Oh, my achin’ back!

BOULDER – If you go to your doctor complaining of chronic back pain, you’re more likely than ever before to face a minimally invasive surgery, or none at all.

Many back doctors in the region now use more minimally invasive procedures, the latest trend in the industry in the last five years.

Others focus more on rehabilitation, treating back injuries with exercise and medication before turning to surgery options. And at least two medical device companies in the Boulder Valley are making back surgery products – Lanx Inc. in Broomfield and Medtronic Navigation Inc. in Louisville (See story, below).

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With back pain being the No. 2 reason patients visit their doctors (the common cold is No. 1), it’s always important to offer the least invasive surgery options, said Sharad Rajpal, a surgeon at Boulder Neurosurgical & Spine Associates in Boulder.

Rajpal said the medical navigation devices he likes to use during surgery are similar to using a GPS tracking device in terms of positioning. Such devices allow him to make smaller incisions and still be able to see everything he needs to see inside the body during surgery, Rajpal said. Medtronic Navigation Inc. in Louisville and other companies make such devices.

“It’s reduced tissue trauma, less hospital duration, less blood loss, and people say it’s less pain,” Rajpal said of surgery done using such devices.

Boulder Valley residents’ active lifestyle make for a busy practice for Rajpal – he handles about four or five surgeries per week. Back injuries he treats with surgery range from bicycle versus car injuries and rock climbing accidents to falls down the stairs, Rajpal said.

Colleague Alan Villavicencio points out that the practice offers a wide range of treatment options in advance of surgery – ranging from anti-inflammatory medications to narcotics, physical therapy, acupuncture, chiropractic care, yoga and Pilates.

“If a patient walks into my office with back pain, they have about a 1 in 10 chance of having surgery,” Villavicencio said. “The vast majority of patients do not need surgery. They can be treated conservatively.”

Villavicencio does kyphoplasty procedures for spinal compression fractures for patients who have osteoperosis. Doctors can elevate a fracture back to its normal height and inject bone cement into the space left behind in the kyphoplasty procedure. But spinal fusion surgeries remain the most common, mainly because they have become a “standard of care” to deal with back pain, Villavicencio said.

Cliff Gronseth at Spine West LLC is a physiatrist – a rehabilitation doctor who focuses on treating patients without surgery.

“We look at the whole person, the whole system, and discuss how they interact,” Gronseth said. “If somebody comes to us and complains about neck pain, we ask about their job, and what might be corrected there.”

Patients can often avoid surgeries if they change some things in their environments or in their bodies, Gronseth said. That can include having molded foot orthotics made for shoes to relieve knee and back pain. As a doctor, Gronseth said he’s trained to look for cancers and other medical issues that need to be treated surgically, too.

“We’re movement and function specialists. If people can’t do the things they want to do, like hike or bike or walk to the mailbox or garden, it’s a functional issue, and we try to figure out why they can’t do that,” Gronseth said.

If a patient needs an anti-inflammatory medication, Gronseth may recommend an herbal remedy, or a cortisone shot. Another colleague at SpineWest does acupuncture, and physical therapy is emphasized. SpineWest personnel also spend a lot of time teaching people how to prevent re-injury, Gronseth said.

Dr. Gregory Arends at the Colorado Center for Spine Medicine finds he does spinal injections and focuses on that and other nonsurgical back pain relief methods.

Many back pain issues come from normal wear and tear on the body, just like many other orthopedic problems, Arends said.

“We were not designed to live to 70 to 80 years old. Back in the day, when running around the Sarangeti (desert in Africa), the saber tooth tiger would catch the older folks,” Arends said.