FAQ Category: General Spine

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.

A schwannoma is a benign, or non-cancerous, tumor. It develops on the sheath or cover of a nerve and grows from there. They are not necessarily painful but can cause pain if they begin to press on the nerves. They are usually very slow growing. Usually schwannomas don’t interfere with the nerves unless they are on a major nerve.

Tests to diagnose schwannomas can include x-rays to be sure the mass isn’t interfering with a bone, ultrasounds to allow the doctor to see the organs around it, magnetic resonance imaging (MRI) to give more detailed images, and a biopsy of the tumor. To do a biopsy, the doctor takes a small piece of tissue from the tumor and it is examined under a microscope to check for cancerous cells.

Acoustic schwannomas actually have four names. They can also be called vestibular schwannomas, acoustic neuromas, or just neuromas. They all meant the same thing: a benign, non-cancerous, tumor on the cranial nerve. This nerve is divided into two: the cochlear division (for hearing) and the vestibular division (for balance).

Acoustic schwannomas grow very slowly. The vast majority (over 90 percent) of patients with an acoustic schwannoma experience tinnitus, or ringing in the ears, and deafness in the affected ear. Problems with balance may start and get worse. Because the mass is growing so slowly, it may not be diagnosed until the hearing loss is quite profound.

A sarcoma is a cancer or tumor that starts in the bone or in the connective tissue around the bone. The three most common sarcomas are osteosarcoma, chondrosarcoma, and Ewing’s sarcoma. There are also soft tissue sarcomas that come from the tissues that support the organs in the body.

Bone cancer can be present for a while before any symptoms are noticed. The most common symptoms is bone pain. Since these cancers are usually along the long bones, these are the ones that will have pain.

Some people who have bone cancer but don’t know it yet may break a bone in a seemingly not serious accident. This can happen because the bone has been weakened by the tumor.

There may be fatigue (weakness), weight loss, anemia (not enough red blood cells), fever, and perhaps swelling or pain in the joint close to the tumor.

Sometimes, bone cancer is detected by accident. If someone is having an X-ray for another reason, the doctor may notice something in the image that causes him or her to investigate further and find the cancer.

The jury is not in on this topic yet. There haven’t been enough studies directly comparing open surgery to the minimally invasive (MI) method. It makes sense that the MI operation would have less blood loss and less soft tissue trauma. But there haven’t been any reports to suggest a lower rate of wound healing or infection with the less invasive technique.

And the final outcome (rate of fusion) hasn’t been any different between the two methods. The surgery takes longer using the MI method. For men, there’s the added risk of problems with sexual function that can occur when the operation is done from the front of the body (anterior approach).

Surgeons are studying patients now to find out who would be the best candidate for this procedure. Sometimes patient selection is an important part of the process. For surgeons just learning the method, the ideal patient may be someone with moderate degenerative disease. This patient should be thin and only need one-level fused.

For now, a review of the studies done so far doesn’t seem to indicate the minimally invasive surgery has better results than the standard surgery. Talk to your surgeon about your interest in this new approach. He or she will be able to answer any other more specific questions you may have.

This is a common Catch-22 problem. It hurts to walk so the person stops walking. But walking might help reduce the pain. In fact, studies show that walking will very likely decrease her pain. You might start by sharing that information with her.

Sometimes it helps to point out that the person has pain whether or not she walks, so she might as well try walking. It might help! And it has other health benefits besides improving back pain.

Sometimes the person just needs someone to get them started. Encourage her to just walk around her house once each hour. Or suggest she take a 10-minute walk. If she lives in an apartment, suggest walking down the hallway and back. If she lives in a neighborhood, she might try walking down the street and back. Start with once a day and increase it to two or three times each day.

If you can’t walk with her yourself, try to find a friend or neighbor who can walk regularly. Don’t force or push her to walk faster or farther at first. Just get some walking started, and see if that doesn’t take care of the rest.

If none of your efforts work, perhaps it’s time to talk to the doctor about pain control first. A short course of physical therapy might help break the pain-spasm cycle. Once the pain is under control, the therapist can supervise her in a walking program to get her started.

Vertebroplasty is a way to strengthen a vertebral bone after it has fractured. The surgeon uses a special kind of X-ray imaging called fluoroscopy to guide a needle into the body of the vertebral bone. Cement is injected into the bone through the needle. It quickly hardens and reinforces the bone.

What you’re suggesting actually has a name: fracture prophylaxis using reinforcement. Prophylaxis is another word for prevention. Reinforcing weakened, brittle bones before injury is a fairly new idea.

Testing is at the conceptual stage. This means computer models are used to see what effect the injected cement would have on compression strength of bones. They are testing this with varying amounts of bone mineral density loss before injury occurs.

How much cement is needed is one question they are testing. At what point should a weakened bone be shored up with cement is another question to be answered. It would be very helpful if we could predict which patients are going to develop a vertebral compression fracture. The expense of prophylactic care for everyone isn’t practical.

More study is needed before this concept becomes a viable treatment option.

It might for awhile. But you may be prone to a vigorous inflammatory response. This leads to the formation of adhesions and scar tissue for some people. Another surgery may only make matters worse.

You’re not alone with this problem. Studies show that at least 10 per cent (and probably more) of the people who have a discectomy develop return of symptoms from scarring. And up to 42 per cent who never had surgery but have had disc problems, develop adhesions.

Scar tissue in the spinal canal or in the area around the spinal nerve can cause this type of pain syndrome. In fact, there are increased amounts of blood vessels that develop in this area too. Many surgeons agree that revision of such scars is very difficult. And since it’s likely to come back again, this type of surgery is avoided.

A program of pain management may be your best bet. Behavioral therapy and exercises to maintain strength and motion are encouraged. There is also a wide range of complementary or alternative treatments available. This might include acupuncture or acupressure, massage, biofeedback, and even hypnosis. Many other forms of alternative treatment are also available.

Talk to your doctor about his or her recommendations for you. Find out what your options are before considering another surgery.

Vertebral bone fractures can heal without surgery. But the fact that surgery has been advised suggests there are reasons why conservative (nonoperative) treatment isn’t the best choice for him.

If there are bone fragments present, they can break off and get dislodged. If they move into the spinal canal where the spinal cord is located, serious problems can occur. If the fractures don’t heal, spinal deformity can develop. If the spine starts to compress and curve forward, then kyphosis is the result.

Pain and neurologic symptoms are common with untreated posttraumatic kyphosis. These symptoms often get worse over time. Patients lose function and work capacity declines.

The best results are reported in patients who have the surgery done as quickly as possible. Plates and screws or a double-rod system can be used to hold the spine stable until a complete fusion occurs. Without this treatment, nonunion, deformity, and spinal instability are all potential risks.

If the surgeon has explained all this to your father and he still refuses the operation, it may be helpful to get a second opinion. Perhaps if your father hears the same information from two different sources, he may rethink his options.

The best you can do is make sure he has been advised of the possible negative results of a conservative approach. The choice and the consequences are still his to decide.

Vertebral compression fractures, or VTF, happen when the bones get thin or if there is a trauma or injury to the back. It’s not uncommon among older people to develop VTF. As the vertebrae in the back begin to thin or are broken, they begin to compress on to one another. Left untreated, this can develop into a kyphosis or curved back, often called a dowager’s hump.

The danger to leaving VTF untreated is that as the vertebrae begin to collapse onto one another and the back begins to curve, there is less room for the lungs to expand and breathing can become difficult. As well, it’s painful and you can start having problems moving around and doing the every day things.

The procedures you heard about are called vertebroplasty PV, and balloon kyphoplasty (KP). During the procedure, a small amount of a cement compound is injected into the fractured area in the back. This strengthens the area and results in less pain. As with all medical procedures, there are some risks involved. After the cement compound is injected, there is a risk of leaking, although the risk is small. If the compound does leak, it could cause a pulmonary embolism, or a clot that goes into the lungs. It could also leak into the area around the vertebrae, causing some nerve problems. Other risks, though small, are heart attack and stroke.

The current standard of care for disc herniation is at least six weeks of conservative care. This usually includes nonsteroidal antiinflammatory drugs (NSAIDs) and physical therapy. Patient education is a large part of the nonoperative approach to this problem.

But doctors know that disc protrusion can be unpredictable. Some patients get better while others get worse. It isn’t easy to tell who will fall into each category. So conservative care is the first step, and if there’s no improvement, then surgery is considered as the next step.

It may be best to redirect your thinking. You did not fail. You faithfully did your program. The program failed you. Having surgery is the next step in the treatment protocol, not a sign of failure.

In studies done by the Spine Patient Outcomes Research Trial (SPORT), 40 to 45 per cent of all patients switch from one treatment group to the other. Some planning surgery get better and don’t need an operation after all. Others trying the conservative route get worse and need the surgery. You are in this second group.

The good news is that surgery is another option when conservative care doesn’t work. And only a very small number of patients (less than five per cent) have complications from this surgery. Most report improvement with sciatica and greater overall function.

Ankylosing spondylitis is one of several rheumatoid arthritic diseases that can affect the spine. This group of diseases cause damage by creating inflammation that attacks the connective tissues of the body.

There are several ways to follow your own progress. The first is to get a baseline to show where you are now. For example, your doctor probably ordered X-rays at some point early in the diagnosis. The X-rays are helpful because they show the condition and position of the joints and bone. Future X-rays can be taken and compared to the original ones.

There are several clinical tests your physician may measure from time to time. The first is called Schöber’s test. This is a measure of movement in the lumbar spine as you bend forward. With AS, it’s common for patients to lose motion and start to bend from the hips and upper spine instead of using the lower spine.

A second test is a measurement of chest expansion. The physician just uses a tape measure to see how much your ribs and chest expand when you take a deep breath. Because AS causes the spine to fuse, there is a natural progression of lost chest expansion.

There are also specific measures of activity for patients with AS. The Bath Anklyosing Spondylitis Disease Activity Index (BASDAI) allows each patient to describe the severity of symptoms on a scale from none to very severe. Morning stiffness is recorded in minutes to hours.

Another similar checklist is the Bath Ankylosing Spondylitis Functional Index (BASFI). By filling out this survey, you rate your activity and function from easy to impossible. This survey includes actions or movements such as putting on socks, picking something up from the floor, or getting up out of a chair or off the floor.

By filling these types of surveys out on a regular basis (such as every six months to a year), you can follow your own progress. This is actually a very good idea because if you see that you are losing ground, you can get help from your doctor and a physical therapist. Managing the symptoms and preventing further deformity are the major goals of treatment.

Ankylosing spondylitis (AS) is a painful inflammatory arthritis of the spine and sacroiliac joints. Other joints can be affected. AS is also known as
Bechterew’s disease or syndrome, Marie Strümpell disease, or spondyloarthritis.

It is a chronic, painful condition that can cause the spine to fuse. This is referred to as bamboo spine. AS is classified as an autoimmune disorder meaning the body attacks itself. There is a strong link to heredity and AS does run in families.

Early diagnosis is important to prevent permanent deformity. Back pain in anyone younger than 40 should be investigated quickly. Other red flags for early AS include morning stiffness that goes away with activity. Buttock pain on one side (it may alternate from side to side) and low back pain and loss of motion are common.

Symptoms that last more than three months should be evaluated by a medical doctor. X-rays and a family history will be taken. The doctor will measure your son’s forward motion and chest expansion. These are two important tests for AS. Special MRI views may help shed some light on the condition, especially if it’s a form of early AS.

Given your family history and your son’s current symptoms, it makes sense to make an appointment to see his doctor. Keep track of all his symptoms from now until his appointment as this will help the physician make the diagnosis.

Epidural steroid injection (ESI) is a treatment option used for low back pain that goes down the leg. This type of pain is called lumbrosacral radiculopathy. A liquid containing a steroid and a numbing agent are injected into the area around the inflamed, irritated spinal nerve.

Patients often get pain relief that lasts. The decrease in pain makes it possible to increase movement and function. But it’s not a cure for the underlying problem. Sometimes physical therapy can help with that. In other cases, surgery is still needed.

Some physicians have used ESI for neck pain from cervical radiculopathy. Although the process is similar (irritation of the nerve causes pain), the anatomy is slightly different. ESI is not routinely used for neck pain from radiculopathy.

There aren’t very many good studies on the use of ESI for cervical radiculopathy. The American Academy of Neurology recently published a review of research in this area. They did not find very many high-quality scientific studies on ESI for the neck or low back. They are suggesting this is an area of need for future studies.

Castleman disease is a benign type of tumor formed by plasma cells in the lymph tissue. It was named for Dr. Castleman who first reported it in 1956. It is fairly rare and usually shows up the in the front part of the chest under the breast bone. This area is called the mediastinum.

It can appear anywhere in the body where lymph tissue (nodes) is abundant. This includes the under arm (axilla) area, abdomen, and neck. In rare cases, the nervous system has been involved. This means the tumor grows inside the brain (intracranial). Even more rare are cases involving the spine.

It’s not clear what causes these benign tumors to grow. Theories today include infection, inflammation, and an autoimmune process. Patients present with symptoms of fever, weight loss, anemia, and an elevated sed rate. A high sed rate suggests infection or inflammation.

Treatment is surgical to remove the tumor. Sometimes radiation therapy or chemotherapy is used as well. There aren’t enough cases of Castleman disease to compare and find out which treatment works best.

Most patients do quite well after treatment. The tumor does not seem to grow back. Only in rare cases has death been reported as a result of this condition. It may depend on the location of the tumor.

Intracranial tumors can cause seizures and edema (swelling). Older adults may develop more problems and have a lower survival rate.

Schwannoma is a rare tumor of the sheath or lining around the peripheral nerves. It starts in the Schwann cells, which is how it gets its name. Schwann cells help form the cover around the nerves called the myelin sheath. Sometimes it’s called neurosarcoma or neurogenic sarcoma.

It is benign, usually slow growing, and painless. It stays on the outside of the nerve. Benign means it isn’t cancer. It won’t spread to other areas, and isn’t likely to cause death. But if it grows large enough to put pressure on the nerve, then pain, numbness, and even paralysis can occur.

Unfortunately, many people with back injuries end up suffering again when the pain returns. If your back pain comes back, see your doctor to be sure that it really is the same back pain as before.

To help prevent your back pain from coming back, it’s important to treat your back properly. If cleared by your doctor, you should begin an exercise routine to strengthen your leg, abdominal and thigh muscles. Strong muscles will keep the weight off your back. Be sure to always use good body mechanics when picking something off the floor, even a piece of paper. Remember to always bend at the knees when picking something off the floor, no matter how small. This way, your leg muscles will take the weight of your upper body and the object you are lifting. If the object you are carrying is heavy, bend at the elbows and hold it as close to you as you can. This, again, prevents your back from taking the weight of the object. Finally, always move in straigh-ahead fashion while carrying something, do not turn at the waist. If you want to move a heavy object from a table in front of you to a counter beside you, pick up the object as described earlier. With your feet, turn your body so you are facing the counter and then lower the object on to it. If you must put the object on the floor, you must bend your knees as you should when lifting something.

More and more patients first contact for muscular, joint, or other skeletal problems is with a physical therapist (PT). When you see a PT first without seeing a doctor, it’s called direct access. There are direct access laws in almost every state of the United States. This gives the consumer the right to choose who you want to see first.

As a result of the change in the law, PTs are now trained at the doctorate level. They learn how to screen all patients for potential medical problems before beginning an exercise or rehab program. The use of red flags is a common method used to identify patients with serious problems requiring medical evaluation.

The presence of any constitutional symptoms in anyone with low back pain (LBP) is always a red flag. This may include fever, chills, sweats, nausea, or vomiting. Rapid, unexplained weight loss, blood in the urine or stool, or skin rashes are some other obvious red flags.

The therapist will ask about a previous history of cancer or recent urinary tract (or other) infection. These are also red flags. Back pain accompanied by abdominal, pelvic, or hip pain raises concern that something else might be going on.

When a patient has one or two red flags, the therapist knows to conduct a more thorough exam and to ask additional questions. The presence of three or more unexplained red flags usually requires medical referral.

It makes sense to see a PT when you have LBP since more than 80 per cent of all cases of LBP are musculoskeletal in nature. Their advanced training in screening ensures that patients with serious conditions will see the physician right away.