According to a recent study by Bailey et al in 2015, treatment of a thoracolumbar burst fracture can include a brace or not with equivalent results. The group utilizing the brace was instructed to wear it at all times, unless in bed, for ten weeks, with a weening out period after eight weeks. In both groups there was a lifting limitation of less than five pounds, and no bending past ninety degrees at the hips for eight weeks. However you should always ask your physician for their specific instructions about use of the brace following your injury, as individual circumstances may indicate a different course of treatment.
FAQ Category: Spine
Does recovery following a thoracolumbar burst fracture include a brace and/or a long period of bed rest?
In the past, recovery from a burst fracture in the thoracolumbar region could include any combination of significant bed rest, surgery, and a brace (orthosis). However, recent treatments have been moving away from these due to the increased costs and risks of surgery and bed rest. In a recent study by Bailey et al they demonstrated that there was no difference between treatment of this injury with or without a brace. The treatment for both groups included a lifting restriction of less than five pounds, and a bending restriction not past ninety degrees at the waist. Neither group was instructed in bed rest and restrictions were lifted after eight weeks. The results of this study indicate that neither a brace or significant bed rest is required for safe recovery. It is important however to discuss your injury with your physician because there can be individual circumstances which would call for different course of treatment.
When will I know if my back and sciatic leg pain are benefiting from Physical Therapy and help from my general doctor if I’m really worried about moving while in this much pain.
Hopefully, you will feel better with PT and medical interventions for your sciatica in the first few weeks of PT after the onset of your pain. There is good evidence to support that the higher the level of your fear of movement and pain initially, the better the chance you will benefit from reducing your leg pain with treatment as far out as one year following your injury.
How common is sciatic leg pain?
Studies vary on the prevalence of sciatica annually, however recent reviews of nine large studies found that the injury ranges between two and 34 percent of adults each year.
My friends and I have been tennis players for many years, and all of us seem to have had some level of back injury while playing, why do these injuries seem so common?
In a recent report by Dines at al, there is a good description of common tennis injuries and why they occur. Tennis has many different movements associated with playing, but frequently there are explosive bursts of energy and there are repeated motions. Over the course of a few months playing this can involve thousands of repeated strokes. This high repletion and high energy can often lead to overuse injuries and many back injuries fall into this category. Specifically, repetitive rotational forces in combination with flexion or extension (very common in tennis, think serving or reaching way in front to get a ball with your back hand) increases the risk for injury to both the discs and joints of the lumbar spine. Usually injuries of this kind are due to tiny forces adding up over a long time. This probably includes forces while playing tennis and in other life activities. As we age this repetitive trauma adds up and can eventually result in pain. Back injuries of this kind are quite common in tennis players because of these factors. Fortunately there are some preventative measures to take, such as working on core strength, flexibility, and body awareness for all movements.
I am considering a spinal fusion for chronic low back pain. Which technique has better outcomes in terms of getting out of the hospital sooner?
Surgical techniques for lumbar spine fusion can be separated into two categories based on amount of tissue disruption. Minimal access surgery is reported to have better short term perioperative results as it utilizes small incisions and minimal muscle disruption. This technique involves use of a tube or sleeve to complete a muscle dilating or muscle splitting approach. Conventional surgery or open spine surgery involves lifting or stripping the musculature along the spine to gain access to the spine. Patients undergoing minimal access cervical or lumbar surgery report less blood loss, lower chance of infection shorter hospital stays and less pain medication and often a faster return to activity.
Is there any difference in cost of a minimally invasive versus an open lumbar fusion?
On the surface, with results such as shorter hospital stays, less blood loss, and a lower chance of infection, it would seem that minimal access surgery would be more cost effective than an open spinal surgery. However, the instrumentation required for these techniques is often expensive and can outweigh the savings. A review of the literature comparing cost of minimal access surgery to open surgery found that there is no economic difference in the two techniques. However, several studies that suggested cost-saving with minimal access surgery were excluded from the review as they did not meet requirements of detailed methodology or long term follow up on clinical outcomes. There is a need for more detailed studies comparing cost-effectiveness of minimal access surgery to open conventional spine surgery in order to better understand the economic details of these surgical approaches.
What is the difference between an anterior cervical discectomy/fusion and a cervical disc replacement?
Both procedures are used for treatment of long term neck pain, neurological deficits, and radiculopathy stemming from the degenerative changes of the neck. Anterior cervical discectomy and fusion (ACDF), has been the gold standard for years. It involves a surgical procedure where an incision is made in the front of the neck in order to remove part of a cervical disc which lay between two vertebrae. Once the disc is removed the two vertebrae are fused together. This procedure has a very high clinical success rate for alleviating symptoms but is also associated with some negative long term side-effects including loss of cervical range of motion, increased degenerative changes at segments adjacent to the fusion level and an increased reliance on future need to solid bony fusion. A cervical disc replacement(CDR), procedure is relatively new. It involves the same approach as ACDF with an incision on the front of the neck. The disc is removed, but rather than fusing the two vertebrae, and artificial disc is implanted. This procedure also has a high clinical result in symptomatic relief, but it also helps maintain range of motion and can decrease degeneration at adjacent segments.
I am considering surgery for a herniated disc in my neck. Is there a difference in quality of life or outcomes after surgery between a microdiscectomy with fusion and a disc replacement?
A group of large randomized clinical studies investigated long term outcomes comparing anterior cervical discectomy and fusion (ACDF), to cervical disc replacement (CDR). They looked at measures including perceived neck function, general health, neurologic improvement and avoidance of future secondary surgical needs. All reported improvement in all outcomes with both CDR and ACDF, with no significant difference between to two procedures. However there have been studies showing that cervical disc replacement in the long term is more effective at preserving range of motion and decreasing degeneration at adjacent segments. In 2014, a cost effectiveness review that included measuring quality-adjusted life years (QALYs)for a five year follow-up found that CDR resulted in 2.84 QALYs while ACDF generated 2.81 QALYs. The cost-effectiveness ratio using these two measures was $35,976/QALYs for cervical disc replacement and $42,618/QALYs for anterior cervical discectomy and fusion. Ultimately, CDR was found to be less costly and also more effective when compared results in a 5 year follow-up span.
My mother suffers from severe osteoporosis and she was just diagnosed with a compression fracture at T12. Will she need to wear a brace?
Ultimately this is up to the treating physician. Recent research has demonstrated that stable benign osteoporotic compression fractures treated without a brace did not result in inferior outcomes in patient disability as compared to soft or rigid-brace treatments.
I was diagnosed with a burst fracture at T11, is this common?
Yes, as far as thoracolumbar injuries, a burst fracture in this region has been shown to make up 20 per cent of all thoracolumbar injuries.
What is a burst fracture and why does it occur?
A burst fracture is a more severe form of compression fracture that typically occurs from a high energy axial load (i.e. car accident, fall from a high height). The vertebral body can be crushed in all directions causing a bursting of fragments which can cause neurologic deficit.
What are some common problems persons with Cauda Equina Syndrome (CES) experiences following damage to that section of spinal nerves?
This important nerve bundle gives sensation and motor supply to the pelvic organs and lower limbs. When injured, persons with CES often have many functional problems with their bladder and/or bowels, experience decreased sensation in their crotch area, and may have sexual dysfunction.
What is the relationship to the highest level of injury and bladder (detrusor) muscle activity.
In a study by Seo-Young Kim, MD, et al, they found 1/3rd of the studied subjects with overactive bladders had their highest level of spinal cord injury at or above the 2nd lumbar spine level. Two-thirds of the studied subjects thus had underactive bladders and had their highest level of spinal cord injury at or below the 3rd lumbar spine level.
My doctor informed me my recent x-rays demonstrated DISH, what is DISH?
DISH stands for diffuse idiopathic skeletal hyperostosis. This means there is a presence of ossification of your soft tissue along the front and side portion of your spine in the lower thoracic and upper lumbar region. Usually this occurs between four continuous segments.
Does the presence of DISH mean that my existing kyphosis will worsen over time?
We are unable to answer this at this time as further investigation needs to occur through longitudinal studies.
I have been suffering from neck pain and out of work for one month secondary to this condition. Would becoming involved in a specific return to work program be beneficial in getting me back to work?
This is a conversation that you first and foremost should be had with your treating physician. They will have the knowledge of what interdisciplinary care is available in your area.
I am part of a return to work focused rehabilitation program. What might this entail?
This will vary from program to program. There will likely be an evaluation by a primary physician and an interdisciplinary component that may include physical therapy, social work, and counseling services.
What is an osteoporotic compression fracture?
Osteoporosis is a disease in which bones become weak and become more prone to breaking. Compression fractures due to osteoporosis most often occur in the vertebrae and are caused when too much pressure is placed on a weakened vertebrae and the front of the vertebrae cracks and loses height
Is spinal stenosis surgery going to relieve my leg pain?
Spinal stenosis is the narrowing of the spinal canal which can lead to pressure on the spinal cord or nerve roots, resulting in pain in the back and legs. This condition is usually caused by changes related to aging in the disc, lumbar vertebra, and supporting structures. Surgery to relieve this pressure accesses the spine through the back and then the excess bone, thickened ligaments and degenerative disc tissue is removed to create space. This improved space often decreases the cause of pain and may relieve back and leg pain, however these results are very inconsistent. In a recent review article by McGregor et al, the authors looked to see if active rehab improved outcomes more than usual care. They did find that there was moderate evidence to support that active rehab following a spinal stenosis decompression surgery increased the long term improvement for leg pain.