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)
* Not currently available for routine clinical use in Australia; described for completeness
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.
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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Your condition may not be suitable for PRP and this should be discussed with Dr Zotti.
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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.
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.
