Since they impact the central nervous system, neuro-spinal disorders often affect patients' overall quality of life, limiting cognitive function, impairing mobility, and causing widespread discomfort. In addition, since the central nervous system is comprised of a complex network of nerves, tissues, and fibers, the exact causes of neurological conditions can be difficult to pinpoint and challenging to treat without risking further damage. Repairing, maintaining, and enhancing patients' neurological health necessarily involves much more than surgical intervention. To effectively treat abnormalities or malfunctions of the central nervous system and related components, accurate diagnosis, pain-relieving therapies, and rehabilitative treatments are vital. Read on to learn more about these important non-surgical neuro-spinal services.
Imaging and Diagnostics
Neurologists and neurosurgeons can't help patients remedy their disorders and enjoy an improved quality of life without first observing their nervous systems in action and identifying potential issues. A clear, informed diagnosis is the first step in successful neurological treatment.
Neurological Imaging Systems
Most doctors begin the diagnostic process by conducting a basic physical exam, using visual assessment to look for signs of illness or injury. However, many of the most important aspects of the central nervous system are invisible to the naked eye. Neurologists and related specialists use a variety of imaging systems to evaluate the structure and function of patients' brains, spinal cords, and adjacent tissues. The most widely used imaging technologies and strategies include:
Functional Magnetic Resonance Imaging (fMRI). fMRI systems use magnetic fields to illuminate the inner workings of patients brains and spinal cords. They show real-time changes in oxygen and blood flow, which is especially useful for diagnosis of brain disorders, since it can demonstrate which segments of the brain are active at a given moment or during a particular activity. fMRI techniques can also be enhanced by using a contrast injection to further detail brain activity.
Radiography. Passing x-ray waves through patients' bodies can create a black and white image of their bones and soft tissues. Radiography is a relatively low cost yet informative imaging method, often used in the early stages of diagnostic testing.
Angiography. This is a more advanced form of traditional radiography, during which the neurosurgeon or assistant injects a special agent, such as iopamido or iohexal, which provides greater contrast to the x-ray. This improves the accuracy of the image generated and can provide information about how fluid behaves within the central nervous system, based on how it flows and pools. When used for the lumbar region specifically, this imaging technique is called discography.
Computed Tomography (CT) Scanning. CT scans harness the power of multiple x-rays (taken continuously as the system passes around the patient's body) to create a more detailed, complete image of patients' central nervous systems. However, most neurologists prefer fMRI for brain imaging, since this system is more precise. To collect more information, some neurologists may perform SPECT, or single photon emission computed tomography, which is a CT scan performed in conjunction with gamma ray detection after a neurologist injects a tiny amount of a radioactive formula.
Positron Emission Tomogaphy (PET). This is an imaging technique neurologists use to examine the brain's functional processes in greater detail. Neurologists perform PET scanning by injecting a tiny amount of radioactive material into the brain or spinal cord and then using a gamma ray detector to look for regions of heightened brain activity. PET imaging creates multicolored, dynamic brain maps.
Near Infrared Spectroscopy (NIRS). NIRS measures brain activity by passing a specific wavelength of infrared light through the brain and recording how it reflects back. The changes in light energy produced demonstrate the amount of oxygen flowing through the brain's blood, highlighting regions of activity.
Electroencephalography (EEG). During EEG testing, neurosurgeons place electrodes onto the patient's scalp. Then, they pass electrical waves through them and record the fluctuations that result from neuron activity. This method allows doctors to observe patients' brain function on the level of milliseconds.
Magnetoencephaloraphy (MEG). Like EEG, MEG allows neurologists to evaluate brain activity in real-time. Rather than passing electrical waves through the brain, MEG uses superconducting quantum interference devices, or SQUIDs, to measure the magnetic fields and wavelengths neurons naturally produce.
Bone scintigraphy. Similarly to PET, bone scintigraphy involves injecting trace amounts of a radioactive formula into the affected area and recording its dispersion throughout the body with special gamma ray cameras. The difference between PET and bone scintigraphy is that bone scintigraphy uses radioactive formulas that the bones tend to absorb, providing more information about the body's bony tissues and structures.
Thermography. During this diagnostic test, neurologists use infrared sensors to record temperature fluctuations, which a computer then converts into a colored or black and white image. Areas of heat and cold within the body can highlight central nervous system activity.
Ultrasonic imaging. Neurologists can map the function of the brain and spinal cord by passing ultrasonic waves through the body and recording how they echo back. Ultrasounds are especially useful in observing and mapping soft tissue.
Diagnostic Testing for Neurological Conditions
Imaging is one of the most important aspects of neurological evaluation. However, it is not the only method neurologists can use to diagnose central nervous system conditions. Other diagnostic strategies include:
Comprehensive neurological assessment. Since the central nervous system affects the body's overall function, neurologists may begin the diagnostic process by assessing patients' motor skills, sensation, reflexes, eyesight, speech, and psychological state. This can provide important information about patients' symptoms and concerns for use in diagnosis.
Laboratory screening. Blood, urine, and fecal tests can help neurologists identify certain central nervous system conditions or rule out other causes.
Genetic testing. Many neurological disorders are inherited, so genetic testing can help doctors determine the root cause of patients' symptoms. In addition, parents with neurological conditions may want to test their children so they can plan appropriate treatment. Neurologists can use chorionic villus sampling, uterine ultrasounds, and amniocentesis tests to assess for neurological disorders.
Biopsy. Removing and analyzing a small segment of muscles, nerves, or other tissues may help neurologists diagnose cancer and other conditions.
Cerebrospinal fluid analysis. Neurologists may perform a spinal tap to extract a small sample of cerebrospinal fluid, which they can then evaluate to diagnose infection, multiple sclerosis, brain hemorrhage, or other conditions. Cerebrospinal fluid analysis can also be used to monitor certain disorders.
Evoked response assessment. Neurologists can place electrodes to measure the auditory, somatosensory (touch), and visual activity of the brain. This method is particularly useful for pediatric neurological diagnosis.
Injectable Therapies
There are many medications that can help alleviate uncomfortable symptoms caused by neurological disorders. Often, doctors recommend oral drugs, such as anti-inflammatory medications or painkillers. However, in some cases, injecting medication directly into the affected region may provide more efficient, effective relief and help repair the damaged tissue. Some of the most popular injectable therapies for central nervous system issues are:
Botulinum toxin (Botox). When injected into the tissue, the active ingredient paralyzes the muscles in the treatment area, preventing them from contracting. Botox can relieve symptoms of essential tremors, dystonia, and other neurological conditions. Botox treatments typically last for three or four months, so they will need to be repeated to remain effective.
Hyaluronic acid. This organic compound is a vital component of connective tissue, ocular fluids, and the synovial fluid that lubricates and protects the joints. Some neurologists use hyaluronic acid injections to treat arthritis, although this technique is still somewhat controversial in the field since its effectiveness seems to vary from patient to patient. Some people find more relief in hyaluronic acids than traditional painkillers. Hyalgan, Supartz, Orthovisc, Euflexxa, and Synvisc are currently approved for use.
Nerve blocks. For patients who suffer from nerve conditions, neurologists can inject anesthesia into the disordered or damaged nerve. This treatment, called a nerve block, can offer short-term relief from discomfort and help patients delay more invasive procedures.
Biologics. These are modified proteins that can help diminish swelling and slow the progression of tissue deterioration in patients with rheumatoid arthritis. Biologics suppress certain aspects of the body's immune system function so that it cannot attack its own joints. The most popular brands of biologics include Actemra, Cimzia, Enbrel, Humira, Kineret, Orencia, Remicade, Rituxan, Simponi, and Summary.
Corticosteroids. Also called cortisone shots, these treatments consist of steroids, which can reduce inflammation, and local anesthetics, which help numb the treatment site and provide immediate, temporary relief. Corticosteroid treatment is typically quite effective, but these injections may only be three to four times per year, since they may actually damage joint cartilage if overused.
Platelet rich plasma injections. Blood platelets help the body recover from soft tissue conditions and regenerate tissue. To assist with neurological damage, doctors can take the patient's own blood, improve its platelet concentration, and inject it back into the affected area.
Prolotherapy. During this treatment, neurologists inject a formula designed to irritate and inflame the tissue, ideally stimulating the body's natural healing response.
Injectable treatments can provide temporary and, in some cases, long-term relief from a variety of neurological conditions.
Physiatry
Physiatrists are highly trained medical professionals who assist patients with neurological conditions by designing individualized rehabilitation plans for them. They go through four years of medical education, one year of general internship, and three years of specialty training in spinal dysfunction, pediatric medicine, spinal cord disorders, brain trauma, pain management, or sports medicine. In addition to using their own expertise and experience, physiatrists often collaborate with physical therapists, neurologists, nurses, orthotists, speech and language pathologists, orthopedists, cardiologists, rheumatologists, occupational therapists, and psychologists to diagnose and prescribe treatments for neurological disorders. In most cases, physiatrists do not actually perform procedures or provide therapies, but synthesize important information to create and direct an appropriate treatment program.
Physiatry is a multidisciplinary area of medicine, meaning that its practitioners draw from many different specialties to help patients improve their brain and spinal cord health. Physiatrists may include the following in their treatment recommendations:
Pain medications. Physiatrists may prescribe traditional painkillers, stronger narcotics if appropriate, anti-inflammatory drugs, or other medications to alleviate discomfort from neurological conditions.
Braces, splints, and other orthotic implements. These devices can improve patients' posture and help hold their limbs in proper position so they can diminish their risk for uncomfortable symptoms and heal well after procedures.
Injectable treatments. These techniques deliver medications directly to the affected area to provide instant relief and help restore the tissue.
Prosthetic limbs. Advanced neurological conditions may necessitate the use of artificial limbs. Physiatrists can help with the design and use of these prostheses.
Heat and cold therapy. Applying heat or ice to the damaged region can help manage pain and swelling.
Massage. This treatment can help alleviate muscle tightness and soreness. Patients with multiple sclerosis, Parkinson's disease, and other conditions often benefit from massage therapy.
Physical therapy. Physiatrists frequently work with physical therapists to help patients recover from neurological disorders and restore a fuller range of motion.
Autologous stem cell therapy. Collecting and using a patient's own stem cells may help to regenerate damaged tissue after neurological damage.
Acupuncture. Physiatrists sometimes refer patients with neurological disorders to acupuncturists. These alternative medicine professionals insert thin needles into patients' tissue to help energy, or qi, flow better throughout the body.
Biofeedback. This treatment method involves using electrical sensors to monitor patients' central nervous system functions, including muscle tension, brain waves, and temperature. By getting constant feedback in the form of light, sound, and direction from the therapist, patients can learn to better understand and control these neurological activities.
Traction therapy. This therapy stretches patients' muscles to treat spinal compression, which can result from sciatica, herniated discs, facet disease, bone spurs, and other disorders.
Electrotherapy. This term encompasses a wide variety of treatments that pass low levels of electrical energy through the tissue to alleviate neurological symptoms.
Physical Therapy
Most patients who suffer from neurological disorders can benefit from physical therapy. This therapy may be as an alternative to surgical intervention, to delay neurosurgical procedures, or as a method of rehabilitation after surgical treatment.
During this customized, one-on-one treatment, a trained professional guides the patient through a series of exercises to help him or her maintain muscle mass, improve range of motion, and perform routine activities more easily and comfortably. Physical therapists can also help patients speak, swallow, and coordinate movements, as well as teaching them to use their orthotic devices, prostheses, or assistive tools.
Typically, physical therapists work with patients on a regular basis, gradually helping them expand their abilities. In between sessions, physical therapists often prescribe daily exercises for patients so that they can continue to stretch and strengthen their muscles, joints, and nerves. Depending on the severity of the patient's condition, physical therapy may take place in a medical center or at the patient's home.
TENS Therapy
TENS, or Transcutaneous Electrical Nerve Stimulation, is a minimally invasive treatment technique to help patients manage the uncomfortable symptoms of neurological conditions. Either in a doctor's office or at home, this treatment involves placing electrodes over the area of discomfort, which are attached to a small mechanical box. After setting the device according to their preferences, patients can run a gentle electrical current through the disordered nerve fibers. TENS can alleviate aching, soreness, muscle tension, and other symptoms of neurological disorders by interfering with the transmission of pain signals and encouraging the body to generate painkilling hormones such as endorphins. This treatment only provides short-term relief, but it can be used on a regular basis to manage symptoms and enhance patients' quality of life. Neurologists have varying perspectives on the success of TENS therapy. While many physiatrists incorporate it into their treatment programs, the American Academy of Neurology has stated that it does not recommend it for chronic low back pain.
Dorsal Column Stimulator Therapy
When patients suffer from chronic neurological pain that cannot be effectively controlled with other treatments, doctors may recommend dorsal column stimulator therapy. This technique involves inserting electrodes into the lower regions of the spinal cord, which then attach to a generator. This system also comes with a remote control, which the patient can use to manipulate the electrical currents that flow through the spinal tissue. Neurologists are not entirely sure of the exact mechanisms that allow dorsal column stimulation to alleviate pain, but they hypothesize that this treatment, like TENS, may scramble pain impulses or help the body produce its own pain-relieving compounds.
Since it requires surgery and may or may not be effective, many neurologists recommend that patients attempt to use other methods before turning to dorsal column stimulator therapy. Neurologists often recommend dorsal column stimulator therapy for patients who have undergone failed back surgery. Dorsal column stimulator therapy provides only short-term comfort, but it can be used on a daily basis to help manage chronic pain and help patients go about their daily lives more successfully.