dbeard@dominionpost.com
MORGANTOWN – Some people with chronic, debilitating lower back pain find that it can’t be treated with surgery. And such things as physical therapy, lifestyle changes and pain medications don’t offer consistent or long-term relief.
Dr. Manish Ranjan, with the Neurosurgery Department at WVU’s Rockefeller Neuroscience Institute, said the problem may be linked to dysfunction or weakness of a muscle that stabilizes the spine: the multifidus muscle.
He recently completed RNI’s first implant procedure featuring a novel device that offers restorative, rehabilitative relief. It’s called the ReActiv8 System. And unlike other implants delivering neurostimulation, it acts on the muscle, not the spinal column.
Lower back pain is one of the leading causes of disability, leading people to miss work and seek medical help, Ranjan said.
Much back pain stems from structural issues, he said – disk degeneration, joint mobility. It can cause instability or nerve compression. It can be corrected surgically with decompression or spinal stabilization.
But many don’t have a problem that can be fixed surgically and, as we said, above, the approaches mentioned above don’t offer adequate help. “They all have limitations and challenges,” he said. So many people live with the chronic pain.
The problem could stem from the multifidus muscle. “The multifidus muscle is one of the strongest muscles in the body,” he said.
Verywell Health explains that the “multifidus muscle is a series of long, narrow muscles located on either side of the spinal column that help stabilize the lower portion of the spine, called the lumbar spine.”
Over time, Ranjan said, it can cease to function properly causing functional instability – not spinal instability. A person can feel unstable bending or picking up something or doing other activities.
Traditional spinal cord stimulation features an electrode in the spinal canal that modulates the pain network – addressing the processing or perception of pain, but not what’s generating the pain.
The Reactiv8 System has the usual battery pack – about 2×1 inches – implanted under the skin. But the wire leads don’t go into the spinal column. The wire leads sit outside the spine next to the nerves that control the multifidus muscle and act on the muscle.
“It’s kind of restorative, rehabilitative therapy,” he said.
The patient controls the system and performs two short treatments per day, up to an hour each. Ranjan offered the example of a 30-minute session before getting up in the morning and another one before going to bed.
The outpatient implant procedure takes an hour or two, depending on the patient, he said. Recovery is quicker that that with spinal surgery, and pain is less because the procedure doesn’t go very deep.
Follow-up comes a week or two later, he said, and they start stimulation after the area is healed, adjusting the stimulation until it reaches optimum performance.
Mainstay Medical makes the Reactiv8 System and follow up study data available on its website shows that patients saw a pain reduction from 7.3 to 2.4 on the 10-point pain scale (called the visual analog scale but most of us know it from the charts with the smiley and frowny faces).
And 71.8% of patients had pai reduction of 50% or more, while 70% voluntarily reduced or eliminated their opioid intake.
Ranjan said addressing chronic back pain is not a quick fix. “We have to be with them in their journey,” and have a good rapport and relationship with the patient. But they should know they are not alone – many suffer similar challenges. “We are here to help.”
