I am going to have spine fusion surgery. The surgeon is going to put metal screws and rods in my back. Will they stay there forever?

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.

I have bad back pain. Do I need surgery?

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.

I have pain in my lower back caused by spondylolisthesis (slipped vertebrae in the lower spine). I will be undergoing fusion surgery, and I’ve been doing some research on the procedure. I’ve read that some doctors like to use a pedicle screw. Would a pedicle screw improve my results after surgery?

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.

I just found out that I’m pregnant. Are there any exercises to keep my back from hurting later in my pregnancy?

Yes. You can take some steps to counteract the extra back strain that is sometimes felt during pregnancy. A careful exercise program can help. The program should build your endurance, strength, and flexibility. Exercises that focus on the lower back and abdomen can help take the strain off your lower back. Strengthening the muscles of your thighs can help them take some of the strain off the back, too. Don’t forget to do mild cardiovascular exercises too, such as walking or swimming.

Whatever you do, don’t overdo it. Don’t do too much or ignore symptoms of fatigue, dizziness, or pain. Make sure you tell your doctor about your exercise program. You might find it helpful to work with a physical or occupational therapist to develop an exercise program just for you.

I had a baby months ago, but my back still hurts. What can I do about it?

You might need to get some help to make the pain go away. Pregnancy can be very tough on your body. The extra weight and new back alignment may have actually injured your back. Your doctor can suggest ways to manage the pain. It might be useful to see a physical or occupational therapist. A therapist can suggest exercises and stretches to return your back to its pre-pregnancy shape.

I am an avid exerciser. Now I’m pregnant, and I want to keep working out. Is that OK, even late in my pregnancy? Are there exercises I shouldn’t do?

It’s great to exercise while you’re pregnant–within limits. It is important to talk to your doctor. Every woman has different problems during pregnancy. Your doctor will take into consideration your pregnancy and your condition.

Keep in mind that your body will go through some changes that make injuries more likely. All the extra weight on your abdomen will stress the muscles and tendons of your back. Your center of gravity will also change, throwing off your sense of balance. In the last trimester, your body produces a hormone called relaxin that loosens your ligaments. This makes your pelvis relax so the baby can fit through the birth canal easier, but it also makes your joints and soft tissues more susceptible to injuries.

For most pregnant women, moderate exercise is best. Now is not the time to add to your workout. Very long or very stressful workouts should be avoided. Low-impact exercises are usually better during pregnancy, especially later on. Avoid overstretching, and limit the time you spend lying on your back. The weight of the baby can put pressure on blood vessels, making you feel dizzy or nauseous. Most importantly, listen to your body. Don’t push yourself too far. If you feel dizzy, faint, or short of breath, stop exercising. Report any pain or bleeding to your doctor.

I am eight months pregnant. The pain in my lower back is excruciating. What can I do to ease the pain?

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.

I’m pregnant, and my doctor says I have swayback posture. Does this mean I’ll have back problems while I’m pregnant?

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.

My fusion surgery didn’t heal right, and the pain is excruciating. My doctor says I have pseudarthrosis. What is it, and what can I do about it?

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.

I am going to have a metal plate put in my back during spine surgery. I’ve heard that bodies sometimes reject implants. Could this happen to me?

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.

I am going to have spine fusion. Will I be able to walk right after surgery?

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.

Why is good posture important for my back and neck?

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.

I’m recovering from my first episode of back pain, and I’m worried. I’ve heard that back pain always comes back. What can I do to try to prevent that?

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.

I don’t have any back problems, but almost everyone in my family does. What exercises can I do to keep my back healthy?

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.

I’ve had back pain on and off for five years now. Why won’t it go away?

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.

I have back pain. Are there any symptoms I should watch out for that mean I should get medical help right away?

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.

I am having back problems. How will the doctor examine my spine?

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. 

I’ve been diagnosed with degenerative disc disease. How fast can I expect my pain to increase as my discs degenerate?

Your pain won’t necessarily increase. Changes in the spine are part of aging. Sometimes the changes cause more pain, but often they don’t. Even if you have spurs in your neck and back, the result is not necessarily increased pain. In some ways, the aging process actually can help stop pain. As your tissues lose water content and become stiffer, they generally don’t move as much. Body parts that don’t move usually don’t cause as much pain.

You are more likely to handle the changes in your spine without increased pain if you stay fit and use good posture. If you have increasing pain, make sure to see your doctor before it gets out of control.

What is a discogram?

A discogram gives a picture of an injured disc. A special kind of dye is injected into the discs before you get an X-ray. The dye shows up on a fluoroscope screen. Discograms work better than a plain X-ray or other tests because they give a better picture of the disc.