FAQ Category: General Spine

Many women suffer some form of back pain with pregnancy. Pregnancy forces the body to adapt quickly to a lot of new weight distributed on the abdomen. This can put a lot of stress on the muscles, tendons, and ligaments of your back. It can even shift the alignment of the spine.

You need to take the weight off your spine. Lying down with your back in good alignment can help relieve the pain. It is best to lie on your side. Use pillows to keep your head and neck aligned so that your spine is straight. A pillow between your knees can help. Don’t lie on your stomach or back. Lying on your back puts pressure on major blood vessels, which can cause dizziness and even nausea.

If your pregnancy has changed your posture, a support harness might help. The harness helps support the abdomen, taking some of the pressure off your lower back.

Make sure you tell your doctor about your back pain. In rare cases, back pain during pregnancy can be a signal of a condition that you need to address.

Not necessarily, although your risk for back pain is somewhat higher. Having swayback posture means that your back is arched and your upper back is rounded more than usual. Extra weight on the abdomen–which you will definitely have in the next nine months–also tends to make the lower back arch more. Too much arch can be a source of back pain.

You may be able to prevent problems by using good posture. Stretching and strengthening exercises may help. Good flexibility is especially important in the front thigh muscles, and strengthening your abdominal and back muscles can help support your spine. Talk to your doctor. She or he may recommend that you work with a physical or occupational therapist to develop an exercise program for your pregnancy.

Pseudarthrosis is a condition that occurs when the bones of a joint don’t heal together correctly. Pseudarthrosis can happen in other parts of your body, but it generally refers to a spinal fusion that doesn’t fully heal.

Treatment of pseudarthrosis is difficult. The bones may need more healing time. In this case, your doctor might prescribe a bone-growth stimulator. This device sends electrical currents through the bones that need to be fused. The chemical reaction that results can help speed bone healing.

If your pseudarthrosis doesn’t heal even with help, another surgery may be your only option. Your doctor will probably want to run many tests before operating again. The tests are necessary to be sure that the pseudarthrosis is truly the source of your pain.

It rarely happens with surgical implants. The metal screws, rods, and plates used in back surgery are usually made of stainless steel, titanium, or alloys. These metals have been tested and chosen for their acceptance by the body.

Implants do sometimes need to be removed because they become infected. But the infection is not a sign that the body is rejecting the implant. Infection is simply a risk of all surgeries.

The goal of therapy is to get you back to speed and control your pain. It might be unrealistic to expect your pain to go completely away during the course of your treatment. It is hard to predict when back pain will go away. But your therapist can help you find ways to control your pain better.

In most cases, your visits to the therapist will end when you can manage your pain and you are moving much better. Your therapist will develop a home program of exercises and stretches. The home program is an important part of your treatment. Stick with it. Recovering from back problems is a long-term process. Keeping your back strong and improving your fitness level will help you avoid–or at least minimize–future back problems.

Epidural stimulators are devices that send electrical currents to the nerve roots that are causing your pain. They can work, but they are invasive treatments. You will need surgery to permanently place electrodes in the sleeve of the nerve roots. Most of the time, doctors will have you try a temporary stimulator to make sure it helps you before placing a permanent device.

Epidural stimulators work by the “gate theory” of pain. The principle of the gate theory is that if you can make the nerve recognize a sensation other than pain–such as heat, rubbing, or electrical current–your central nervous system “closes the gate” on any other sensations. This means the pain doesn’t register. Electrical currents get to the spinal column much faster than pain impulses, so they are pretty effective at closing that gate.

Eiduralysis is a treatment for people who have scar tissue around the nerve roots of their spine. This scar tissue sometimes forms after injury or surgery. It can cause back pain and pain down the leg. Doctors use special dye that shows up on a special imaging test in order to see where scar tissue has built up around the nerve roots of the spine. Then they inject either a corticosteroid, a saline solution, or a special enzyme called hyaluronidase into the area.

Epiduralysis has been used for about 10 years. It generally gives good short-term relief for people with severe back pain and pain that shoots down the leg. The pain relief can last from three to twelve months people. However, epiduralysis treatments don’t last forever. Many people need more than one treatment. Epiduralysis is also more effective when it is used along with other strategies to manage pain.

Living with back pain can be a lifelong project. Once you’ve had a bout of back pain, you have a 90% chance that it will come back some day. Keeping your back strong and flexible and improving your overall fitness can help prevent recurring back pain. Exercise and staying active are also ways to help you decrease pain.

Usually the metal pieces used in spine fusion surgery are left in place. They are not needed after the fusion has healed. But it is generally not worth going through another surgery to get them out.

Occasionally the screws or rods break, cause you pain, or can be seen or felt under your skin. In these cases, they may need to be removed. Broken rods or screws may mean that the fusion didn’t heal well.

Most back problems don’t require surgery at all. Only a few spine problems require surgery right away. Even if your doctor is considering surgery, he or she is likely to recommend several months of conservative treatment first.

The term “conservative treatment” really just means “non-surgical treatment.” Conservative treatment involves using medications, rest, exercise, and pain control techniques. The goal will be to manage your pain and regain your ability to move. This can take time. You may need to try several different approaches until you find the combination of techniques that works for you. Your doctor may also recommend that you work with other professionals, such as a physical or occupational therapist, a nutritionist, or an ergonomic specialist. They can work as a team to help get you back to speed.

Probably not. Fusion surgery can effectively relieve the pain of your condition. Pedicle screws are sometimes used in fusion surgery, but most studies suggest that they don’t add benefits for people with spondylolisthesis.

The pedicle screw is inserted in the bony point–the pedicle–that connects the ring of bone around the spinal canal to the vertebral body. The theory behind pedicle screws is that extra fixation will help the fusion heal more effectively. In fact, using a pedicle screw involves higher risks during the surgery. The surgery takes longer, and patients lose more blood during surgery. Research suggests that pedicle screws don’t show better fusion success or have any benefits in easing pain or getting patients with spondylolisthesis back to their activities.

Keeping your spine aligned helps prevent pain and injuries. Joints function best when they are aligned in their natural positions. This means sitting and standing without slouching, avoiding awkward positions that twist the spine, and not “freezing” your back into one position for long periods of time.

Back pain does tend to recur. Once you’ve had low back pain, you have a 90% chance that it will come back someday. That’s why it’s important to learn ways to prevent future injury and flare-ups, and to know how to treat back pain as soon as it starts.

If your back pain comes back, rest your back immediately. Avoid anything that makes it feel worse. For the first two or three days, use cold packs to lessen the pain and swelling. After the symptoms are under control, try using heat treatments.

The most important part of preventing back problems is learning how to use your body to avoid injury. You may work with a physical or occupational therapist to help you learn ways to stretch and strengthen your muscles. Therapists can also suggest ways to minimize the stress on your back while you go about your daily activities.

If you have been working with a therapist, be sure to follow the home program, even if your back is feeling much better. Prevention is definitely the best medicine for back pain.

Exercises to strengthen your abdomen and trunk muscles can help prevent back problems. You also need to make sure that you use good posture in all your activities–no slouching or “freezing” your back in one position for long periods of time.

Overall conditioning is also important in keeping your spine healthy. You need aerobic exercise, such as swimming, cross-country skiing, walking, or aerobics classes. Pick something you enjoy so you keep doing it.

Recurring back pain is common. Once you have had an episode of debilitating back pain, you have a 90% chance that it will come back. There are many possible reasons why your back pain keeps recurring. You may be straing or overusing your back in some activity that you do regularly. You may have a weak disc that has started to bulge, which puts pressure on the joints, nerves, or ligaments. You may have weak muscles or ligaments around your spine, which make your spinal joints unstable.

Whatever the cause, you will probably benefit form an exercise program designed specifically for you. Your doctor can direct you to a physical or occupational therapist. Your doctor and therpist can also help you find more effective ways to manage the pain.

Spine problems don’t usually cause emergencies. But there are some symptoms that mean you need to get medical attention immediately.

If you lose control over your bowels or bladder, call the doctor right away. This usually happens when a disc herniation in the low back fills the spinal canal, pressing on nerves. (This condition is called cauda equina syndrome.) This pressure paralyzes the muscles that control the bladder and bowels. If the pressure isn’t relieved soon, the nerves can be damaged permanently.

A sudden onset of pain or numbness with no obvious cause is also a reason to call your doctor.

Problems with the central nervous system can also cause referred pain in more than one limb. Pain like this is caused in one part of the body and felt in another. For example, kidney pain can feel like low back pain. Aortic aneurysm and stomach ulcers can cause what feels like spine pain. Gall bladder problems can lead to pain in the right arm. These problems are serious and need immediate attention.

As in other visits, your doctor will begin by asking you questions about your health history and your current symptoms. Then your doctor will physically examine you. In the case of spine problems, there are some common parts of the physical exam:

* Spine motion. How well can you twist and bend? Does it cause pain? Are you less flexible than you used to be?
* Pain. Your doctor will look for especially tender areas around your spine.
* Weakness. You will be given simple tests for muscle strength.
* Reflexes. Your doctor will test the tendon reflexes below the knee or behind the ankle.
* Sensory abilities. Your doctor will check to make sure you can detect certain sensations–such as a pin prick, heat, or cold–in parts of your feet and hands.
* Motor skills. You may be asked to walk on your heels or toes. 

Your doctor will also be on the lookout for indications of problems like tenderness in certain areas, a fever, abnormal pulse, or rapid weight loss. Your doctor may ask questions about steroid use. Any of these findings may mean you have another problem that is not directly related to a spine problem.

After the exam, your doctor may recommend further tests. The most frequently recommended tests initially are X-rays and other types of imaging tests, including MRIs and CT scans. Lab work, such as blood tests, may also be needed. 

Some patients need the added support of a walker or cane for a few weeks after back surgery. Even if you don’t need this extra support, build up your walking gradually to avoid overdoing it at first. Taking a little extra time and care gives your healing back a chance to recover and can protect you from reinjuring yourself.

Avoid doing anything that makes the pain worse or carries the risk of re-injuring your back. What exercises are safe to do depends on the activity and on what exactly is wrong with your back. Your best bet is to start slowly and gradually begin doing your usual activities. If you normally do intense exercise or sports that involve twisting your back, like golf, you need to wait until your back is better. Walking and swimming are probably the best exercises for rehabilitating your back. They keep you from putting too much stress on your body, yet they get your entire body moving.

Talk with your doctor and physical therapist about how to get started on a program of exercise to help you get back to full function.

You can learn to move in ways that don’t strain your back.
* To get in and out of bed, do the “log roll” technique. When you are lying down, roll your whole body to the side, as if your body were a log. Then gently raise your torso and move your feet to the floor.
* When you sit or stand, keep your back straight and bend from the hips.
* Instead of bending at the waist, use a grabber to pick things up from the floor or putting on shoes or socks.
* When you have to bend over, don’t bend at the waist. Keep your back straight and bend forward at the hips.
* Don’t ever test your back by carrying or lifting something that’s too heavy.
* Even when you are lifting lightweight items, keep your back straight and bend your knees so that you can lift with your legs. Hold the item close to your body, no matter how light it is.