The varied causes of middle back pain leave a plethora of modalities to approach for a permanent cure. This means every patients treatment has to be individualized according to the cause and age at the time of treatment. Thus, it is always better to leave this herculean and cumbersome task at the hands of an experienced orthopedic surgeon. There is no single treatment that can give complete relief of symptoms. Thus, the treatment plan chalked out by the orthopedist should be religiously followed, which may last for a few months to a couple of years. Even after that regular followups are necessary to ensure a complete recovery from the disease and prevent recurrence !
Treatment of Middle Back Pain – Deformities
The deformities arising out of birth defects are dependent on the bony growth (can be roughly equated with height) of an individual, which occurs up to 16-18 years of age. During the growth period a deformity may increase or decrease in severity. The common approach for dealing with deformities is
- If deformity is severe and increasing with age, then immediate surgical correction is necessary.
- If deformity is mild and increasing with age, then the patient is observed until completion of growth period. During this period, corrective orthosis (with belts or traction), may be used to decrease the severity of the deformity.
- If after completion of growth, the deformity is mild then surgical correction is NOT necessary.
- If after completion of growth the deformity is causing symptoms, then a corrective surgery is done followed by orthosis and physical therapy for 6-8 months.
For a kyphosis deformity, the surgery done is anterior fusion of the involved vertebrae. This surgery is generally done after the growth period is complete otherwise it causes severe restriction of back movements in later life.
Picture 1: Orthosis for Kyphosis
(Source: Wikimedia Commons)
For a scoliosis deformity, posterior fusion of the involved vertebrae is done. This is a major surgery and can be life threatening. The mobility of the back is affected but it has to be sacrificed for the purpose of stability to the internal neural structures like the spinal cord and the spinal nerves.
Treatment of Middle Back Pain – Infections
Infections of the back cause weakening of the vertebrae, making them prone to fracture from trivial injuries. Even the normal stress on the vertebrae causes them to become flattened (vertebrae plana). Thus, complete bed rest is a must in these conditions. If not followed the weakened and flattened vertebra cause added pressure on the spinal cord leading to complete paralysis of below the waist. Thus, making complete bed rest an unavoidable compulsion !
After a few months of treatment with appropriate antibiotics the focus of infection is driven out of the vertebrae. This is observed with a bi-monthly x-ray examination. When there is no evidence of any infection and the bone shows healing changes, a person is allowed to get up from bed and gradually resume some daily activities. However, a stiff orthosis has to be worn to support the healing vertebrae. Once the healing of the vertebrae is complete (in approx. 6 months) the orthosis can be discarded. If the weakened vertebra is deformed causing a kyphosis or scoliosis deformity, then after healing assessment of the deformity is needed. Depending on the severity of the deformity, surgical or orthotic treatment is instituted.
Treatment of Middle Back Pain – Tumors
Tumors of the back are associated with profound pain and weakening of the involved vertebrae. The abolition of the cancerous cells is the primary concern, which dictates the overall life expectancy of the patient. But after that, the treatment of the remnant deformities and supporting the weakening structures requires extensive planning and surgery. The age of the patient and the ability to bear the stress of surgery are important things to consider before taking this option. Many times it is prudent to leave an elderly person to the fate of the disease, rather than go through with the treatment. However, in younger patients its always better to take the hardship of the extensive surgery, which often gives a much better outcome. The decision to undergo surgery should never be delayed for second opinions, as any delay can change a positive outcome into negative.
The treatment for a spinal tumor consists of
- Surgery to remove the tumor cells from the body.
- Chemotherapy to kill the tumor cells which have spread to the other parts of the body.
- Radiation therapy at the site of the tumor to prevent recurrence of the tumor.
Unlike low back pain, middle back pain is always associated with grave diagnoses, which demand complicated and time consuming treatment. But with appropriate treatment at the right time, most of them can be cured with certainty !