MANILA, Philippines?Low back pain is a very common condition, affecting up to 8 out of 10 human beings at some point in their lives. In fact, disorders of the back and spine are the most frequent and most costly musculoskeletal impairments, and rank third behind arthritis-rheumatism and heart disease as the top cause of disability among working-age people.

Common nonsurgical treatments for low back pain include pain medications, proper ergonomics and posture, physical therapy and back exercises. Unfortunately, some patients with significant low back pain do not respond to such conservative treatments. For them, the usual alternative is to surgically remove the rear part of a vertebra and take out the herniated (swollen) disc to relieve pressure on compressed nerve roots. These surgical procedures are called standard laminectomy and discectomy.

Pain in lower back

Trevor Douglas, a 53-year-old Canadian missionary, is one such patient. He has been teaching the Ifugaos of Benguet and poor communities in Nueva Vizcaya for more than 25 years now. A few months ago, however, severe low back pain threatened to end his labor of love.

?The pain in my lower back became so unbearable that I could hardly walk or move. I was so frustrated because the pain was disrupting my work,? Trevor says.

Physical therapy, reflexology and back exercises failed to ease Trevor?s pain. A fellow missionary suggested Dr. Mario Ver, an orthopedic spine surgeon at the Institute of Orthopedics and Sports Medicine in St. Luke?s Medical Center.

At St. Luke?s, Dr. Ver subjected Trevor to a thorough physical examination and diagnostic workup. ?I ordered X-rays and magnetic resonance imaging (MRI) to identify the exact cause of his low back pain,? Dr. Ver says.

Tests showed that nerve roots at the L4L5 and L5S1 levels of Trevor?s lumbar spine were inflamed and compressed. The lumbar spine consists of the five bones or vertebrae of the spine in the lower back.

Improved surgical outcomes

According to Dr. Ver, microsurgery and other advancements in surgical techniques dramatically improved surgical outcomes in the late 1970s. Advances in anesthesia delivery likewise made a big contribution to surgical improvements. With general anesthesia, the patient is rendered unconscious before being operated on. By the dawn of the 21st century, progressive local anesthesia was being combined with epidural anesthesia to provide pain control during surgery while allowing the patient to be fully awake.

The world-renowned American orthopedic surgeon Dr. Stephen Kuslich mentored Dr. Ver in the use of progressive local anesthesia. The Filipino surgeon then enhanced the combination of local and epidural techniques for use in more extensive lumbar spine surgery. Dr. Ver?s team used this unconventional technique, ?micro discectomy under awake anesthesia,? in performing Trevor?s surgery.

Trevor was slightly sedated but fully awake during the operation. He assumed a kneeling-sitting position that allowed him to fully cooperate and answer questions. (He watched the procedure via television during the entire operation.) Dr. Ver used a special microscope to look closely at the nerve roots in his lumbar spine. Each time an inflamed nerve root in his lumbar spine was gently pressed, Dr. Ver would ask Trevor whether the degree of pain he felt was similar to that he experienced with his back condition.

?In this way, we were able to identify and target the exact nerves that were causing Trevor?s lower back pain,? Dr. Ver explains.

Valuable technique

Dr. Ver believes that micro discectomy under awake anesthesia is a valuable technique that provides a safer and more accurate decompression of the lumbar nerves caused by a herniated disc. The procedure, which can be done on an outpatient basis, has a success rate of 94 percent with majority of patients able to return to work in less than three weeks. Dr. Ver points out that the small percentage that does not fall under the ?success? rate refers only to some instances of mild infection or pain brought about by a recurrent slipped disc. Such cases are easily addressed by medication or another operation, he adds.

Although microsurgical lumbar nerve root decompression under awake anesthesia is a safe and a cost-effective technique, only a few doctors in the world are able to perform it due to lack of training opportunities, according to Dr. Ver. ?St. Luke?s is one of the few hospitals worldwide that routinely performs the procedure. Since 1993, my team and I have successfully performed the technique on hundreds of patients.?

Free from debilitating low back pain, Trevor is now back with the people and to the work he loves. With wife Norma, he is engaged in church-based leadership development of the Ifugaos and the people of Nueva Vizcaya.

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Angelo Palmones is a science and technology broadcaster. For feedback, please e-mail the Healthcare Technology and Outcomes Information Bureau at inquire@htoib.com.