less emphasis on invasive treatments or surgeries, unless clinically recommended for issues like progressive weakness or bowel and bladder involvement.
“It has been well-documented that traditional surgery produces poor outcomes for axial low back pain,” said Nemeth. “Other conservative measures that have been beneficial include the use of radiofrequency ablation for facet mediated pain and sometimes spinal cord stimulation to help with chronic pain management. Another big shift in the past 10 to 15 years has been moving away from chronic opiate therapy to manage chronic low back pain.”
Nemeth was trained in a conservative approach to physical medicine and spine care and can recognize when surgical intervention is necessary. He believes in a diagnostic approach in order to find the exact cause of a patient’s problem, and this approach enables him to provide targeted therapy so maximal benefit can be achieved.
According to Nemeth, his patients respond favorably to a targeted treatment protocol. “My goal is to identify the pain generator in order to provide targeted treatment. The interventional procedures I perform, such as epidural injections, facet injections and radiofrequency ablations, typically work best when coupled with a strong neutral spine home exercise program to offload the disc and joints and prevent further degeneration,” he explained.
Nemeth said that in many cases, surgery is the last option in the treatment of spinal issues. Still, there are cases when patients have a rapid and progressive loss in strength and balance or loss of bowel/bladder control, where surgery becomes necessary.
“Spinal degeneration is common in older individuals,” said Nemeth. “But degeneration alone is not always necessarily painful. When that degeneration leads to severe arthritis, tears or herniations of the disc and nerve root impingement, the patients typically will have increasing pain that will require medical intervention. Spinal degeneration is becoming increasingly more common as the average lifespan increases.”
Spinal degeneration and injuries are equal among males and females, reported Nemeth. “The only instance where I believe females have more common back pain is with sacroiliac joint dysfunction during pregnancy,” he noted.
The longer we live, the more likely it is that we may suffer from other ailments, such as cancer and tumors, he added. “As the average lifespan increases, this is one category where we will likely see an increase in metastasis to the spine, which is currently very uncommon.”
The doctor believes that spine research “is headed into less invasive and more conservative treatments. We are finding that less is usually more in regard to spinal treatment. We are also hopeful that lumbar fusions will soon be replaced with lumbar disc replacement surgery to prevent what we call adjacent segment breakdown. Currently, there is limited evidence that lumbar disc replacements are superior to lumbar fusions; however, with improved technological advancements, this may change in the future.”
For more information on Signe Spine & Rehab LLC, visit www.signespine.com.