FAQ Category: General Spine

In general, infection after any spinal surgery is a major risk for all patients. Reports suggest this may happen in up to 10 per cent of all spine patients. Deep infections are expecially problematic. They don’t heal well. Often they are resistant to antibiotics.

Late infections are not uncommon either. The body can harbor bacteria for weeks before the patient develops symptoms. This is especially true in younger patients who have a good immune system that tries to overcome the infection. It remains at a subclinical stage until the body can no longer fight it effectively.

Then the bacteria multiply enough to cause pain, fever, pus, and poor wound healing. Treatment is with intravenous antibiotics. Surgery to debride (clean) the wound may be needed. In a small number of cases, skin graft is needed to help bring the edges of the wound together enough to close successfully.

It’s always a good idea to review your bill after any medical or hospital procedure. Any questions you have can be brought to the billing department directly for explanation.

VAC stands for vacuum assisted closure. It’s a system of foam dressings, tubing, and pump that is used to treat wound infection. Wound infections can be deadly. Infection puts the patient at risk for surgical failure.

Antibiotics are used but sometimes that’s not enough. In more serious cases, the wound is débrided (cleaned out) and irrigated (rinsed) with saline (salt) solution. A special spongy foam-dressing cut in the exact shape of the wound is placed on top of the open site.

The dressing must make close contact with the tissue and seal off the edges so no further bacteria can get in. A piece of flexible tubing is carefully inserted through the dressing. Surgical tape covers the opening where the tube goes in. A pump connected to the tubing sucks out the dead tissue, bacteria, and excess fluid.

The VAC helps speed up healing by improving circulation and closing the size of the wound faster. The cost of the pump and all dressing supplies varies but $150.00 per day is typical. Treatment can range anywhere from one to six weeks.

There are other ways to treat wound infection. But studies show VAC is safe and effective. It can reduce the number of times the patient has to go back for further wound débridement and irrigation.

National and even international experts agree that competent healthcare professionals who are not doctors can evaluate patients with low back pain. This is called first contact or direct access.

Physical therapists and nurse practitioners are the most common healthcare providers to fulfill this diagnostic role. By asking a series of questions and conducting a standard set of physical exams, they can quickly and efficiently triage a patient. Triage means to sort patients into different groups or categories.

During this process, the healthcare provider will be looking for yellow or red flags. Yellow flags point to the possibility of psychosocial risk factors. Red flags suggest a more serious underlying problem such as fracture, infection, or tumor.

Only a small number of patients (probably less than one per cent) have a serious enough problem to need a medical doctor. Most patient respond quite well to a program of supervised activity, exercises, and postural changes.

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.

With improved surgical tools and advanced imaging techniques, more and more surgeries of all kinds are being done these days. The number of spinal operations performed in the United States has really increased over the last 20 years.

There are risks and complications with any surgery. Many studies in the recent past have focused on identifying those risks. Predicting which patients will have a good outcome is a key part of risk assessment.

There are two basic groups of risk factors to review. Patient risk factors include age, obesity, tobacco use, and nutrition. The surgeon will also look at comorbidities. This refers to other health problems the patient may have. Diabetes, incontinence, cancer, and heart disease are some examples of comorbidities.

Operative risk factors are the second group to look at. Anything that increases the operation time or length of stay in the hospital is important. The more complex the operation, the greater the chances for problems to occur. The amount of blood loss can make a difference.

There are other risk factors to consider in the case of spine surgery. How many spinal levels were involved? Did the patient need a bone graft? Did the bone graft come from the patient or a bone bank? Was it necessary to use plates or screws called hardware to stabilize the segment?

Having risk factors doesn’t necessarily mean the patient can’t have the operation. This information helps surgeons formulate a plan of care. The plan takes these risks into consideration before, during, and after the operation.

Although you and your friend may have many of the same symptoms, you may not have the same back injury. That could be one reason. But, let’s say that you both do have the same problem with your back and there still is that difference in opinion. Treating chronic back pain without a specific diagnosis can be hard. Right now, there aren’t any tried and true methods that have a good rate of success in curing chronic back pain. In fact, studies that have been done have come out with opposite findings. One study says that surgery is better at relieving pain, another says that surgery isn’t any better than nonsurgical treatments like physiotherapy, medications or even cognitive therapy to teach you how to manage your pain.

Right now, what we do know is that surgery helps some people and more conservative treatment, like physiotherapy and pain control, helps others. So, it’s likely that your doctor is more conservative and wants to see if not operating and giving you some other therapy might be the best treatment for you.

Bracing for scoliosis (curvature of the spine) is not recommended for adults. There’s no proof that it reduces the size of the curvature. The spine is stiff and some muscle contractures have developed. And wearing a brace may inhibit muscles that are already weak and in disuse.

Recent studies have shown that uneven muscle strength may be contributing to scoliosis in young people. An exercise program to strengthen the trunk rotator and lumbar extensor muscles has shown improvements in the scoliosis curvature.

The same exercise program may still be helpful for adults with scoliosis. Reports are that a program of progressive resistance exercise (PRE) can help control back pain in older patients with this problem.

It’s best to seek out a place where equipment is available that provides PREs to the spine. Measuring your progress and giving you feedback is very important in helping you stay with the program long enough to see results.

Syringomyelia describes a disorder in which a cyst or tubular cavity forms within the spinal cord. This cyst, called a syrinx, stretches and gets longer over time. Cerebrospinal fluid collects in the syrinx. This condition can destroy the center of the spinal cord.

Since the spinal cord connects the brain to nerves in the arms and legs, this damage can cause pain, weakness, and stiffness in the upper body and even the legs. Weakness of the trunk muscles can result in scoliosis (curvature of the spine).

Surgery may be done to take pressure off the spinal cord. A piece of bone from the back of the cervical spine is removed to enlarge the subarachnoid space. This space is where the cerebrospinal fluid flows.

Studies show that surgically treating the syringomyelia doesn’t change the scoliosis by more than five degrees. The presence of scoliosis is actually a negative predictive factor. Patients with syringomyelia and scoliosis are more likely to have a poor outcome after surgery.

This is true when patients with syringomyelia and scoliosis are compared before and after surgery with patients who have syringomyelia but without scoliosis. But the benefits of the surgery still make it a valuable treatment method even for those with scoliosis.

Recombinant bone morphogenetic protein-2 (rh-BMP-2) or BMP for short is a protein that helps bone (and cartilage) grow. It sets up an inflammatory reaction that stimulates bone growth, but can also cause soft-tissue swelling from the inflammation.

Cases of extreme reactions with soft tissue swelling such as you describe are very rare. The use of BMP is usually very safe and very effective. The fusion site heals faster, allowing the patient to resume normal motion and activity sooner.

It does not appear to be a problem with antibody formation and rejection. The protein is cleared from the circulation quickly. There probably isn’t enough time to set up an antibody response.

Studies of this problem show that the dose or amount used of the BMP may be the key to preventing severe reactions. By using a smaller dose or releasing it more slowly, a controlled amount of BMP can be delivered.

Bioresorbable cages are being used more often now in spinal fusion and other orthopedic surgeries. Studies are ongoing to see how long it takes to break down or be absorbed by the body. Researchers are looking to see if any one thing increases or decreases the rate of degradation.

In some studies, X-rays show that solid fusion is often complete at the end of six months. By the end of the first year, fusion and bone remodeling is observed in all cases. Other studies report fusion is complete by the end of three months.

It takes much longer for the implant to slowly become incorporated into the bone structure. Some degradation is seen by the end of 12 months. Much more has occurred by the end of 24 monnths (two years). Scientists are looking for ways to speed this up so future patients may not have to wait as long for full recovery to take place.

Syringomyelia is a general term used to describe a cyst or tube-shaped cavity that forms within the spinal cord. The cyst expands and gets longer filling with cerebrospinal fluid. Sometimes it extends over several spinal levels. Over time, this syringomyelia can destroy the center of the spinal cord.

Your fiancé may or may not have any symptoms now, but studies show that the condition can get worse over time. As the syrinx stretches and fills with fluid, it can put pressure on the spinal cord. Neurologic symptoms can develop. These may include headaches and neck and upper back pain and stiffness.

Over time, the condition may progress and other symptoms can occur. Muscle weakness of the arms and legs have been reported by some patients. Weakness of the trunk muscles can result in scoliosis or curvature of the spine.

There is treatment available for this problem. If your fiancé has not been evaluated by a medical doctor, this may be a good time to suggest a baseline exam. Follow-up on a regular basis to identify any worsening of the condition and appropriate treatment can prevent many problems.

Skip lesion is a term used to describe a condition that affects an area of the body at more than one level but not necessarily adjacent segments or in a continuous line. The disease skips an area and reappears several levels away.

For example, skip lesions are present in cancer when one or two lymph nodes are affected. The next group of nodes is normal but cancer occurs further along the lymph node chain.

The same type of skip lesion can occur in the spine affected by tuberculosis (TB). The affected vertebrae may have normal vertebral bones on either side with spinal TB present several levels higher or lower.

Before whole body MRI was done, the incidence of skip lesions was thought to be about 10 per cent. Now we know it’s more like 70 per cent. Whole body MRI is important in making an accurate diagnosis needed to plan the best treatment.

Most people think of tuberculosis (TB) as a pulmonary or lung disease. But in fact, this infection can spread to other parts of the body. The bones and especially the spine can be affected. Spinal TB is also known as Pott’s disease.

The patient with spinal TB may or may not have symptoms. Or there may be back pain at one level when there is spinal TB present in multiple places along the spine. When vertebral bones are affected with normal segments in between, it’s called a skip lesion.

The best way to identify areas of the entire spine affected is by doing whole body MRI. Studies show that only 10 per cent of lesions are identified with X-rays, CT scans, or bone scans. This is true even when all three are used at the same time. But whole body MRI shows a 70 per cent incidence of spinal TB.

Whole body MRI is suggested for anyone suspected of having a spinal infection. Sixty (60) per cent of the HIV positive patients will have skeletal TB. Early detection and intervention can reduce many of the problems that can occur when the spine is affected.

MRI provides important information about location, amount, and type of spinal cord compression, epidural pus, and bone necrosis (bone death). As Ben Franklin once said, An ounce of prevention is worth a pound of cure. Whole body MRI is probably a good idea in this case.

Pain, dysfunction, and an unstable spine are the usual reasons someone might need a spinal fusion. Severe scoliosis or curvature of the spine may require fusion to hold it in a more upright position. The operation stops motion and stabilizes the spine to give patients pain relief and improve function.

There are many other possible reasons or diagnoses that may warrant fusion. However, experts do advise that spinal fusion is not the answer to every case of chronic low back pain (LBP). Patients with chronic LBP from disc degeneration or spinal stenosis may be good candidates for this operation.

Spinal stenosis is a narrowing of the spinal canal where the spinal cord is located. Pressure on the spinal cord or spinal nerves can occur with spinal stenosis. Rates of spinal fusion have increased over 200 per cent in the last 15 years making this one of the most common operations for chronic LBP.

Patients should always be informed of the potential complications after any surgery. A one in five chance of reoperation means 20 per cent of the patients have further problems after the first operation. It also means that 80 per cent have a successful outcome.

There are some factors that predict a greater likelihood of a second operation. For example, younger patients (especially those on workers’ compensation) are at the greatest risk of needing a second operation.

Some conditions are more likely to require a second operation. For example, fusion for spinal stenosis has a higher reoperation rate compared to just doing a decompressive procedure. Decompression refers to removing the disc and/or bone around the disc to take pressure off the spinal nerve.

On the other hand, fusion for spondylolisthesis had a better result than decompression. Spondylolisthesis refers to a condition where the body of the vertebral bone slips forward over the vertebra below putting a traction (pulling) force on the spinal nerves.

You may want to review your specific situation with your surgeon. Ask about any risk factors and the usual results for the type of operation recommended for you before making a final decision.

Rescue medications, also called quick-relief or fast-acting medications, usually work right away to relieve your symptoms when they occur. These types of drugs are often used for conditions like asthma or back pain where there is a need for immediate help.

For example with asthma, rescue medication inhaled directly into the lungs opens up the airways and relieves wheezing, coughing, and shortness of breath within minutes. Rescue medications are also used for patients with musculoskeletal pain. For example, patients with chronic low back pain that flares up occasionally may need a rescue drug to get through the flare-up.

Rescue medications don’t have a long-term effect. That’s why some patients use what’s called a controller medication. This is a preventive or maintenance medication. It’s taken long-term on a regular basis and work over a period of time to control and help prevent symptoms from occurring.

As with any chronic pain condition, the goal is to avoid dependence on drugs. But in some cases, this isn’t possible. Rescue and controller medications may be part of an overall management plan that also includes exercise, relaxation techniques, and behavioral changes.

A medical examination is probably in order. Although her symptoms sound like they are caused by spinal stenosis, there could be many other causes as well. Spinal stenosis is a narrowing of the canal through which the spinal cord goes from the neck down to the lumbar spine.It is a common condition associated with aging.

Examination by a medical doctor along with imaging studies may be needed to find out the cause of the problems. The symptom of dysesthesia in the feet is a disagreeable sensation produced by ordinary stimuli. Patients may describe it as being like numbness, but not exactly. Walking or even just touching the skin can result in this symptom.

Treatment is based on the underlying cause. Sometimes medication can be used. Capsaicin-containing cream helps some patients when applied to the skin. Surgery may be helpful for some patients. You are right to be concerned about the effects of inactivity. Talk with your mother about seeing a physician sooner than later. Early treatment can make a difference in results.

Surgery may be a possible option. An operation called a cervical osteotomy is done to change the angle of the spine. In ankylosing spondylitis (AS), the bones start to fuse locking the person in a bent position.

In an osteotomy procedure, a wedge of bone is removed from the back of the spine. With the bone removed, the spinal cord and spinal nerves have more space around them. The patient can be straightened up without pinching or compressing the nerve tissue.

There are certain risks with this operation. Not all patients are good candidates. Good, overall general health is required and a sincere desire to complete the rehab program. The first step in the process is to see a medical doctor. It may be helpful to your uncle if a family member goes with him to offer support and discuss the pros and cons of treatment.

Most likely your husband will have an MRI with a contrast dye to see what’s going on inside the spinal canal. There could be many potential problems causing this new development.

The symptoms suggest pressure on the spinal cord. Although very rare, a hematoma could be the source of the problem. A hematoma is a pocket of blood from internal bleeding during the operation. Usually patients have symptoms with this right away in the postoperative period.

But in some very unusual cases, delayed hematoma can cause the kind of symptoms you reported. Neurologic deficits can occur days to weeks after the spinal surgery. You were right to bring him to the hospital quickly. Immediate surgery may be needed to relieve the pressure and prevent permanent damage.

Your husband will likely have a short stay in the hospital until he is stabilized. He may go to a transition unit where he will be in a rehab program. Or he may be sent home and attend rehab as an out-patient.

The use of bone taken from the patient’s pelvic crest is common. This is called an autologous bone graft. The bone is close to the surface and easily harvested. However, there are some potential problems.

Pain shortly after the operation is to be expected. But when that pain persists weeks to months later, then the problem can become chronic. Some patients also report a patch of numbness over the area.

In a small number of cases, the donor site doesn’t heal. Infection and wound breakdown can occur. Painful symptoms can result in a change in the way the person walks. In the worst cases, the pelvic bone fractures or the sacroiliac joint becomes unstable.

Most of these problems are really rare. Expect some short-term local pain over the donor site. If you notice anything unusual, report your concerns to the surgeon right away.