FAQ Category: Lumbar Spine

Back injuries can happen at just about any job although some jobs are harder on your back than others.

Any job that requires heavy lifting or repetition is a higher risk job. This could include furniture moving or working as a cashier, for example. Other jobs, such as driving trucks, can also cause sore backs because of the long periods of sitting.

If you have a job that requires heavy lifting, it’s important to be sure that you life properly. Remember to always bend at the knees when picking something off the floor, no matter how small. This way, your leg muscles will take the weight off your upper body and the object you are lifting. If the object you are carrying is heavy, bend at the elbows and hold it as close to you as you can. This, again, prevents your back from taking the weight of the object. Finally, always move in straight-ahead fashion while carrying something, do not turn at the waist. If you want to move a heavy object from a table in front of you to a counter beside you, pick up the object as described earlier. With your feet, turn your body so you are facing the counter and then lower the object on to it. If you must put the object on the floor, you must bend your knees as you should when lifting something.

If your job is repetitive, like working as a store cashier, try to change your movements as you work. If your job is sedentary and you’re sitting down most of the time, get up and move around at least once an hour, and make sure that your workstation is set up so that you are working comfortably.

It’s always best to alert your host (or hostess) ahead of time of any special needs you may have. They may be able to solve the problem before it becomes one.

One possible solution is to purchase ahead of time slipper socks with a leather bottom. Your husband can remove his shoe and slip the sock over the brace. This doesn’t give him the complete support of a shoe but may prevent an embarrassing fall.

If he will allow it, he should take your arm for support while walking without the brace. And though many older adults refuse to use a cane, it can be very useful when traveling. It gives a visual but silent message to your host and other guests of special circumstances.

Drop foot (sometimes called foot drop) is caused by pressure on the spinal nerve root as it leaves the spinal cord. A bulging disc or other degenerative disorder of the lumbar spine can have this effect.

Nerve impairment can result in muscle weakness. When the L5 nerve is affected, motor loss of the tibialis anterior muscle can occur. The tibialis anterior is the muscle along the front of the lower leg. It pulls the foot up toward the face. Weakness of this muscle results in the toes dragging along the floor as the foot and leg move forward.

Surgery to remove pressure from the nerve can prevent this problem from happening. For those patients who don’t have the surgery soon enough, drop foot can be permanent. The sooner surgery is done, the better your chances are for full recovery.

In a recent study from Japan, researchers found that more than half the patients did recover function. Only about one-third had a complete recovery. These patients were younger, had greater strength of the tibialis anterior muscle before surgery, and a shorter duration of symptoms.

You have a much better chance of recovery with the surgery than without. Talk to your surgeon about what to expect. Motor recovery can be a slow process taking up to two full years for complete return of strength.

Many people may need disc replacement surgery, but only certain people may be chosen to have it. This is because doctors already have a good idea who will not benefit from the surgery and they don’t want to put people at unnecessary risk.

Patients with bones that have begun to thin or soften from osteoporosis or some other bone disorder aren’t usually good candidates for disc replacement. If your bones aren’t strong enough to anchor the disc, it won’t work properly. If you have a disorder called spondylolisthesis, a condition where some bones may slip, causing pressure on the nerves, you also are not a good candidate for disc replacement.

Other problems can interfere with you having surgery, such as infections, morbid obesity or other illnesses. Some may delay the possibility of surgery and some may rule it out completely.

After surgery for a disc replacement, you may spend one or two nights in the hospital but don’t be surprised if the nurses get you up and out of bed on the first evening following your operation. The earlier you get moving, the better for your body.

Most patients don’t need a rehabilitation or physiotherapy program. You may be given a list of exercises to do once you get home. This could be given to you by your doctor or a physiotherapist while you’re in the hospital. Your doctor will prescribe medications if you need them and will advise you on what’s best for you, such as when you can begin lifting things, when you can return to work and other daily activities.

Most patients return for regular visits to their doctor after about four to six weeks and then for a while after, depending on the doctor’s preference and the patient’s progress.

That question is hard to answer, because there really isn’t a way to tell whose back will get better and whose won’t. That being said, there are ways to help you prevent further back injury once you’ve been hurt.

Once the initial back pain is gone, it’s important to treat your back properly, to lessen the chances of becoming re-injured. Learning proper body mechanics, or how to move your body when lifting or moving an object, is one of the most important things in back injury prevention. Learning how to move, how to lift and how to carry, are all ways to help protect your back. Becoming someone who is aware of the back and of the ways it can be hurt, can go a long way to keeping your back from getting injured again.

Finally, exercising and keeping your body in shape can help. If your abdominal muscles are strong, they can help support your body, taking the load off your back.

Your spine is made up of many small pieces. Between the bones, ligaments, muscles, discs and other body tissues, there are many parts that can get injured and cause pain. Back injuries can happen from activities as simple as lifting an item that is too heavy, to just bending the wrong way to pick up a pencil. Other back injuries can be the result of traumatic events, like an accident or a fall. Infections or diseases, like arthritis, can cause back pain too.

The injury doesn’t have to be severe to very painful. A tight, tense back muscle can be very painful, as can a herniated disc. When a disc in your back breaks, the substance inside can leak out and press on the nerves, causing pain. This is called a herniated disc.

Because many people aren’t aware of good body mechanics, how to move your body safely to prevent injury, back injuries are common, particularly in certain types of jobs that are very active or require a lot of lifting and bending.

As you say, there may be pain, but the pain can vary depending on what is causing the pain. The pain could be across your back, down one side into the leg, constant or every once in a while. Back injuries can also cause numbness in one or both legs, or a tingling sensation. Some back injuries can also cause loss of control of the bowel or bladder, or both.

If you have having pain that is keeping you from participating in your daily activities, or it is keeping your from sleeping, or you have any of the signs such as loss of control of your bladder, you should see your doctor as soon as possible. A more severe back injury could cause more damage so treatment should be started as soon as possible.

Your back is complex system, made of bone, disks, a jelly-like substance between the disks, and nerves. When you bend over or lift anything heavy, it’s easy to do it in such a way that your back is bending the wrong way and you could slip a disk, pull a muscle or otherwise hurt your lower back.

Sometimes, back pain happens a while after the initial injury as the muscles begin to tighten up as they try to protect your back from further injury.

Every time you bend over to pick up something, even a pencil, you put your back at risk. To reduce the risk of injury, you need to learn good body mechanics. That means moving so that your back is moving as it should, without putting stress on any particular section.

First, when lifting anything, be sure to bend your knees and keep you back straight. Do not bend over, keeping your legs straight. By bending your knees, you’re lowering your body’s center of gravity, and you are letting your leg muscles bear the weight of your body and the item you are picking up.

If you’re lifting something heavy, hold it as close to your body as you can, don’t stretch out. Finally, always keep your body straight, don’t turn at the waist if you’re carrying or lifting an object. If you need to move a box from the floor in front of you to the counter beside you, bend at the knees, keep your back straight, pick up the box and then stand up straight again. Then, turn with your feet, not at your waist. Move your body so it is facing where you’ll put the box down.

If you often lift heavy objects, consider getting a special belt that helps support your lower back when you lift.

A lot of research has been done and is still being done about back injuries because they are so frequent. There is so much that isn’t known about the best way to manage back injuries. A back support is one of those that doctors don’t all agree on. In fact, in a recent study, back supports didn’t rank well among the factors that would help prevent back disability.

While a back support will likely not hurt, it may not help either. Of course, there may be other reasons why your friend’s doctor feels that the back support will help her. While your back injury may seem the same as your friend’s, it’s possible that there is a difference that you don’t know about, causing your doctor to recommend different management for your back.

Back pain is often a chronic, or long-term, injury. It can disable a person for quite a while. While it may just be bothersome for some people, it can be incapacitating to others.

It’s known that people with chronic injuries can get depressed because of several reasons. With back pain, the pain may be constant, non-stop, and that
can wear a person down. You often don’t sleep well if you’re in chronic pain and then you’re tired because you can’t sleep. Also, back pain can restrict
how you move and what you do, your daily activities. If you’re someone who likes to get out and is very active, the notion of not being able to participate in these activities can be discouraging. What worries many physicians is that if their patients who have chronic pain become depressed, they may be less likely to get help to relieve their pain and then a vicious cycle begins.

Steroid injections into the epidural space around the spinal cord have been used for many years with mixed results. What researchers are finding out now is that some people are better candidates than others for this treatment.

Patient safety is the main motivator for turning someone away from having this procedure. Based on studies we know that anyone taking an anticoagulant drug should not have an epidural space injection (ESI). Anyone who has had a bad mental or physical reaction to ESI is also not advised to have an ESI.

Diabetes, infection, or spinal malignancy also rule out this treatment. A few precautions are also followed. ESI is only used occasionally for anyone with congestive heart failure, during pregnancy, or when the injection failed in the past.

Patients who seem to benefit the most from this procedure include those with low back pain and sciatica who have not been helped by other treatment. ESI is sometimes used as the last resort before surgery.

If the surgeon is aware of these factors and knows the ESI is not indicated, he or she will not advise patients to have an ESI. This is true even if you had a previously successful result. Your situation could be changed now from a medical point of view.

Don’t hesitate to ask your surgeon for a more detailed explanation for saying you aren’t a good candidate. Knowing the reasons could save you time, money, and perhaps prevent unnecessary problems.

A recent review of the literature may offer some help. Surgeons from the University of Washington looked at many studies on the use of epidural steroid injections (ESIs) for low back pain.

They found that there’s no strong evidence to support the use of ESI for back pain alone. Back pain that radiates (travels) down the leg is called sciatica. Sciatica is a sign that the spinal nerve is pinched or irritated. Back pain with sciatica may benefit from an ESI.

The natural history of back pain with or without sciatica is that the symptoms will improve and go away in most people during the first seven to eight weeks. Treatment may not speed up this healing process.

For that reason, some experts don’t advise any treatment during that first eight weeks. Others suggest that early intervention could help keep the problem from becoming chronic.

ESI may give patients the temporary help they need with painful symptoms. ESI is a reasonable treatment choice for some patients to decrease their pain and speed up their return to work or function. This may help them avoid becoming a chronic pain patient. It can also prevent the need for surgery.

Spinal stenosis is a condition in which the spinal canal narrows and compresses the spinal cord and nerves. This usually occurs over time as a natural process of spinal degeneration. It’s not likely to become symptomatic until a person is 60 years old or older.

It can sometimes occur in younger adults if it’s caused by spinal disc herniation, osteoporosis, or a tumor. Spinal stenosis can affect any part of the spine but occurs most often in the lumbar spine. Lumbar spinal stenosis causes low back pain. Patients also report leg pain or discomfort with certain positions.

Bending backwards or even just straightening up for older adults with spinal stenosis decreases the spinal canal space. Anything that does this can put pressure on the nerve tissue and cause pain.

As the vertebral bones extend, the thick ligament inside the spinal canal buckles and pushes forward against the spinal nerve. At the same time, the disc material bulges slightly in a posterior (backward) direction. The effect on the spinal nerve is the same (pressure).

Bending forward or flexing the spine has the opposite effects. The forward movement of the vertebral bones opens up the spinal canal. The ligament stretches tight and the buckling is relieved. This phenomenon is called postural dependency.

Spinal stenosis is a narrowing of the canal where the spinal cord travels from the skull down to the sacrum. Many age-related changes add up to cause this problem. For example, bone spurs can form around the edge of the opening. The ligaments holding the spine together start to thicken and fill in the space.

Disc degeneration and disc bulging can also reduce the amount of space for the nerve tissues. In all of this, the result is low back pain. Some patients have leg pain as well.

A normal spinal canal is a round, symmetrical or even opening. A trefoil-shaped spinal canal is more triangular. In some cases it may look more like a three-leaf clover instead of a round circle.

The shape occurs as a result of how the vertebral bones are shaped and positioned. In particular the position of the facet (spinal) joints and lamina create this shape. The lamina is the part of the vertebral bone that forms an arch around the spinal canal.

Most often this trefoil-shape is only present in the lower lumbar spine around L3 to L5. This condition does put a person at increased risk of developing spinal stenosis. Degenerative changes over time at the joint create or increase the trefoil-shape.

This normal anatomic variation may or may not be hereditary. The only way to know if you have this effect is with imaging studies such as an MRI.

Obesity has been shown to be a risk factor for complications after surgery of any kind. Specific studies of spine surgery have shown the same thing.

There are several technical challenges. First, clear imaging studies needed before surgery can be hard to obtain. The MRI machines don’t always accommodate large sizes. A similar problem can occur with X-rays. The machine isn’t large enough to take pictures of the spine as the patient bends and straightens.

Large amounts of fat make it more difficult to find veins and arteries. The same problem exists when trying to keep the airway open during anesthesia.

There is a known link between diabetes or high blood pressure and surgical complications. Obese patients are more likely to suffer either or both of these problems as a result of their obesity.

Not all studies show a direct link between obesity and surgical complications. Each physician must carefully choose patients for surgery. Obesity is just one of many risk factors to consider.

Very obese patients having spinal surgery are at risk for positional neuropathy or nerve palsy. It sounds like your husband may have this problem. This means there was too much pressure on the nerve for too long in one position.

The weight of the obese individual pulling or pressing on a nerve can cut off blood supply to the nerve and/or compress it causing damage. Spine surgery is often done with the patient in the prone (face down) position.

The force of the body weight at the armpit or groin can lead to this type of positional neuropathy. The problem is most likely to occur in the extremely obese patient. Special care must be taken to limit the amount of time in one position. Support and padding for the arms and legs is also important.

Some surgeons insists that overweight patients lose weight before an operation. Weight loss can help prevent these (and other) kinds of problems.

Physical therapy (PT) after lumbar disc replacement (LDR) is strongly advised based on studies in Europe where disc replacements have been done much longer than in the United States.

In the early days of artificial disc replacements, the rehab program after LDR included bracing. Motion was limited for the first eight weeks. There was no sitting or bending allowed during this time.

Researchers reported a large number of patients ended up with complete ossification. This means the bone fused at that level, and motion was no longer possible.

With active PT starting at the end of the first week, this problem was eliminated. Early movement is now highly recommended to avoid cases of partial or complete fusion. Your husband will likely have better results after this surgery if he follows the rehab program.

More and more experts are calling into question the use of powerful opioids for the treatment of chronic back pain. Studies aren’t supporting their long-term use. Patients may get some short-term pain relief, but there’s no change in their pain levels or function in the long run.

Patients such as yourself bring up a good point. What if you would be worse off without this painkiller? What if by not taking it, your pain level goes up while the quality of your life goes down? It’s possible the drug is helping you maintain your current level of function.

On the other hand, there is always the concern of addiction and other side effects from the long-term use of this drug. Sometimes a drug holiday is needed to find out where you are in the process and maybe even reset the system. Taking a break from the medication could be a very good idea.

It may be best to follow your doctor’s advice. He or she should help you slowly come off the drug to minimize the side effects of withdrawal. Other nonopioid medications for pain control can be used at the same time until you see how much more pain (if any) you are still having without the drug.