M.D. News
“Does your patient have constant back pain?”

Laser techniques propel spinal pain management into the future

By Cerise Preston

Chronic back pain is one of the most common ailments in America today, almost as common as the cold. Yet, doctors and surgeons have found it difficult to effectively treat many of the causes of this pain without ultra-invasive open back surgery. Until now.

The Foothills Regional Pain Center, located right here in the Upstate’s Seneca, SC, is a facility which features one of the newest technological advancements in the field of spinal pain management, laser disc decompression. Using laser technology and advanced imaging techniques, pain management specialists can now find, diagnose, and correct most chronic back problems in a time and cost effective, minimally invasive way.

“I have several patients with chronic back pain. How do I know if they are eligible for this treatment?”

Natural spontaneous healing generally occurs within six to twelve months for 90-95% of the population with spinal pain. The average patient becomes eligible for this type of treatment after experiencing six to twelve months of unrelenting back pain, which may also be accompanied by chronic pain in the extremities, often caused by nerve root compression. Most patients with persistent back pain are first prescribed the traditional conservative remedies during this time, which include medication and exercise. If these do not prove effective, that provides another indication that a patient may be a good candidate for the laser treatment. 

“I’ve been treating this patient for over a year. Why should I send him to you now?”

Dr. Marion McMillan, one of the specialists at the Foothills Regional Pain Center in Seneca, notes that during his experience as a physician, the field of spinal pain management had remained relatively unchanged over the past 10-12 years prior to this development. The main focus has been to cover the pain. “There has now been a paradigm shift in the approach to the patient with spinal pain,” Dr. McMillan observes. With the advent of these laser-based techniques, there is a way to reduce back pain without requiring a patient to undergo open back or neck surgery with its increased costs, risks and complications. Laser technology renders the surgery safer, more precise, cost-effective, and minimally invasive when compared with conventional surgery methods. Also, the surgery can correct pathologic changes caused by herniated discs. Dr. McMillan believes that in the next 5-10 years, this laser surgery will become the standard of care not only for the treatment of herniated and ruptured discs, but also for discs that are degenerating in that direction. 

“I have decided to pursue this line of treatment with one of my patients. Now what?”

The specialists will perform a medical history and physical, specifically looking for signs of discogenic pain and evidence of nerve root compression. Other diagnostic tools include detailed neurological testing, MRI scan, and cervical and lumbar discography. The MRI scan is the most helpful and information-rich source to doctors aside from the bedside examination. Cervical and lumbar discography can reveal degenerative disc disease and herniated discs, and determine the disc level responsible for pain symptoms. Sophisticated diagnostic methods are used as well to establish relationships between the anatomic abnormalities discovered during the testing, and what the patient describes themselves as feeling.

After the combination of a good medical examination, review of patient records, and review of imaging tests, they can say with 95% accuracy if the patient has disc-related pain. If he does, the consequences and number of discs affected can also be determined. Dr. McMillan explains further. “One of the beautiful things about the laser is: because of it’s minimally invasive, precise nature, one, two or three discs can be treated simultaneously with no additional increase in morbidity for the patient.” This way, you don’t have to wait until a problem becomes debilitating to treat it, yet the level of patient risk remains relatively static.

How long is the recovery time?

Most patients are ambulatory approximately 45 minutes after the procedure. For those whose jobs and lifestyles require a low level of physical activity, they can return to work after three to five days of bed rest. A longer 2-4 week period before returning to work is required for those patients with high activity lifestyles. The need for physical therapy may impact the length of recovery time, but both high and low activity recovery times are estimated to be 1/5 the amount of convalescence needed for open back surgery.

When the patient has fully recovered, the average result is a 70% reduction of previous pain in 80% of those treated. Though traditional methods usually only ameliorated leg pain, the laser surgery helps disc-related spinal pain in addition to nerve compression pain in the arms and legs.

Studies are still being conducted locally and nationally in this new technology. Dr. McMillan cites a possible 20-30% failure rate, and a 1/500 to 1/1000 chance that the patient may contract a disc infection. Unintentional perforation of the abdominal organs has been reported from misuse of the laser by inappropriately trained individuals. Neither complication has been observed at the Seneca facility.

You can contact the Foothills Regional Pain Center for more information and referral assistance on their website, located at www.foothillspain.com, or by phone at (864) 886-9888.

The Men Behind the Medicine –Profiles

DR. MARION MCMILLAN (right) is originally from Atlanta, GA, but traveled around the United States during his schooling. He has attended Yale University, Tufts University, the University of Pennsylvania, and the National Naval Medical Center. He is married with three children, and likes to spend his free time hunting and fishing. He is also on the Board of Directors at his local church, United Assembly of God in Seneca, SC.

DR. PICKENS PATTERSON (left) is also from Atlanta. He attended Hampton University and has recently completed his formal medical education from the Medical College of Georgia and Vanderbilt University. He is newly married, and enjoys spending time with his wife, Cristale, establishing their new home in Seneca. His hobbies include fishing and lifting weights.

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