FAQ Category: General Spine

Your doctor likely ordered an Xray or MRI of your spine. The disc space or height between the vertebra is evaluated. If it is shorter than expected, or in the case of the MRI the disc is dark, a diagnosis of disc degeneration is made.

Yes, studies have shown that there is only a weak correlation between disc degeneration and symptoms such as pain.

What you are referring to is called rapid prototyping (RP) technology. Federal money was used to develop and expand the use of RP models in surgery.

Besides complex pelvic and spine problems, this type of 3-D model has been used in bladder surgery, facial surgery, and neurosurgery. The models give the surgeon a better understanding of the changes in anatomy caused by the condition. The models make it possible to create special implants if needed.

Right now RP is only in use in academic (university) settings. In time, as the technology advances, it’s likely that commercial providers will step in and manufacture these. Safety and benefits must be proven first.

It is likely that equipment will be developed specifically for RP modeling for all kinds of surgeries. With increased availability, the cost will come down. Insurance companies may even include such steps as a necessary part of the procedure.

This will depend on studies showing that the model will reduce complications. Fewer errors and shorter operating times will result in decreased problems. Improved long-term results following surgery will also aid in supporting the commercial use of RP models.

Scoliosis is a curve or curves in the spine that go from side to side. You can have one curve, or you can have two, shaped almost like an “S”. Kyphosis is a curve as well, but it’s outward. This is the type of curve that you see with people who have humped backs. The spine is curving out and then inwards again.

It does seem to make sense to perform two surgeries at the same time – it means only going under anesthetic once, one recovery, and so on. However, to do any simultaneous procedures (more than one at a time), the surgeon has to take into account how long each procedure takes, how long complicated they are, and how difficult it might be for the patient to recover.

For example, if the two procedures are quite long, it may not be best for the patient to be under a general anesthetic for that long.

Although cost is not the main factor in deciding what type of surgery might be done, if the doctor has the choice between two types with similar outcomes, chances are he or she will go with the lower cost option.

For example, in a recent study of one type of disc arthroplasty (replacement), researchers compared the operating room (OR) cost, blood loss in the OR, and recovery time after surgery between the replacement and the older fusion type surgery. The researchers found that although the outcomes between the surgeries were similar, the cost of the implant could be significantly lower than with the fusion.

Many factors come in to play when a doctor is deciding how to proceed with surgery. First, the doctor must evaluate what needs to be done. Certain situations will rule out one type of surgery or the other. If both types are still acceptable, then the surgeon looks at the strength of the spine to see if it would stand up to a fusion or would a replacement be better.

Other issues, such as availability of certain types of implants, the surgeon’s experience with either surgery, as well as recent research reviewing pros and cons of the surgeries, may all come in to play in the decision-making process.

Burst fractures of the spine occur most often after a traumatic injury such as a fall or car accident. The force of a sudden, severe load up or down through the spine can cause the vertebrae to burst into small pieces.

If any of those bone fragments press into the spinal canal and push on the spinal cord, neurologic problems can develop. Back pain can also occur if bone fragments move into any of the soft tissues surrounding the spine.

Increased kyphosis or forward curvature of the spine is not uncommon after burst fractures. Only a few studies have been done in this area. But what has been reported is that the kyphosis seems to stop progressing about six months after the injury. It’s not likely to get worse after this amount of time.

It doesn not appear that the kyphosis is linked with symptoms or function later. In other words, back pain and disability are not worse in patients who develop a kyphosis after burst fractures of the spine.

With advances in imaging technology, current studies may be able to shed more light on this. MRIs and CT scans provide better pictures of the spinal canal compared with plain X-rays. There is some evidence that the spine can remodel itself after fracture repair.

There’s no way to know for sure what the results might have been for you if you had opted for surgery. Studies of burst fractures over the years have reported good to excellent results with conservative care.

One study from Sweden followed patients treated nonoperatively for thoracic or lumbar burst fractures for up to 41 years. More than half had an excellent result with no pain or loss of function. One-third of the patients had mild symptoms years later. Twenty per cent reported moderate to severe pain.

When these results were compared with adults of the same age who didn’t have a back injury, the number of people with back pain was about the same. So, the burst fracture didn’t seem to increase the risk of back pain later in life.

The only exception was for those patients who suffered paralysis as a result of the fracture. Their symptoms did not improve. Patients who had mild to moderate neurologic involvement did improve gradually during the follow-up period.

There aren’t very many studies of patients with this type of injury and treatment. From what has been reported, it looks like patients who have surgery get back on their feet faster. Their recovery time is shorter, and they return to work sooner. But the final results years later are no different from those who did not have surgery.

In many cases, exercise works well both to prevent and to treat various injuries, illnesses, and conditions. Low back pain (LBP) is a fairly common problem in adults of all ages. Exercise is often used in the treatment of LBP.

But finding the right kind of exercise to help all LBP patients has been a challenge. Physical therapists and other health care specialists have been tackling this problem.

Reviews of many studies has brought about the recommendation of strengthening exercises for chronic LBP sufferers. More recently, studies have been focused on finding subgroups of LBP patients who might benefit from extension exercises.

Current standards of care for acute LBP advise patients to remain as active as possible. Since your symptoms started last week, you would be considered in the acute phase of injury and recovery. During this phase, do not rely on bed rest or inactivity to help.

If your symptoms are not improved over the next 10 days, see your doctor. A proper diagnosis may be needed before seeking a specific exercise or treatment program. If your pain is the result of mechanical factors (soft tissue or bone structures), physical therapy may be helpful.

While there are many lumbar supports available on the market, it is likely that using a fixed lumbar support will improve comfort. In a study with 31 subjects who did not have back pain, it was reported that sitting motionless for two hours caused low back pain. Sitting tolerance was improved with both a lumbar support that inflated and deflated, and one that had a fixed amount of air. This study also demonstrated that buttock numbness was improved with the use of an air filled lumbar support that inflated and deflated. It was not improved with the lumbar support with a fixed amount of air. Unless you are experiencing buttock numbness, the use of the less expensive lumbar support that had a fixed amount of air seemed to be just as effective overall in decreasing discomfort while sitting for two or more hours.

People who receive spinal fusions most often have degenerative spinal disease. The fusion is done to stabilize the spine, keeping it from deteriorating further. However, because manmade material can break, or the condition of the spine can change over time, sometimes the materials break or they cannot hold on to the bones any longer.

If you are experiencing new back pain or the pain you had before the surgery appears to be returning, you should visit your surgeon to be evaluated. He or she should be able to tell through a physical examination and x-rays if there are any problems with the hardware used for the fusion.

Total disc replacements may have several advantages over fusion. There are not long term studies to compare to the other surgeries available for the spine however. The device used is called a prosthesis. Some of the complications include shifting or movement of the disc replacement device from where it was placed, fracture of the vertebral bone, and malplacement of the prosthetic joint. Malplacement of the device can cause device wear, loosening, and wear and tear on adjacent facet joints and discs in the spine. Nerve root compression, and curvature of the spine may also be complications of disc replacement.

Harvesting and using your own bone for spinal fusions or other spine surgeries is still the safest method. This is called an autologous bone graft.

The risk of infection and inflammation from allograft (donor) tissue is much greater than with autografts. But there are both minor and major problems that can occur with autografts. Chronic pain at the donor site is one of them.

Almost 40 per cent of patients with autografts still report donor site pain six months after the operation. After two years, this number drops to 20 per cent. Patients with chronic pain are disappointed and dissatisfied. Although the spine surgery helped, now they have a different type of disabling pain.

Scientists are actively seeking materials that can be used as a substitute for bone grafts. This could reduce and/or eliminate such problems. One popular bone graft substitute is calcium phosphate.

When large amounts of bone graft are needed, calcium phosphate makes a good bone graft extender. This material is porous but also dense. It has the right kind of surface to encourage bone ingrowth without negative side effects.

Hopefully in the near future, patients needing extensive spine surgery can avoid the complications of autologous bone grafts. Bone graft extenders may be used safely and effectively as bone substitutes.

More and more surgeons are looking for safe substitutes for bone grafts. Major spine surgery requires a large amount of graft material. Sometimes this is more than the patient can donate and more than is available in the bone bank.

In such cases, a substitute product called a bone extender may be used. The most common material is calcium phosphate. It has just the right surface area (density) and pore size to allow for bone ingrowth.

The natural bone in the area reacts to the presence of this material. Bone cells may grow faster and bond to the surface of the bone substitute. The calcium phosphate product gives the bone a place to anchor and grow.

Scientists are studying ways to help bone grow, attach, and spread where needed. Sometimes the bone growth is faster with substitutes but not always. It’s not clear what happens at the molecular level to promote bone growth.

Some studies are being done to find out. Red blood cells have been injected into the bone subsitute. It may be possible for cell attachment to occur faster when there are serum (blood) proteins present.

Firm conclusions about the use of these products aren’t available yet. In the future, there may be enough studies with different materials to allow comparisons between various products currently available.

Autologous bone grafts are grafts that come from your own bones. Allografts are those that come from someone else.

When deciding whether to use auto or allografts, the surgeon takes into account many issues, the most important being the condition of your own bones. If your bones are weaker than they should be because of a disease, such as osteoporosis, Paget’s disease, or hyperparathyroidism, to name a few, then using your own bone would likely not be a good idea. The bone graft may not be strong enough to hold. In that case, an allograft is chosen.

If you are going to be using your own bone, the piece of bone is usually taken from your pelvis, near the hip area. The necessary amount of bone (not much) is shaved off and used in the spinal fusion.

Actually, blindness is a very rare potential complication of cervical spine fusion. But again, the reports of this problem are rare. Patients at risk are in a state of anesthesia for more than six hours. They are also in the prone position (face down) during the entire time.

Many surgeons perform a cervical spine fusion from the front of the spine. This is called an anterior cervical discectomy and fusion (ACDF). Others perform the operation in two steps. This process is referred to as a staged procedure.

Staged procedures reduce the time spent under anesthesia in any one operation. The total time from both operations may exceed six hours but the risk is in the length of each individual procedure.

There are other risks that are much more common than blindness. Your surgeon and/or the surgeon’s staff will review all possible problems that can develop. Anything from infection to death is possible but not probable.

The likelihood of serious complications in the first 30 days after surgery is less than four per cent. Other problems such as infection or osteomyelitis can occur months later. These are usually related to delayed infections from pneumonia. Infection controls in place at most hospitals prevent this type of outcome.

The most commonly taken X-rays are anterior-posterior (AP) or lateral. AP is a front-to-back view of the spine. Lateral is taken from the side. A third type of X-ray called oblique is a view from the side but taken at an angle.

Each view gives the doctor different information about the condition of the spine. Location, type, and degree of deformity or pathology can be assessed from X-rays. For example, the oblique view allows for a better view of the pars interarticularis. This is part of the vertebra where the facet (spinal) joint attaches to the bone.

The oblique view is taken if the doctor suspects a condition called spondylolisthesis. A fracture at the pars results in the vertebral body slipping forward over the vertebra below. This is a condition that may require surgery.

The dynamic flexion-extension (F/E) X-rays you mentioned are taken in the standing position. First, the patient bends forward as far as possible. An X-ray is taken of the lumbar spine in this position. Then the patient straightens up and extends or bends backward as far as possible. Another X-ray is taken.

Dynamic F/E X-rays offer information about the spinal instability with movement. This type of data can help the surgeon when considering or planning surgery. They can help rule out the need for surgery as well.

Some spine clinics advocate taking spinal X-rays with each new patient who has low back pain (LBP). Other experts suggest X-rays are best saved for those patients (like yourself) who don’t get better with conservative care.

X-rays can be useful when looking at the location, type, and amount of spinal degeneration. They also provide information about alignment, fractures, or other deformities.

But the cost of and exposure to unnecessary X-rays prompts some doctors to avoid ordering them routinely. This diagnostic step is only taken when there are justifiable reasons to do so.

There are no standards or studies to guide physicians in making this decision. One study recently published did show that additional dynamic flexion-extension radiographs are not needed unless surgery is planned.

Back pain that has been present three months or more is often considered mechanical. This means there is an imbalance in the soft tissue and/or bony structures contributing to the problem. Conservative care with mobilization or manipulation, exercise, and postural and behavioral training are still the suggested management plan.

Talk to your doctor about your concerns and questions. You may benefit from further testing and/or a change in the treatment program.

When someone has degenerating discs in the back or neck, this can cause severe pain and restrict their ability to move and participate in daily activities. Fusion, taking some bone usually from the hip and fusing it to the affected area, is often done to help remedy the situation.

Fusion, although successful in many cases, does have drawbacks. The joining of the bones limits movement as the area is no longer able to bend and move freely. As well, doctors have found that patients who have had fusion can end up having to have repeat surgery at the discs right above or below.

Using a prosthesis, a replacement, is an attempt to mimic the movement of the back or neck, improving the outcome.