FAQ Category: General Spine

Discs located between the vertebral bones of the spine have two parts. The inside called the nucleus is a gel-like cushion. The outer shell called the annulus is more tough and fibrous.

Scientists report the content of the nucleus as water, collagen, and proteoglycan. Collagen is a member of the protein family. It’s what gives connective tissue its strength and flexibility. Interestingly, collagen turns into a gel like the nucleus when it’s boiled.

So far, 20 different types of protein have been identified. Proteoglycan is another member of the protein family. It has a large amount of water, but we aren’t sure what it does exactly. It’s found on the surfaces of every cell in our body.

Researchers hope to find out what happens when the disc ages or is injured. Through this knowledge, we may be able to find ways to prevent disc degeneration over time.

We can only guess what might be happening at this point. Research into the cause of disc damage and stages of repair is ongoing. From what we do know, it appears that the mechanism for triggering disc degeneration differs depending on the injury.

In other words, does the damage comes from inside the disc or by forces and pressure on the outside? The effects of aging versus trauma may be different. Or perhaps repetitive mechanical trauma from doing the same activity or motion over and over is the major key
to disc damage.

From a study in Sweden using pig models, we know what kind of damage a hole can do when poked in the disc. The researchers think a small hole results in minor leakage of fluid from the disc. Healing is faster, too. Maybe the healing in a small injury is more
complete than a large injury.

With a larger hole poked in the disc, there’s a faster loss of nucleus material right away. The site of the injury doesn’t heal well, and the disc can’t get enough nutrition. This may explain the differences in your two disc events, one may be a small injury with
a slow leak, while the other was larger with slower healing.

Good question. Airbags are, in fact, designed to pop out and blow up from the front based on impact. They are less likely to deploy with a hit from the side or the rear.

Some cars like the newer VW bug have airbags along the sides now. This doesn’t solve the problem of rear impact. Head and neck injuries are still a problem with rear impact.

Until all vehicles have a more complete restraint system, it’s best to use your seatbelt at all times. Studies show seatbelts combined with airbags still offer the best protection.

Pulmonary embolism (PE) or blood clot to the lungs occurs in half a million patients every year. Death is often the first sign of this problem. That’s why it’s called a “silent disease.”

Doctors are aware this problem can occur most often during or after an operation of any kind. That’s why research is ongoing to find out who’s at risk and what can be done to
prevent blood clots. The risk of a blood clot is greatest with surgery to the pelvis and legs. This is especially true for total hip and total knee replacements.

The risk of blood clot with spinal surgery hasn’t been fully reported. Only case reports or studies after the fact are available. Recently a group of Italian doctors from several centers started a study to follow this problem. The results of their findings may help formulate future decisions about prevention of blood clots after spine surgery.

Computer-assisted surgery has been in use for over 10 years now. Infrared cameras at the end of probes and instruments are used to transmit images or pictures to a computer screen monitor.

Wireless sensors are part of the camera system. They detect movement and can be attached
to any instrument. Since there are no batteries or power cords, the tools are free to move as directed by the surgeon.

Before entering the body, the computer is given data from CT scans. This allows the doctor to navigate the body. The computer calculates the thickness of the bone and drills the holes for screws used to hold the bones together. The system keeps the screw from going all the way through the bone. Damage to nearby blood vessels and nerves is avoided with this method.

Fear of movement and fear of reinjury are common problems after accidents and trauma of all kinds. Patients expect increased pain and start to avoid certain movements. The body starts to stiffen up and pretty soon they’ve lost normal motion and function.

Studies show that patients can get better with the right kind of rehab. Improving motion and fitness while reducing disability are the goals. The patient is exposed to a small amount of the feared activity with support and supervision of a trained rehab professional. Gradually, the patient attempts more and more with less help. Reducing the anxiety, fear, or worry associated with movement is a big part of the program.

We can’t give you a straight answer on this because it just isn’t clear yet what works the best. National trends show an increased number of visits with doctors for back pain of unknown cause. This may be based on what health insurance covers. Some patients report
the best results with chiropractic care, but fewer patients are going to chiropractors today compared with 10 years ago. More patients are relying on specific exercises given by physical therapists.

Until the right mix of treatment is found, patients are on their own to find what works best them. In the meantime, watch the news for research results in case anything changes.

A recent study from Denmark shows this is fairly typical of older adults. They studied 4,486 adults ages 70 to 101 and found a greater amount of neck and/or back pain in aging adults with other health issues.

Poor health in general is linked with an increase in neck or back pain. Often these two occur together, but they don’t last long. Spinal pain in more than one area is also linked with poor general health.

It may be a good idea to have a medical exam if she hasn’t been seen by her doctor lately. Back pain can be caused by other diseases and illnesses that are treatable.

Studies of twins from around the world don’t support that conclusion. Despite lower birth weights, twins have the same amount of many adult diseases. This includes diabetes, thyroid problems, and heart disease. They have the same life expectancy and mortality
rate as the general population. This means they live as long as everyone else and die at about the same age.

A recent study from Denmark used the Twin Registry (data collected on twins) to assess back and neck pain. They found twins have the same amount of back pain alone, neck pain alone, or back and neck pain together as the general population.

Twins are considered part of the general population and don’t need to be studied separately when it comes to health issues.

Discography is a fairly new technology. As a result of many studies, it has recently become more accepted as a good diagnostic tool. It is a reliable indicator of pain caused by a disc problem.

With discography, doctors can see if the disc is damaged or degenerating. It can show which part of the disc is involved (center or outer ring). A dye is injected into the disc space most likely to be the source of the patient’s pain. Then a special X-ray is taken.

Discography is called provocative because it can provoke or cause the patient’s
painful symptoms. In fact, pain is the indicator that the test is positive. Most patients don’t like the test. However, most doctors won’t perform disc surgery until the disc is tested in this way.

Science has been searching for a less invasive way to confirm the presence of discogenic pain. Weighted MRIs can show high intensity zones, which is a sign of disc damage. Provocative discography must still be used to decide if it’s the disc that’s truly causing your pain.

There isn’t any way to test this out on live subjects. Researchers have used spines from human cadavers to study the forces of impact on the neck and back. They are able to come close to the response of an unwarned occupant using this type of model. They can’t mimic the active forces of muscles contracting to brace for impact.

Even so, this kind of research gives some good information. Scientists think it may be impossible to build up enough muscle contraction before impact to make a difference. Studies of simulated rear-end collisions show that peak muscle tension occurs between 149 and 924 milliseconds. Strain on ligaments occurs at around 150 milliseconds. Some people may not respond quickly enough to prevent injury.

There are two factors here: the speed of response and the amount of muscle strength needed to protect the neck. Studies so far show the muscles of the neck can’t respond quickly enough or with enough strength to protect the neck.

Again, these studies aren’t done with live models so there may be some factors scientists can’t account for.

Extraforaminal is an anatomic location. The vertebral bones of the spine consist of two main parts. There’s the round bone of the main body. The body is attached by a bridge of bone to the spinal joints (facets) and spinous processes. The spinous process
is what you feel as the back bone through your skin.

Between the main body and the spinous process is a round circle. When the vertebrae are stacked up on top of each other these circles form a canal. The spinal cord passes through this space. It’s called the foramen.

Anything that’s inside the foramen is called intraforaminal. Anything outside the foramen is extraforaminal. A disc that’s extraforaminal has pushed outside of its own space but is not inside the spinal canal. It has probably pushed out more toward the side.

A disc that protrudes straight back can enter the foramen. An intraforaminal disc can put pressure on the spinal cord. An extraforaminal disc is more likely to push to the side and press on the spinal nerve.

Artificial disc replacement (ADR) is fairly new (approved in October 2004). Not everyone is a good candidate for this treatment. Patients are selected carefully based on bone strength, attitude, and overall health.

Since ADR is so new, results of long-term studies aren’t ready yet. We do know a second surgery after spinal FUSION is needed in up to 30 percent of patients. The hope is that this number would be much less with ADR.

Revision surgery after ADR would be needed if the implant slips or collapses. Bone fracture may require removal of the implant. Studies done so far show that patients with
mild malpositions of the implant do just fine when it’s left in place. A second surgery isn’t always needed for this problem.

Yes. Research now shows that disrupted discs from aging and wear and tear can form tears that are highly sensitive. Long lasting pain can occur when the tear goes all the way to the outer edge of the disc covering (called the annulus fibrosus).

Chemicals are released that irritate the spinal nerves in this area. A new treatment called radiofrequency is being used with some success. The surgeon threads a tube around or through the disc to the damaged or torn area. Radiofrequency is used to heat
the tissue high enough to stop nerve tissue from sending pain messages.

No one should have to suffer years, even decades with painful disc problems.
Radiofrequency or spinal fusion are two surgical options with good results for many patients.

Studies are slowly trickling in on the use of artificial disc replacements (ADR). In Germany and France they’ve been used for at least the last 10 years–long enough for some analysis of the results.

X-rays taken right after the operation are compared to X-rays taken up to 10 or 11 years later. Doctors look for places where the ADR has moved or migrated forward or back.
Sometimes the implant sinks down into the end plates of the vertebra. The end plate is a layer of cartilage between the disc and the vertebral bone. The implant can even sink so far as to go through the end-plate into the vertebral body.

Fusion is not the goal with disc replacements. If fusion occurs, the body does so spontaneously. A recent study from France reported interbody fusion at the level of the ADR in one patient. The ADR penetrated the end-plate and bony fusion occurred at that level.

It looks like fusion after ADR occurs in rare cases.

What works and how well it works with artificial disc replacements (ADRs) is largely unknown. Studies conducted over the last 10 years are coming out more and more now. Most studies have reported the final results after several years (up to 11 years). They may have included patients with single-level and multiple-level ADRs but without comparing the results of the two.What works and how well it works with artificial disc replacements (ADRs) is largely unknown. Studies conducted over the last 10 years are coming out more and more now. Most studies have reported the final results after several years (up to 11 years). They may have included patients with single-level and multiple-level ADRs but without comparing the results of the two.

A new study from France did specifically compare the results of single level implants with multiple level groups. They found similar results with both. So for now, it looks like patients can have more than one disc replaced at a time. The operation is both safe and effective.

This is a good question that doesn’t have a good answer. Some experts suggest if a person always sits or stands in a slouched posture, then over time the body assumes that position permanently.

There are some social theories about tall people or large busted women assuming a stooped position to hide their height or body parts.

A forward head and forward shoulder posture is seen in people of all sizes, shapes, ages, and gender. If there is a genetic trait for poor posture, no one has found it yet.

It’s clear that problems occur with a forward head or slouched posture. Pressure on the spinal nerves can cause numbness and tingling down the arm. Muscles get out of balance when the upper body is held in unnatural positions for long periods of time. Shoulder, neck, and upper back pain can occur.

Researchers are looking into the use of taping to help correct the posture. The goal is to improve muscle function and reduce pain when present. Short-term results have been reported but long-term studies are needed.

Taking out a herniated disc is the most common type of back surgery today. The direct cost of treating disc-related back pain is more than 20 billion dollars a year. A minimally invasive method of treatment was started in order to reduce the dangers and cost of back surgery.

Instead of a large incision to open the spine and allow the surgeon to see what he or she is doing, a small opening is made. A long, thin needle is then inserted. A tiny TV camera on the end of the needle sends a picture to a TV screen. This shows the surgeon everything inside the area.

It’s done on an outpatient basis meaning the patient goes home the same day. This compares to a three-to-four day inpatient stay for the standard surgery.

The patient has very little pain after the operation so the need for pain medication is less than in the traditional surgery.

Patients can often return to normal daily activities, including work, in two weeks. It can take up to six weeks to reach this level of recovery after the standard surgery.

One advantage of the traditional operation with an open incision is the amount of disc material that can be removed. With open surgery there’s no limit to how much material can be taken out. There is a physical limit to how much can be removed using inimally invasive methods.

Pain lasting two years and longer is reported by up to 40% of all patients who use their own bone for the fusion site. The pain isn’t usually debilitating. It doesn’t keep the patients from their daily activities. But it is annoying and persistent.

Some studies even report patients with chronic pain up to 10 years later. About 20 percent of all patients are unhappy with how the donor site looks, too. Scar tissue, puckering, and even a sharp edge sticking out are reported.

When bone is removed the body tries to replace it. Often too much bone is formed to compensate for the loss. The body will slowly remodel any excess but it doesn’t always do so in smooth, curved lines. Sharp bony edges are possible. The new bone may press on nearby soft tissues causing pain from the pressure.

We don’t have an easy answer to this problem at the present time. Using a bone bank may become more popular with bone fusions of all kinds.

Worldwide it looks like 80 percent of all adults will have neck or back pain at some point in their lives. In general low back pain is more common than neck pain.

A 1996 study from Hong Kong reported that neck pain was more common in managers and professionals. Back pain was more likely to affect manual workers.

More and more studies are showing a strong link between neck and back pain and psychosocial factors. Emotional stress, lack of job satisfaction, and other occupational factors may have more to do with back pain than anything else.

We must find a direct cause and effect to neck and back pain before treatment can be prescribed with success.