FAQ Category: General Spine

Many factors play a role in return-to-work decisions. The policies of Workers’ Compensation are one important factor. The availability of disability benefits is another major contributor. The business and legal climate of our country also makes a difference.

Social expectations about return-to-work change with changes in each of these policies. And published research on the subject of injury, chronic pain, and disability can also sway treatment programs.

For a long time, we operated under the belief that bedrest was the best treatment for low back pain (LBP). Then about 20 years ago, a group of researchers published a landmark study that changed everything.

They showed that activity and exercise was the best way to manage low back pain. Specific exercises, training in work-related tasks, and work simulation became the new focus. Patients spent up to 57 hours a week in a work hardening program. This was designed to get them back on the job.

The results of this new approach have stood the test of time. Many other independent studies have backed up the conclusions of the original research. Preventing deconditioning with activity has been shown to reduce the number of days off work.

The focus is no longer just on reducing pain. Managing the pain while improving function is the new direction. Patient education focuses on overcoming patients’ beliefs about their limits. This may be what you are seeing in your own particular area of industry.

Your surgeon is the best one to advise you. Obviously you have had some imaging studies done (such as an X-ray) to know about the rod breakage.

Implant damage does not always mean revision surgery is needed. The surgeon will review your symptoms and function along with measurements taken from the X-rays. If the spine has remained stable, then no further surgery may be needed.

Many spinal fusion operations for scoliosis involve a large number of vertebral bones. In fact, according to a recent study at the Children’s Hospital in Boston, an average of seven segments are fused this way.

If the bones have fused well and there’s no problem with the fractured rod, then the treatment may be just careful watching. If the spine has continued to progress and the scoliosis is getting worse, then a second surgery may be needed.

If the rod is pressing on a nerve or the spinal cord, then serious neurologic problems can develop. In such a case, the rod would be removed. Many times, implant fracture occurs but the instrumentation does not move or shift. It can be left alone.

You didn’t mention your age or sex but data show that this experience is common in postmenopausal women. The most likely cause of weakened bone resulting in fractures is osteoporosis. Osteoporosis is a decrease in bone mass. It commonly occurs with aging and especially in women after menopause.

It’s estimated that 10 million people in the United States have osteoporosis. More than a million fractures are caused by osteoporosis each year. Women between the ages of 65 and 84 are affected most often.

Any bone can be affected but the wrist, hip, and spine are the most commonly affected sites. Only about half of all vertebral fractures are discovered. Many are diagnosed similar to your situation: by X-ray for something else.

Vertebral fractures aren’t always pain-free. They can cause very severe and disabling pain. If the bone is fragile enough, it may collapse causing spinal instability and deformity.

Scientists aren’t really sure why one person has a pain free vertebral fracture and others have extreme pain. Treatment varies according to the age, general condition, and symptoms for each patient. Sometimes the fracture has already healed and the goal is to prevent future fractures.

Over the years, there have been many reports of pain after surgery at the donor site. In fact, many patients complain more about problems at the donor site than at the primary site of the surgery. The incidence of this problem is reported anywhere from six to 39 percent in various studies.

A recent study from two orthopedic surgeons in The Netherlands may offer some new insight into this problem. They compared patients having a spinal fusion at the T2 to L2 levels with patients having the same surgery at L3 or below. All the patients had a traumatic fracture of the spine requiring a fusion.

They found that 40.9 per cent of the patients who had the low fusion reported chronic donor site pain. This is almost half of the entire group. Only 14 per cent of the patients with a high level fusion had similar problems.

It looks like the site of the low fusion is close enough to the donor site that the patients can’t tell the difference. This fact may result in an overestimate of true donor site pain.

Patients are warned about the donor site pain for two reasons. It’s natural to think the operation is going to take care of the painful back symptoms. Patients aren’t expecting to have more pain after surgery. And from all reports, it looks like donor site pain is often much worse than the painful back disorder.

Surprises like this are not appreciated by most people. Surgeons may find that the information presented up front is a good way to avoid a dissatisfied patient.

There are several factors to consider in a case like this. First of all, there are differences in reported pain after fusion when the patient donates his or her own bone for the graft.

Twice as many patients who have surgery for a painful low back disorder have donor site pain. This is compared to patients who have fractured their spine. Doctors aren’t sure how to account for the difference.

It may have to do with the patient’s ability to cope after an accident or injury versus after a degenerative condition. The intensity of the pain seems to be worse for patients who have a fusion at L3 or below.

The most likely explanation for this to occur is that the bone donated is taken from the posterior iliac crest. This site is not that far from L3 or below. It’s possible the patients are just mistaking low back pain from donor site pain. The two sites are too close together to separate out where the pain is really coming from.

You should discuss this concern with your surgeon before having the surgery. There are some known surgical techniques to help reduce donor site pain. The surgeon can make an incision that avoids injury to the cluneal nerve. Trauma to this nerve during surgery has been shown to increase problems with donor site pain.

In the medical world, conservative treatment is usually any treatment that is not invasive or surgical. That means, nothing is inserted into your body and no surgery is performed.

In the case of treating a neck injury, conservative treatment could mean physiotherapy, medications, exercise, heat/cold treatments, or bracing to keep your neck steady.

Unless it is urgent that surgery be done, as can be in some cases, conservative treatment is usually among the first options.

Even though crystal deposition is a common problem in the joints, scientists still don’t know a lot about the process. The crystals seem to form most often in the extracellular matrix (ECM). The ECM is connective tissue in the body. It provides support and a place for cells to attach. The ECM also separates groups of cells while still keeping them connected.

From what we do know about crystal formation, there are four possible reasons for this problem. The first and most common is idiopathic. This means it happens for no apparent reason. There may be a reason, we just don’t know what it is.

Secondly, it could be hereditary. Some families just seem to have this problem. The exact genetic link is also still unknown. Metabolic diseases, especially affecting the thyroid, is a third cause of crystal formation. The joints are affected most often but the discs may be affected, too. And finally, trauma or surgery (a form of trauma) can start the process of crystal formation.

Crystals have been found in herniated discs. Adults 60 years old and older are affected the most, so it’s likely age-related. How much crystal deposition contributes to disc degeneration and herniation remains unknown. It does apear that crystals forming in the disc accelerates or speeds up the degenerative process.

Scoliosis is a curvature of the spine that can affect any part of the back from neck to sacrum. The lumbar (low back) area is affected most often in older adults. And it’s a fairly common problem after age 65. X-ray studies show that more than half of older adults tested have degenerative changes of the spine with scoliosis.

The problem in older adults begins with the effects of aging on the bony structures, discs, ligaments, joints, and muscles. Bone loss and joint osteoarthritis so common with aging result in wedging of the vertebrae. The discs start to collapse. The ligaments get thicker.

All of these changes can cause the bones to slip sideways and start to twist or rotate. At the same time, the altered position of the spine puts pressure on the spinal nerves. The result can be back and/or leg pain. Surprisingly, X-rays studies often show much worse degeneration than the symptoms would suggest.

The type of scoliosis you may be experiencing from age-related changes is called degenerative scoliosis. It’s not clear yet what happens with this condition. Some patients get worse over time. Others stay the same. Treatment is to address the pain and improve function. Surgery may be an option when all else fails but it’s not the first choice.

You may be a good candidate for a surgical procedure called microdiscectomy. The surgeon makes a tiny incision in the skin and inserts an endoscope. The herniated disc can be removed through the endoscope. The surgeon may take part or all of the disc.

Many people can recovery fully from a herniated disc without surgery. But it takes time before the painful symptoms go away. Studies show that in a year’s time, patients who don’t have surgery have just as good of results as those who do.

But like you, sometimes people have hardships that go beyond pain. Many blue-collar workers don’t have the insurance or savings to go without working. They may not even be able to take off work for one to two weeks much less months.

If you are at risk for losing your job, early surgery may be the best option. The first step is to see a surgeon. Explain your social and work situation to the surgeon. This way, the information can be taken into consideration. It may still be possible to recover with nonsurgical care. Find out what all your options are before making a final decision.

Research is ongoing in the area of spinal fusion, finding better materials, and even using artificial disc replacements. Interbody cages were first approved by the FDA in 1997.

Since that time, they have become very popular for spinal fusion. They help the spine bear greater loads than bone graft alone. The surgeon can fill them with bone material to help strengthen the fusion.

Bone is still a better material than metals or alloys. So scientists continue to look for ways to fuse the spine without screws, metal plates, or cages. A recent study using bone dowels was reported.

Threaded bone dowel taken from cadaver bones (preserved after death for use) were used instead of cages. Bone transmits forces through the spine better than titanium cages but can’t sustain as much load as cages.

Patients who got the bone dowels did better when the spine was bolstered with screws at the same time. Stand-alone bone dowels met with a high rate of complications and failure. The bone dowels cracked and broke. Then the surgeon had to take them out and replace them with cages anyway.

Studies will continue to try different materials and methods to perfect spinal fusion. At the same time, artificial disc replacements are now available to replace fusion altogether.

Neuroreflexotherapy (NRT) is the name of the treatment you saw a special about. It is exactly as you described: tiny staples implanted under the skin in painful areas triggered by a specific point called a trigger point.

The staples are left in for about 12 weeks before they are surgically removed. Sometimes they are left in longer if the patient is still improving. The theory behind this treatment is that nerve cells responsible for pain, inflammation, and muscle dysfunction are deactivated. The exact mechanism isn’t understood completely.

Studies so far show they work best if used early. It’s advised that the staples should be implanted when pain lasts more than 14 days. The pain should be rated as a three or higher on a scale from zero (no pain) to 10 (worst pain).

The longer pain is present, the less likely NRT will help. But even some patients with chronic pain lasting months got pain relief and experienced improved function by using NRT.

A recurrent herniated disc, or a recurrent disc herniation, is the herniation or bulging of a disc that happens after someone has already had one. Most often you would have surgery to correct it.

The repeat injury could be caused by a new trauma, or it could happen spontaneously, on its own. Statistics show that about 5 percent to 15 percent of patients who have disc surgery have a recurrent herniation.

What you may be seeing is a test that has turned into an exercise. The Sorensen Test (ST) is a reliable way to measure muscular endurance of the lumbar spine in healthy people.

As you described it, the goal is to support the hips and lower body on a table. From there the person holds him or herself in a horizontal position without supporting the chest or upper body. The idea is to stay in this position for as long as possible. After a short rest period (two minutes), the exercise can be repeated.

Studies show that when it comes to preventing low back pain, muscle endurance is more important than muscle strength. The ST is an easy tool to build that endurance.

If you find you can’t do this test starting from the horizontal position, it can be modified. A special piece of equipment called the Roman chair (or a similar piece of equipment) is needed. This chair allows you to start in a more upright position. You can gradually lower yourself closer to the horizontal position as you build up your endurance in the more upright positions.

If you’ve never done this exercise before, ask the physical fitness coordinator or trainer on staff to help you. It’s best to start doing this exercise with guidance and supervision from someone who has been trained in using this equipment for this purpose.

It sounds like you need to go back to your doctor for a recheck. It’s possible the drug you are taking is causing these side effects. Or it could be a natural progression of the problem that’s causing your pain.

If it’s the drug, you may just need a change in the dosage. Sometimes patients need more of the drug but usually, the side effects are caused by too much of the active chemical. If the drug can’t be changed in how it’s taken or how much is taken, then a different drug may be needed.

When it comes to treating nerve pain with medications, overall nerve transmission is cut off. The nervous system is affected too. So along with decreased pain, you can also get increased sedation, decreased memory, and changes in the way your arms and legs move.

It’s best to have this checked out right away to avoid any long-term consequences. Don’t stop taking the drug and don’t change the dosage until you contact the doctor who prescribed it for you.

Even if you can’t get an appointment right away with your doctor, call and report your symptoms today. They may be able to advise you directly or get you in to see the doctor sooner than later.

Pain and how it works in the body is still a large mystery. What we don’t know about pain is much more than what we do know. Everyday, scientists are studying the problem of pain. Animal studies are helping us get closer to understanding the problem and finding a solution.

For example, researchers in Japan are testing rats with crushed nerve injuries. They have found a signaling pathway that may be part of how pain gets turned on. They found specific receptor sites in the spinal cord just waiting for a specific protein to go by. That protein is released when a nerve cell is damaged.

Once the brain receives the signal of pain, the healing process is triggered. After seven days, when the healing process is well on its way, an interference protein is released. This chemical messenger knocks the signaling protein out of its receptor site. The result is a decrease in pain and the system is restored back to normal.

Future research will focus on finding out how the interference chemical works. We may be able to use that substance to make a drug to turn off the pain signals. Right now we have ways to override the signal such as certain medications or transcutaneous electrical stimulation (TENS). We don’t know yet how to turn off the signals.

More and more, we are finding it’s time to rethink lifting advice. Studies show that under the skin, spinal motion is the same whether we stoop, squat, or lift freestyle.

It’s likely that the load and shear forces on the ligaments and joint capsules is the same, too. Likewise, the spinal muscles generate the same amount of force. If anything, changes are more likely to occur in the middle part of the spine called the thoracic spine. It’s possible that by only looking at the lower (lumbar) spine, we’ve missed a key factor: the thoracic spine.

There are long muscles along either side of the spine that start in the thoracic spine. It’s likely that forces generated by these muscles account for the increased flexion seen in the thoracic spine every time a lift occurs.

Despite the results of these new studies, guidelines for lifing have not changed yet. Somtimes it takes many years and many studies to confirm new information before change occurs.

At this point, more study is needed to understand lifting as a concept and how the spine responds to different positions and loads. Until more is known, you may be better off just using the method you use most often and/or are most familiar with.

Always follow your surgeon’s advice about how much to bend the total hip replacement. To pick up smaller items, you can use a special tool to grab things. For larger, heavier items, it may be best to ask someone else for help. Check with your doctor for any other precautions or liftin positions to avoid.

Naprapathy literally means to correct cause. It’s a hands on method of reducing pain and restoring function of the muscular and skeletal systems. The connective tissue around these two systems is the focus of treatment.

Naprapathic treatment combines manual therapy with nutrition and modalities. Manual therapy includes massage, joint mobilization or manipulation. Modalities refer to treatments such as ultrasound, electrical stimulation, and laser.

Naprapathy was first started in the United States in the early 1900s. There are many more licensed naprapathic practitioners in Sweden (935) than anywhere else in the world. But there are approximately 250 licensed practitioners in the U.S. The National College of Naprapathic Medicine is located in the Chicago area.

Common problems treated by naprapathy include neck and low back pain, sciatica, sprains and strains, headache pain, and shoulder pain. Other conditions such as carpal tunnel syndrome, chronic pain disorders, tennis elbow, and fibromyalgia may also respond well to naprapathic treatment.

The American Naprapathic Association (ANA) provides a directory of licensed practitioners in the U.S. You can get this information on-line at the ANA’s website available at http://www.naprapathy.org.

For over 100 years, graft material has been taken from the patient’s own pelvic/hip bone whenever possible. This is considered the gold standard in successful fusions.

An alternate choice is allograft material. This is bone taken from a cadaver (donor bone harvested after death). It is specially treated and frozen until ready to be used.

More recently, scientists have discovered proteins that are osteoinductive. This means the graft material can form new bone in a non-bony area. These proteins are called bone morphogenetic protein (BMPs).

There are at least 14 BMPs that belong to a group of proteins called growth factor-ß. Two BMPs are now available for patient use. These are recombinant BMPs meaning they have been developed for use in a lab.

Mention your concerns and questions to your surgeon. He or she has access to your imaging studies and knows the condition of your bones and your general health. There are many factors that go into deciding the best way to perform a spinal fusion, including the surgeon’s own expertise and preferred methods.

Bone graft material donated by someone else is called an allograft. proteins in the bone matrix make it possible to cause bone formation in your own body using bone from someone else.

There are many factors that can affect allograft materials. The bone is harvested from the donor after death. The ability to cause bone growth is affected by the donor’s age and bone quality. The way the bone is harvested and processed is also important.

Studies show that allograft materials work much better when combined with autograft bone. Autograft material refers to bone donated by the patient for his or her own use. The pelvic bone is the site used most often for autografts.

Allografts seem to function best as a bone graft extender. This means the framework for bone growth is already in place. Bone inducing cells (autograft material) are already present. The allograft helps bone to extend beyond the original bone.

Allograft has a significantly lower fusion rate when used as stand-alone graft material. It is recommended that allograft should only be used as a graft extender unless there is no other autograft bone available.

Good posture can be an important key to preventing musculoskeletal imbalance and injury. Any extreme motion or position can put pressure on soft tissue structures. As a protective measure, the muscles may contract to keep the body from moving further in one direction. Resulting muscle contracture can lead to tightness and loss of motion.

A slouched posture usually brings the head forward. This puts stress and strain on the ligaments, joints, and soft tissues around them in the spine. Uneven pressure and compression through the spine can result in neck, upper back, or low back problems.

Shoulder protraction is another key feature of poor posture. The shoulders round forward and the scapula (shoulder blade) moves forward away from the spine. Over time, this position will alter the delicate balance of muscles, joints, and ligaments in the shoulder complex. Shoulder pain, stiffness, and impingement may occur. Impingement refers to pain and loss of motion when soft tissues get pinched during shoulder motion.

On the other hand, an over exaggerated military posture can be just as harmful as a slouched position. Chronically shortened muscles can result in problems of their own. An excessive upright posture changes the natural curves of the spine that are needed for normal motion.

The best choice may be to find a neutral position. This is a place where the head isn’t jutting forward like a turtle. And it’s not pulled back in a chin-to-chest position. The shoulders are in line with your ears, hips, and ankles when viewed from the side. And your bottom isn’t tucked completely under or sticking out in a swayback position.

Work toward finding a relaxed, comfortable neutral position. Holding any posture (even a good one) can fatigue the muscles and create problems. Start by finding what is neutral for you. Choose several times each day to check your posture. Assume the neutral position for a couple minutes (or until you forget and go on to do something else).

Being aware of good posture and practicing it is a good, lifelong habit. It will benefit your spine, improve your breathing, and possibly prevent future musculoskeletal problems or injuries.