FAQ Category: Lumbar Spine

Nonspecific low back pain occurs in a wide range of people of all ages and backgrounds. There are an equal number of different reasons behind their back pain. Mood and psychosocial factors can certainly be a part of the big picture.

In fact, many studies have shown now that psychosocial issues are a key factor in patients who develop chronic pain. If you’ve had back pain for six months now, then you fall into the definition of someone who is having a problem with chronic pain.

When infection, tumor, or other more serious cause of back pain has been ruled out, it’s a good idea to look more closely at the psychosocial piece of the puzzle. Many studies have shown now that the presence of anxiety and/or depression makes a difference.

Patients are less likely to respond to any kind of therapy or treatment if there was a high level of distress before treatment. This is true whether they have surgery, physical therapy, or some other form of treatment. Higher levels of distress actually predict greater pain and disability over the course of follow-up.

It sounds like you are in good hands if your PA knows this and is making an effort to explore all areas of possibility with you. It’s probably not the case that he thinks this is all in your head. A good health care professional recognizes all factors (including psychologic and social) that can contribute to a problem.

Fenestration comes from the Latin root word fenestra, which means window. Surgical fenestration for a disc problem is an operation to cut an opening in the vertebral bone. By doing this, the surgeon can remove the disc without creating an unstable spine.

When the disc protrudes or herniates, it can put pressure on the spinal cord or spinal nerves as they leave the spinal cord. The resulting symptoms can be very disabling. Back and leg pain, numbness, and muscle weakness can occur. Even worse, paralysis is even possible.

With the new minimally invasive, endoscopic procedures, surgeons can use a small opening (fenestra) and avoid cutting a large portion of the bone out. Removing the bone from around the disc is called a laminectomy. The lamina is the curved arch of bone that forms a circle around the spinal cord to protect it. Fenestration takes the place of a laminectomy.

Fenestration just cuts a hole in the lamina. Complications can still occur with this operation. Spinal cord fluid can leak if the covering over the spinal cord it nicked or cut by mistake. Infection is always a risk with any operation. And whenever the spinal cord is involved, there’s always the small chance of paralysis.

Good question. Start with your doctor. Make sure you don’t have a serious health condition. If you get the go ahead, most experts agree lifestyle changes are in order.

If you are overweight, seek help for gradual, sustained weight loss. Programs that emphasize exercise and good nutrition are advised. Quick weight loss methods without changes in your eating habits don’t usually work in the long-run.

Increase your activity. Walking, biking, and/or swimming are the easiest ways to improve your overall health and fitness. Burning a few extra calories each day will help you achieve your weight loss goal. Studies have shown over and over there is a benefit in regular, daily exercise for chronic low back pain.

Monitor your thoughts. If you find yourself saying things like, I can’t do that, my back won’t let me, then you may need some help changing your belief systems. A psychologist and/or a physical therapist trained in cognitive behavioral therapy can help you identify some of these thought patterns. They can guide you in breaking out of this fear-avoidance behavior (FAB).

The therapist can also help you monitor your posture and body mechanics. Setting goals and learning pacing and stress reduction are often part of the PT program for chronic LBP patients.

If you’ve had back pain for three months or more, then you have chronic back pain. If there’s no known cause for this pain like a tumor or infection, then it’s often referred to as mechanical pain.

Assuming you have seen a doctor and been told there isn’t a medical problem, it’s likely that increasing your activity won’t cause any harm. Whatever happened to trigger the first episode of pain has most likely resolved by now. But the nervous sytem has turned on the pain signals and they haven’t been turned off.

Many studies have shown now that physical activity and exercise is an important treatment tool for chronic back pain. A gradual program slowly but steadily introduced and increased is often beneficial.

Don’t jump in and try to take on the full activity at a level equal to someone who doesn’t have back pain. Pace yourself. Do a small amount one day and wait a day to see what effect it has. Many times patients have to work through a temporary increase in pain frequency, intensity, or duration before they are able to move ahead.

Give yourself a full month to six weeks of regular activity and exercise before deciding which way to go next. You may want to seek the counsel of your physician or the services of a physical therapist to help you with this program.

While bedrest used to be recommended for back pain, many doctors began to worry about the long-lasting effects of bedrest. For some people, it could cause their muscles to atrophy, or get smaller and weaker from not being used. Bedrest can increase the chances of weight gain, and there are other issues, such as social isolation and psychological problems such as depression that may come in to play if the bedrest is long-term.

As doctors encouraged their patients with some types of chronic lower back pain, they found that there was no difference in the healing if a patient stayed in bed or didn’t. So, for this reason, bedrest is not automatically recommended now for all cases of chronic lower back pain.

First, make sure you have your surgeon’s approval to begin your exercise program. It may be best to consult with him or her to find out if there are any restrictions or guidelines you should follow.

You may want to consider seeing a physical therapist (PT) to help guide you through this process. If you’ve already seen a PT for post-operative rehab, this would be the next step of the program. It would progress you to a strengthening and endurance phase of rehab.

When it comes to preventing low back pain (LBP), we know that endurance of the lumbar extensor muscles is more important than strength. Being able to hold a position of extension for 20 seconds or more is the goal. One way to practice this is over the edge of a table.

Support your lower body and hips on the table (face down). The upper part of the body (trunk, chest, and arms) is unsupported. Hold your body in a straight line (horizontal) for as long as you can. Rest and do it again. Try for three repetitions twice a day.

An overall fitness program is also advised. This can be walking, biking, or swimming. Whatever you choose to do, include 20 to 30 minutes in your daily routine at a moderately fast pace.

If you have any trouble or experience increased pain or symptoms, see your doctor or physical therapist. You may just need a minor adjustment to the program. You’ll want to stick with it and make forward progress for the best results after your surgery.

First, it’s important that if you have back pain, you get a doctor’s opinion as to the best treatment for you. While some injuries may not need bedrest, this is not a one-size-fits-all type of treatment approach.

For those whose doctors have told them not to stay in bed, the reasons can be many. What researchers and doctors have found over the years is not moving doesn’t add anything to the healing process of some back injuries and may slow it down. If your back injury is not aggravated by movement, your doctor will likely advise you to try to continue your daily activities as much as possible.

Pain and its mechanisms remain one of the world’s greatest mysteries. Scientists are slowly starting to unravel the how, what, and why of chronic pain. But we are far from understanding it fully.

When it comes to the spine, there are many tissues that have nerve endings for pain. The spinal or facet joints have free nerve endings. So do the discs, ligaments, and muscles.

When a pain signal is started, the spinal cord relays the message to the brain. The brain signals the body part to let it know that it hurts. But the pain we feel is usually diffuse or widespread over an area. It is not pinpointed to one spot. This makes it difficult to isolate the underlying cause of the problem.

Trauma or injury (even microtrauma) often starts a cascade of events that results in inflammation. The chemicals produced during inflammation appear to be the source of the pain. The pain is more likely caused by the inflammatory changes in the joint than caused by actual joint destruction seen on x-rays. That’s why it’s possible to have a perfectly normal looking spine or joint and still have great pain.

There is a new method for testing the facet joints. Researchers have found that increased nitric oxide (NO) in and around the joints is common when there’s inflammation. In fact one study from Sweden showed that patients with chronic back pain had three times the level of NO compared to healthy adults without back pain.

NO is a gas that acts as a messenger in the body. It has many functions but obviously has a role in inflammation as well. For patients with elevated NO, steroid injection has been shown to help reduce pain and improve function.

The hope is that in the future, we will be able to identify molecular markers in the blood to tell us exactly where the pain is coming from. For now, patience is required as doctors try to sort out the complex issues around back pain. Sometimes it’s just a matter of trial and error until we find what works for each individual patient.

There are three possibilities that come to mind regarding your situation. The first is that despite all test indications, it’s possible your pain just wasn’t coming from the facet joints. You may have had a false positive test response.

There are nerve endings in many of the tissues of the spine. It isn’t always possible to tell whether the pain is coming from the discs, joints, ligaments, or muscles.

Second, it’s possible you did have inflammation in and around the facet joint. A steroid injection seems to help many, but not all, patients with this problem. Scientists aren’t sure why this happens, yet.

And finally, studies show that people with facet joint degeneration often have more than one level involved. If you only have one level injected, the source of the pain hasn’t been completely eradicated. You may need more than one level injected.

Don’t give up on finding the help you need. Sometimes it takes more than one injection to do the trick. Even a failed response to treatment offers some helpful information to your doctor. Make a follow-up appointment and find out what other treatment options are still left open to you.

Back pain is costly and disabling around the world. Billions of dollars are spent on back care in the United States and in other industrialized countries. Many studies are under way to try and find the most effective, least costly treatment for this problem.

The international guidelines proposed come from England. They are based on population studies from Europe. The emphasis is on pain management using exercise and advice. Spinal manipulation has been shown helpful in the early phases of back injury. It may not be so helpful for chronic problems.

Different therapists taking various approaches to the problem of chronic low back pain. They help patients pace their activities with the goal in mind of returning to usual activity and work. Stabilization exercises for the trunk and abdomen may be helpful in reducing pain and disability for chronic low back pain sufferers.

With decreased disability and improved activity, physical therapy helps improve patients’ quality of life. Physical therapy has been shown to decrease the total dollars spent on back care. Both you and your pocketbook feel better.

Without knowing the specifics of your situation, it’s difficult to predict or advise you on the next step. It’s probably safe to say that you have not failed anything. It’s more likely that your pain just didn’t respond to the treatment you received.

Physical therapy has been shown helpful for chronic low back pain (LBP). But there are many different types of therapy. Not all work for every patient. Finding the right treatment for each person can be a challenge. It may take some time and may even require changing therapists.

Many studies show that chronic back pain sufferers can really benefit from a cognitive-behavioral approach in physical therapy treatment. This means that patients are educated about their spine, including basic anatomy and spine mechanics.

Wrong beliefs about the spine and about the cause of back pain are challenged and corrected. Patients learn how to manage their pain and improve their function. With chronic pain, the goal is no longer cure. Instead, self-help is the focus. The goal is to improve function and decrease disability while living with the pain.

In some cases, there are other treatment options. Epidural injections, spinal implants, and decompressive surgery are common procedures used. The type of operation needed depends on the underlying problem.

It’s probably a good idea to make an appointment with your treating physician and review your case. Provide him or her with a timeline of what happened, what type of treatment you’ve had, and when it took place. Review the results of each treatment method. And then ask for options to consider as your next step.

It’s true that one of the possible problems after spinal fusion is adjacent-segment deterioration (ASD). This doesn’t always happen. Scientists aren’t sure why it happens to some people but not to others.

In a recent study, surgeons in Korea compared two different fusion methods used to see if the type of fusion made a difference. Their patients either had a posterior lumbar interbody fusion (PLIF) or an anterior lumbar interbody fusion (ALIF).

Posterior means the operation is done from the back. Anterior is from the front. In both methods, the disc was removed. Bone chips and/or a tiny cage were used to fill the empty disc space. This graft material stimulates additional bone growth to occur. Screws were used to hold the spine stable until the fusion was complete.

Surgery done from the front (anterior) is less likely to cause ASD. This may be because damage to the posterior parts of the spine is avoided. The structures that hold the spine in place remain strong. No change in the alignment may be a protective factor.

One study comparing ALIF to PLIF showed that ASD is more likely to occur with PLIF. The posterior soft tissue structures are disrupted possibly contritbuting to the proglem. But even with ASD forming, the patients did not need additional surgery. They seemed just as happy with the results as the patients who had ALIF and no segmental degeneration.

More studies are needed to find ways to eliminate the complication of ASD after spinal fusion.

Spinal fusion can be done in a variety of different ways. You may be describing the posterior interbody lumbar fusion (PLIF) and the anterior lumbar interbody fusion (ALIF). The basic surgery is the same between these two. The major difference is whether the surgeon opens the spine from the front (anterior) or from the backposterior.

The surgeon usually makes this choice based on several different factors. First is the patient’s symptoms. Neurologic symptoms such as numbness, tingling, or weakness may require the posterior approach. Back pain without signs of nerve damage can be treated with the ALIF.

The surgeon also develops his or her own preferences. Sometimes based on the surgeons own training, comfort, and types of patients treated, he or she may prefer one method over another.

The reason there are many different types of back injuries lies in the complex way your back is made. Unlike an arm or a leg that have bone, muscles, tendons, and ligaments, your spine has many small pieces of bone (Vertebrae), muscles, joints, ligaments, discs, and roots. And, the many discs make for many openings for bending and twisting, giving more leeway for injury.

If the larger roots of the spine are irritated or injured, you could feel pain in your arms or legs, instead of the back. If the smaller nerves along the spine are irritated, this can hurt the back itself. Then, there are the muscles and ligaments that can be pulled, stretched, or even torn; the joints could become swollen, and discs may move out of place.

Many studies are attempting to measure the results after different kinds of treatment for lumbar disc protrusion. Some studies compare the results of patients receiving treatment with people who have never had back pain.

It looks like patients after back surgery for a discectomy (disc removal) don’t really get back to normal. There is often a residual loss of function and quality of life. The researchers are careful to match patients and healthy subjects by age so they get a more accurate picture of each age group.

It’s possible that a rehab program after discectomy is needed. Studies have not been done before and after to show if rehab would make a difference. And studies are needed to identify which program works the best.

There may be other factors to consider. For example, what is the influence of age on recovery? What’s the ideal duration of program needed for the best results? Who can benefit the most?

Until we know more about this, you may want to pursue an individualized rehab program. A physical therapist can help you plan such a program based on your particular needs. If you stick with it long enough, you may be able to progress to a fitness program and possibly prevent future problems from occurring.

Without knowing exactly what the problem is and the type of surgery your doctor is proposing, it’s not possible to get specific. However, most surgeries do have the same types of issues. First, how bad is your pain? Is it affecting your lifestyle? Have you tried various pain relieving medications and/or physiotherapy, or other treatments? Has it affected your ability to move around or control your bladder or bowels? These are some things to consider.

You will need to weigh the potential benefit of surgery against the potential complications. Like most surgeries, there is a chance of infection, bleeding, or blood clots. And, of course, there is always the chance that the surgery is not successful.

This is something you must discuss with your doctor before you make any decisions.

If you need to have a spinal fusion, usually rods and screws are used to help stabilize the area. In fact, the implants act like splints, increasing the chances of the surgery being a success.

The types of screws and rods that your doctor chooses to use will depend on which he or she is most comfortable using and what they will be used for.

The role of heredity and genetics in disc degeneration has taken a front seat in the last few years. We are paying a lot more attention now to the family history link.

But it’s not clear yet just how this information will help. A family history of back problems doesn’t necessarily mean you will develop them, too.

A long-standing belief that occupational lifting or manual labor contributes to back problems has come under question as well. These types of activities may not harm you as much as they help.

Research is showing that physical loading through work-related and leisure activities may actually benefit the discs. Repeated mechanical stress increases the number of cells in the nucleus pulposus (center of the disc). More studies are needed to understand the role of loading and metabolic response.

A recent study of twins done in Finland showed that increased body weight and aging may be the two most important factors in the health of your discs. You can’t do much about your age, but keeping your body weight down is a good idea. Not only will your spine benefit, but so will your heart health and general health!

But to answer your question, X-rays and MRIs will help show disc height and hydration. Just how this information will help is still a little sketchy. There’s still so much we don’t know about which discs are at risk, why, and how to tell.

If you did have this type of imaging done, how would it change what you are already doing? At age 30-something, you have time on your side right now. Armed with the knowledge that this is a potential problem in your family, weight loss and staying active are your two most important preventative tools.

Despite the large number of people who suffer back pain from disc problems, we still don’t have a clear answer on what treatment is best. Research does support exactly what you pointed out. The main reason to have surgery is that people who have the operation report pain relief sooner than later.

There are still so many variables that it’s difficult to compare treatment results. For example, discectomy (removing the disc) is a standard operation. But even among patients of one single surgeon, there can be differences in how the operation is done. Differences in surgical technique and results can occur from surgeon to surgeon across the U.S., too.

The wait time between onset of symptoms and surgery varies. Some patients suffer painful symptoms much longer than others. Several studies have shown that longer duration of symptoms is linked with poorer results after surgery.

Likewise, nonsurgical treatment varies. Even if all the patients are given the same nonoperative program, some do it, some don’t. Some do it some of the time. Some do it everyday. Compliance (or noncompliance) most likely makes a difference. And even if everyone is given the same program and does it everyday, the way people do their exercises might be different enough to make a difference.

Scientists haven’t given up trying to sort this out. Studies are ongoing to compare different types of treatment and the results obtained.

For a long time, we have believed that repetitive lifting causes back problems. It seems to make sense that repeated loading on the spine can cause degeneration of the discs and spinal joints. But studies have not been able to confirm this idea.

In fact, a recent study from Finland suggests that routine (daily) physical loading of the spine may have a training effect. The old sayings, Motion is lotion and Move it or lose it may be true once again.

As it turns out age, body weight, and genetics may be the key factors in back problems from degenerative disc disease. Older age and higher body weight may be more important in disc degeneration than physical activity at work or during our leisure time.

If it turns out that routine or repetitive loading actually benefits the spine, you may be ahead of the game. This type of activity may actually delay the effects of aging on the discs.