B a c k / N e c k
Surgical and non-surgical interventions for spinal disorders
B a c k / N e c k
Orthopaedic and Spinal Surgeon
MBBS (Hons 1) MS (Ortho) Dip. Anat FRACS FAOrthA PFET (Spine) GEPI CIME
Adjunct Assistant Professor, Bond University, Queensland
P - 0499 NEC BAC
[0499 632 222]
F - (07) 3009 9992
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P.O. Box 211 Isle of Capri QLD 4217
Non-surgical treatments for Neck & Low Back Pain
CAUSE / TARGET TREATMENT OPTIONS Efficacy/Evidence
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Disc Disc biacuplasty High (RCT)
(Back) Intradiscal biologics (PRP/Stem Cell/A2M*/Discseel*) Mixed
Disc-FX/Annuloplasty/Plasma disc decompression Mixed
Hydrafil*/ PerQdisc* Mixed
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Vertebrae Basivertebral nerve ablation High (RCT)
​(Back/Thoracic)
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Facet Facet blocks (local/steroid) Short term
(Back/Neck/Thoracic) Radiofrequency Facet denervation/pulsing Mixed
Endoscopic medial branch rhyzotomy Medium term
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Poor Muscular control/ Restorative neurostimulation [Reactiv8] High (RCT)
Instability (Back) (Please visit 'Multifidus' page)
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Interspinous impingement Steroids, -
(Back)​ Endoscopic osteoplasty
Irritated nerves Epidural or nerve root steroid; PRP Short term
(Back/Neck/Thoracic) Nerve pulsing Short-medium term
Dorsal root ganglion stimulation Mixed
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Sacroiliac joint /Cluneal pain Steroid injections/Fibrous PRP Short term
(Back) Radiofrequency denervation; Endoscopic RF Short-medium term
Cooled radiofrequency Medium term - High Level
Peripheral cluneal stim. (Stimwave/Nalu*)
Fracture Vertebroplasty/kyphoplasty* Mixed
(Back/Neck/Thoracic) Gray ramus communicans block Short term
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Post spinal surgery Spinal (dorsal column) stimulation High (RCT)
[No surgical target]
(Back/Neck/Thoracic)
From top left, clockwise to bottom left:
Interlaminar Epidural,
Radiofrequency facet denervation, Nerve root pulsing, Disc biacuplasty,
Multifidus (ReActiv8TM) and spinal cord stimulation, Basivertebral nerve ablation, Sacroiliac joint injection
To learn more about surgical options click other website options to right
For layperson consumer summary of surgical treatment for back pain - disc replacement vs fusion (USA) please visit:
https://www.verywellhealth.com/total-disc-replacement-or-spinal-fusion-297279
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For an academic summary of operative management please see review which Dr Zotti helped to author:
Please note that the above algorithm is suggestive and does not constitute medical advice or the type of procedure that will be recommended. Often problems co-exist that will require a tailored or a la carte approach to treatment multiple or segmental problems.
Biologic and regenerative therapies
[Image - Far right]An example of blood product after centrifuge with aspiration of platelet rich plasma (PRP) layer for later injection to musculoskeletal areas. The Buffy coat layer and plasma is aspirated for injection to targeted sites.
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[Image - right] A common site for PRP is to the sacroiliac joints as part of an augmentative prolotherapy strategy where injection across or within key ligaments (as indicated by blue stars of diagram) can encourage new fibrous tissue to be laid augmenting ligament stability.
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Bone marrow aspirate (see images) is another method of harnessing regenerative cells from your own body to inject at sites of degeneration or inflammation - this method concentrates your body's mesenchymal stem cells at higher levels than from your peripheral blood samples. The optimal method of harvesting, delivery and method of carriage for stem cells is still being evaluated and evidence is limited at this time for the best approach while trials are ongoing.
Your condition may or may not be suitable for PRP or other biologic options and this should be discussed with Dr Zotti.
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Finally, Interleukin antagonists and A2M proteins have also shown promise in spine and peripheral joint injections but require specific preparation and are not readily available in Australia without equipment from overseas.
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Please find below links to scientific articles synthesizing current scientific literature on ligaments/tendons, spinal and disc related injections of PRP and Bone Marrow Aspirate with Autologous Stem Cells.
Bone Marrow Aspirate
Vertebroplasty is a minimally invasive nonsurgical technique to treat severely painful but stable thoracolumbar spinal fractures with renewed evidence (Vertos V and VAPOUR trials) in patients with acute fractures <4 weeks old and failure of other therapies such as rest, medications and bracing.
See information below to learn more about the procedure and suitable candidates.
