FAQ Category: Lumbar Spine

The type of electromagnetic field (EMF) your doctor is suggesting doesn’t produce
radiation and can’t be compared directly to power lines. They are both forms of energy on a scale or continuum called the electomagnetic spectrum. When used to enhance bone growth, EMF is delivered in a pulsed form. This means the wave is turned on and off, so
you aren’t exposed to a steady dose of EMF.

Pulsed EMF still has biologic effects even if it’s not strong enough to cause ionizing radiation. The waves produce electric currents in tissues, causing a heating effect. Increased heat in an area brings more blood to cool it off. Improved circulation may be what enhances bone formation and solid fusion.

Some doctors are using a device that emits pulsed electromagnetic field (PEMF) in cases like this. A recent study in The American Journal of Orthopedics reports good success with PEMF. One hundred patients with failed fusion used PEMF for at least two
hours every day for 90 days or more.

Two-thirds had a good fusion with this treatment. It’s inexpensive and avoids the dangers of another operation for patients in poor health. Ask your doctor about the possibility of using PEMF with your mother.

Maybe not. Some research has shown X-rays aren’t entirely accurate in showing pseudoarthrosis. Pseudoarthrosis refers to a “false joint” where the motion is taking
place.

Patients with pseudoarthrosis on X-ray don’t always show any actual loss of stability when the doctor opens up the spine to repeat the fusion. If you aren’t having any symptoms, you may want to adopt a “wait-and-see” approach.

See your doctor at regular intervals, and see what happens in six months to two year’s time. You can always have that second operation, but waiting is a good option if it turns out you don’t really need it.

Researchers have found specific stabilization exercises are more effective for postpartum
back pain than a regular program of physical therapy. Frequency, intensity, and duration remain a matter for study. Physical therapists at the University of Oslo in Norway had good results using a 20-week time period.

Each woman did the exercises three times a week. They had good results with this prescription. Even a year later, the women remained pain free and able to function. It’s possible the same results could occur with a 10-week program, or perhaps with only two sessions a week. We just don’t know yet.

Generally, exercise is advised at least three times per week. Keep a log or journal to help you find out what’s best for you. Write down when you do the exercises and what you’ve done. Record any symptoms throughout the day. Compare the results from week to week. This may help you with future episodes of pain.

The results of that study by Li and Bombardier (2001) show that 569 therapists were interviewed. Only 30 percent surveyed said they thought spinal manipulation was effective
in treating low back pain. Studies showing manipulation is successful are fairly new. It may take a bit longer for therapists in Canada and some parts of the United States to see these reports.

What we know so far is that spinal manipulation improves symptoms and function in about
two-thirds of the patients. There are a couple qualifiers to that statement. First, the patient must be having acute back pain. This means the spinal manipulation takes place within the first month of painful symptoms.

Second, the patient must have just back pain, not back pain that spreads to the buttock or down the leg. And third, motion in the low back area shouldn’t be restricted but be within normal limits.

Activities at work and home seem under better control today. Automation and robots have reduced our lifting load. There are many programs to prevent injury. The focus is on lifting properly and avoiding repetitive tasks.

Studies show muscle weakness isn’t the problem leading to back injury or reinjury. It’s really more likely there’s a problem with the pattern of muscle firing.

A study in Canada showed that patients with chronic low back pain reach a peak muscle contraction sooner than those without pain. Researchers think early episodes of pain
cause anticipatory postural responses. The patient knows the pain is coming so the muscles contract sooner than needed.

Specific exercises to get normal motor control back may help prevent a repeat bout of back pain.

You’re right. Last year we spent 100 billion dollars on this problem. The high cost of back care may be caused by reinjury, chronic pain, and long-term disability. Studies show that many back pain patients still have pain after one year. Only about 25 percent of the
back pain patients recover and return to normal activities including work.

Money spent on back care per patient can add up quickly with drugs, doctor’s fees, chiropractic care, and other services. If conservative care fails, surgery may be the next treatment option. Operating room costs, hospital costs, and surgeon’s fees are just
the tip of the iceberg.

Researchers think so. There are many studies now showing that patients with chronic low back pain lack proper trunk motor control. This includes the abdominal, trunk, and back muscles. These are the core muscles targeted by Pilates.

Joseph Pilates started the Pilates method of exercise in the early 1900s. Pilates is a way of moving and exercising to stretch, strengthen, and balance the body. Breathing is
an important part of the exercise program. Pilates can be used to improve fitness as well as rehab after an injury.

More studies are needed to find out exactly which exercises are best after back injury and to prevent a repeat injury. We’ll need to know how many of each exercise are needed for the best result. Like most exercise, Pilates must be done on a regular basis to work
well.

Lumbar discectomy is the removal of disc material from between the bones of the low back. The inner disc doesn’t have its own blood supply so healing can be slow.

The wound usually takes one to two weeks to heal. It can take longer if the patient moves too much, too soon. Scar tissue forms in the area. This gives the spine some stability during the healing phase. The muscles on either side also contract to act as stabilizers.

Many doctors ask the patient to limit motion. Some advise using lumbar support for the first few weeks. Restriction on work after discectomy is common up to two to three months.

Studies are being done to find the ideal amount of disc to remove and the right amount of sick leave. It may be that sick leave can be shortened to less than two weeks. Future studies will help answer this question.

There’s quite a bit of debate over the ideal amount of disc to remove in a lumbar discectomy. Doctors are concerned about increased motion at the level where the disc used to be. This may cause disc damage at the next level up or down.

A new study from researchers in Japan and the University of Toledo suggests taking the smallest amount possible. This minimizes the increased range of motion and increased instability that can occur with complete removal.

The disc is a firm spongy material located between the vertebral bones of the spine. Severe damage to the disc may require disc removal or discectomy.

The disc protects the spine from compressive forces and excess motion. Doctors try to leave as much of the disc as possible. A limited discectomy removes part, but not all, of the disc. This may be up to half of the inner portion of the disc called the nucleus pulposus.

A radical discectomy takes out the entire center of the disc. The outer part of the disc is called the annulus. Removing part or all of the annulus is an annulotomy.

Direct costs refer to actual money spent on the treatment of back pain at any health care service. This includes hospital visits, surgery, drugs, X-rays and so on. Indirect costs are often calculated based on lost time at work, lost wages, and lost productivity.

If a spouse, partner, or family member has to miss work to care for the patient, the costs to the caregiver can be direct or indirect. This may be lost wages (direct), emotional stress (indirect), physical fatigue, and decreased productivity at home. Even ordering out food for dinner can be counted as a cost if the caregiver can’t take the time to prepare a meal while caring for the patient.

Loss of money into a retirement pension while the patient is on sick leave is another indirect costs. Some indirect costs can’t be given an equal dollar amount. This relates to quality of life issues such as personal happiness, sexual function, or loss of sleep.

Treatment for chronic low back pain does depend on the cause of the problem, health and age of the worker, and even worker motivation. Lumbar fusion is advised for patients with back pain of unknown cause that lasts more than six months. The patient usually has failed more conventional, nonoperative treatment.

Researchers are busy carrying out studies on back pain patients. They are comparing what works with how much it costs. Chiropractic, physical therapy, rest and light activity, and surgery are a few of the areas under investigation.

A recent study from Sweden found workers who qualified for lumbar spinal fusion were twice as likely to return to work as workers who qualified but didn’t have a fusion. More workers returned to work either full or part-time after lumbar fusion.

A recent study from Sweden compared the results of patients with chronic low back pain (CLBP) who had a fusion to those who didn’t. They found the cost was about twice as much for the fusion group. The fusion group also had twice as many patients that got better
and went back to work.

There’s no way to tell if you’ll be in the back-to-work group or not. Returning part-time may be better than not at all for some patients. A good attitude goes a long way toward return to work. Good, overall health will also help. Follow your surgeon’s advice about rehab and exercise after the operation.

According to a review done by doctors at the Boston University School of Medicine, lumbar fusion doubled from the 1980s to the 1990s. It continues to increase as a popular treatment method. Why?

Some researchers think the trend reflects the success of the treatment. Positive clinical reports continue to be published. There’s also the fact that companies making surgical supplies related to fusion are marketing heavily in this area.

There’s been some thought that reimbursement to doctors is higher with spinal fusion than more conservative treatment. We don’t like to think the pocketbook rules decisions, but
there may be some truth to the idea.

The fact that the overall fusion rate or rate of success hasn’t changed in 20 years has been brought out. Further study of your question about the best treatment is needed before a final answer can be given.

Doctors are trying artificial ligaments in an effort to avoid problems that occur with spinal fusion surgery. The operation is called a graft ligamentoplasty. It’s used
to hold the spine in place. The first artificial ligament was made of Dacron (a plastic fiber) in 1986. Results of the early studies showed good results with pain relief and spinal stabilization.

The product has been improved and can be used in cases of spinal degeneration. This type of degeneration occurs after disc herniation or as part of the aging process. Ligamentoplasty isn’t for everyone. However, it can replace spinal fusion when used in the right patients. It also prevents the spinal segment above or below the problem from
degenerating or wearing out.

Graft ligamentoplasty can’t completely replace spinal fusion. In a small number of patients, it has been shown to hold the spine steady and keep proper spinal alignment.

Yes and no. Yes because most lumbar fusions are done for cases of spinal degeneration. The number of successful cases with spine fusion is highest for this diagnosis because more patients getting a fusion have this problem than any other condition.

The degeneration may occur as a result of changes that come with normal aging. Disc herniation, painful disc degeneration, and adult curvature of the spine called scoliosis can lead to the need for spinal fusion. Lumbar disc degeneration is also possible. Some patients have arthritic conditions causing spinal pain. Others have
fractures or tumors.

No to your question because results can vary according to the overall health of the client. For example, nonsmokers heal faster than those who smoke. Patients with diabetes have more complications than those without this condition.

Results are also better if only one level is fused. The more bones fused, the less chance for a good healing and recovery.

The spine is made up of cervical, thoracic, and lumbar vertebrae. Below the lowest lumbar vertebra is the sacrum. The sacrum is a triangular shaped bone. After that comes the
coccygeal vertebrae or coccyx.

The coccyx is the end of the spinal column. It’s also triangle-shaped. This may be what could be referred to as a “tail.” In fact, it is called the “tailbone.”

The coccygeal vertebrae are fused together for the most part. In some people the first and second coccygeal segments may not be fused together. Several muscles and ligaments attach to the coccyx, but these don’t allow us to move or wiggle the tailbone.

Treatment is more likely to work when the coccyx has normal mobility. Steroid injection with a numbing agent such as lidocaine (like lidocaine) may help. Massage and stretching of the nearby muscles after the injection has helped many patients.

Some chiropractors suggest an adjustment to realign the coccyx. The results of this treatment depend on how mobile the coccyx is. A more extreme treatment option is surgery
to remove the coccyx. This is called a coccygectomy. Conservative care is always tried first before surgery. The results are somewhat unpredictable.

Patients with spinal stenosis (narrowing of the spinal canal) often have back, buttock, and leg pain. The pain is worse when they walk and gets better when they rest with their
spine bent slightly forward. The patient may also have restless-leg syndrome, an
uncontrollable shaking or movement of one or both legs.

Surgery is a common treatment option for spinal stenosis when everything else has failed. Doctors usually try drugs and exercise first. Surgery doesn’t relieve the back pain for everyone. Quality of life is improved when claudication gets better or goes away. Surgery may give relief from the restless leg movement and leg pain.