Lumbar Spinal Stenosis

Jeffery Rowe, MD, is a physical medicine and rehabilitation physician, also known as a physiatrist, with a subspecialty in pain medicine. He practices at Main Line Spine and specializes in minimally invasive interventional spine surgeries.

In this Q&A, Dr. Rowe shares how he helps patients with new technologies and advanced treatment options to relieve chronic pain of the spine, including the low back and neck.

You practice a unique subspecialty. Could you tell us more about it?

When you have chronic pain, there are two ends of the spectrum where you can seek treatment.

At one end of the spectrum are physiatrists who utilize non-surgical and minimally invasive approaches and procedures to treat your pain. These approaches might range from exercise to physical therapy, medication management, and injections such as epidural steroid injections, facet blocks, and SI joint injections. Anesthesiologists who have had a spine fellowship also traditionally use these approaches.

At the other end of the spectrum are orthopedic and neurologic surgeons. They focus on much more major surgical procedures to address spine pain issues. These procedures include lumbar and cervical fusions and decompressive laminectomies to relieve pressure on the spinal nerve roots.

Many new treatments fall in the gap between these two extremes. These are minimally invasive surgical procedures to relieve pain, appropriate when conservative treatment options haven’t provided long-term benefits. These procedures offer patients options that are far less severe surgically than those where orthopedists and neurosurgeons traditionally focus.

My surgical subspecialty is providing patients with pain relief options in this treatment gap.

What kind of treatments and procedures are we talking about in this gap?

One area in this gap includes neuromodulation devices that work by interrupting pain signals before they reach your brain. These include traditional Spinal Cord Stimulators (SCS), Dorsal Root Ganglion (DRG) stimulators, and Peripheral Nerve Stimulators (PNS).

Neuromodulation technologies have improved by leaps and bounds over the past five years, and they now incorporate improved batteries and Bluetooth technologies for programming.

Another minimally invasive treatment option is an interspinous spacer device, which can provide relief from lumbar spinal stenosis. This procedure can be an alternative to surgical decompression, such as a laminectomy.

I began to adopt these procedures four years ago when they officially became commercially available. Given that I was one of the early adopters of this treatment option, I now regularly teach other physicians and surgeons on the proper usage of this decompressive technology.

I also perform a minimally invasive SI joint fusion procedure. This procedure is often appropriate when SI joint injections fail to provide long term improvement.

In the past, SI joint fusion surgery involved a lateral approach with significant muscle disruption, requiring a lengthy recovery period. Now we use a posterior approach with a small incision to provide SI joint stabilization and fusion. This new alternative causes minimal tissue disruption and has a very short recovery period.

Beyond those, there are several other procedures that I’m currently using to provide additional minimally invasive treatment options, as well as others emerging on the horizon.

How did you end up with this specialty focus?

I have a surgical background from the start of my medical career. I completed two years of general surgery and then worked at a burn surgery center for eight years. These experiences provided me with an extensive foundation in handling complex surgical conditions.

I also completed a physical medicine and rehabilitation residency at the University of Pennsylvania Hospital and a spine fellowship. From that point, I began specializing in providing patients with access to technologies and treatments in the gap that weren’t previously available.

The sum of this training and experience enables me to consider, with a surgical perspective, how best to use these advanced procedures.

What kind of patients do you see? When is it appropriate for a patient to consult with you?

I see a broad range of patients. Some have only recently experienced an onset of pain, and others have been suffering from pain for years.

I pride myself in offering patients treatments when they have been told they exhausted all available pain treatment options. These previous failed attempts may have included epidural steroid injections, facet blocks, SI joint injections, rhizotomies, and radiofrequency nerve ablations.

For example, let’s say a patient has multi-level degenerative disc disease and they’ve had multiple injections but still have ongoing symptoms. The injections may have worked well, but the effectiveness wore off over time.

This hypothetical patient is now at a point where they need a longer-term solution with a more permanent treatment option. Neurostimulation or an interspinous spacer device may be an appropriate option for them.

My initial consultation is extensive as I tease through the issues each patient has been dealing with. I need to hear their full backstory, including how long they have been managing their condition and what they’ve done previously to attempt to alleviate their pain. I also review their diagnostic studies, including any MRIs or CT scans.

This thorough evaluation allows the patient and me to review the treatment options which are best suited for their condition. It also enables me to recommend a long-term treatment plan using one or more of the new technologies that sit in the gap.

Nationally, neuromodulation therapies don’t always work effectively for some patients. Why is it that you seem to get successful results with your patients?

Our ongoing successes build from a variety of factors. Patient selection is key to having a successful outcome. I take great care where I place the leads and reinforce that with strict testing protocols to make sure I’ve optimized lead placement correctly. I also use an advanced lead anchoring technique, so the leads don’t move out of position.

I additionally attribute my success to performing hundreds of neuromodulation trials and implants each year for patients across the country and teaching these procedures nationally.

What is your life like outside of the Main Line Spine medical practice?

It is very important to me that I balance my medical practice with my family life. When you work as hard as I do, it’s crucial to have a great family support system.

My family includes my wife, two daughters, a Savannah cat, and a Belgian Malinois dog. We enjoy outdoor activities including hiking and riding dirt bikes. For me, at the end of the day, it doesn’t get better than that.