Lower back pain is one of the most common patient complaints. A new minimally invasive procedure at Duke Health promises relief to some patients. When the spine’s multifidus muscle atrophies, the resulting instability compounds lower back tightness and pain. The multifidus can be difficult to activate through physical therapy, but a restorative neuromodulation technique can stimulate the muscle to rebuild strength.

“We’ve used electronic stimulation in spinal care to modulate pain for quite some time,” says orthopaedic surgeon Peter G. Passias, MD, associate chief of the Duke Spine Division. “This is a relatively new procedure that’s novel in that it directly stimulates the muscle. We’ve found some regeneration correlatives of clinical improvements in pain and function.”

For patients with chronic low back pain who have failed conservative, noninvasive management, consider referral for evaluation. “I would advocate for patients to be evaluated at our Spine Center,” Passias says. “We have robust evaluation processes with the means and expertise to care for all types of back pain.”

If patients experience continuing lower back pain without a clear neurological or orthopaedic etiology, an MRI can help diagnose multifidus atrophy in the lumbar region. A same-day, minimally invasive procedure places a small controller in the pelvis with leads running to segments of the multifidus.

After the minimal recovery, the leads are programmed to stimulate the multifidus to contract and relax, strengthening the muscle over time. Rather than neuromodulation to override pain perception, the restorative technique helps rebuild the muscles that support the spine.

“To the patient, it can feel like exercising the lumbar area. They continue the regimen at home and typically see relief in three to six months,” Passias says. “Our studies have shown symptomatic and functional improvement, and five-year follow-up has seen steady improvement.”

The procedure is performed by Passias, orthopaedic surgeon Joe T. Minchew, MD, and neurosurgeon Nandan Lad, MD, PhD. It is offered at all Duke hospitals in the Triangle and is projected to be performed at Duke ambulatory surgical centers in the future.

“We pride ourselves on treating not only everyday conditions but ones that escalate to more complex levels of care,” says Passias. “Simple problems can become complex if not treated appropriately initially.”

Passias emphasizes that the support of the full system across all disciplines is key to patient outcomes. “Many people are involved in the process of undergoing surgery and recovery, from skilled providers in radiology, anesthesia, nursing, ICU, floor care, and postoperative rehabilitation. A center like Duke can coordinate care and offer expertise at all levels.”