FAQ Category: Lumbar Spine

Studies of back pain haven’t been able to find an exercise program that works yet. This may be because the studies use the same exercises for everyone. It’s likely that a “one-
exercise-program-for-all” doesn’t address the needs of each person.

A new study from Canada showed that patients got better faster when they kept all their movements in the direction that doesn’t cause pain. For example if bending forward hurts
then their activity and exercises were geared toward the opposite direction (extension). If bending to the left increases painful symptoms, then exercises moving to the right
were taught.

This approach to back exercises is called the McKenzie Method. Some physical therapists have training in the McKenzie Method. The therapist examines the patient to find which movements cause painful symptoms. Then an exercise program is devised to help
the patient move in the preferred (painfree) directions.

Ask your doctor about trying this program. He or she may know someone in your area with this type of training. You should be able to see if it will help you in a very short amount of time.

A recent study from the Department of Orthopaedic Surgery at Massachusetts General Hospital suggests removing the coccyx or tailbone is a safe and effective way to treat this problem.

The operation is called a coccygectomy and gives permanent pain relief in 90 percent of all patients.

Other more conservative treatment includes injections of a numbing agent with a steroid. This is only successful in about 20 percent of all patients. Physical therapy can bring relief in some cases. Chiropractors can manipulate the coccyx if malalignment is the problem.

There are several factors to consider here. First of all, is your mother getting better from the time she started until now? She should have less (or no pain) by now and increased function.

Sometimes after the acute episode of back pain is taken care of, a conditioning program is needed. This is especially true for older adults who may be too sedentary.

It might be helpful if you went with her to her next appointment. See what she’s doing and ask some questions. It may be a good time to switch to a community exercise program. Is there a local YMCA or other similar type of health club that offers exercise programs to fit her needs?

Exercise may not be the only benefit your mother is getting. She may enjoy having a reason to get out and be with other people. Perhaps you could ask your mother what she thinks the program is still doing for her after this much time.

Good question. Studies show that without specific help or education, patients just don’t see which movements to avoid and which activities will help. Sometimes patients don’t have a preferred direction so this advice doesn’t help.

Your doctor’s advice works best for those patients who can find a direction that always causes pain and an opposite direction that relieves pain. The goal is to avoid the painful direction. Activities and exercises in the pain free (preferred) direction are
set up.

You may need the advice of a trained professional for this kind of help. Physical therapists trained in the McKenzie Method use this approach. It only takes one session to find your preferred direction. The therapist will help you learn how to “centralize” or bring your pain just to the center of your low back area. If you have pain down the leg, the therapist will show you how to avoid activities and positions that increase your back pain and/or send pain shooting down your leg.

You may need a few follow-up visits to progress your activities and advance the exercises needed to restore your normal, pain free motion.

Most of today’s disc implants in use are made of metal alloys and plastic. Titanium is the metal most highly favored so far. Nickel can’t be used because so many people have a nickel sensitivity.

Plastic is becoming more popular because it wears well and is less stiff than metal. It also eliminates the problem of wear debris seen with metal implants. Bits of metal get shaved off the implant with daily movement. Metal debris can cause pain from inflammation and implant loosening.

Researchers have found that what works well in one area of the body doesn’t always hold up elsewhere. For example, one type of plastic used in hip replacements wears extremely well but doesn’t hold up in the knee. It isn’t used in the spine either.

Find out what kind of implant your doctor is using. Ask him or her this question, too. A combination of titanium and plastic might work best in your situation.

Artificial discs have been used in animal and human studies but there are no long-term results ready yet. Studies show they have similar results to spinal fusion in the short-run. Research is still in the clinical trial phase. Recent approval from the FDA should bring this option more to mainstream America as more and more surgeons are trained in this procedure.

There may be some advantages to the disc implants over fusion. First and most important, the patient is able to keep his or her spinal motion. Second there are fewer problems and complications after surgery for the disc replacement compared to fusions. Third, it looks like the problem of disc breakdown above and below the level of the fusion doesn’t exist with disc replacements.

There are several different designs on the market. Researchers haven’t been able to show that one is superior over the others yet. More studies are underway using the disc implants for both the neck and the low back.

Finally, activity level is according to the patient’s tolerance. Most patients with the disc replacement are able to resume normal activities sooner than patients with spinal fusion. Since you’ll have full motion, once healing takes place, you should be able to do what you could do before the surgery.

Possible and probable! Research shows that disc herniation in the upper lumbar spine (L3-L4) doesn’t show up the same way a disc problem does located lower in the spine. First, L3-L4 disc herniation occurs more often in older adults (average age: 53 years old).

Second, thigh pain is the most common finding with an upper lumbar disc problem. Leg weakness and decreased knee reflexes are also found.

Third, signs of disc herniation in the upper lumbar spine can be missed with imaging studies. This is because there is a wide ligament along the back side of the lumbar vertebrae. It gets narrower as it goes down toward the lower lumbar segments. The ligament is called the posterior longitudinal ligament (PLL).

The PLL keeps the discs in the upper lumbar spine from pushing backwards into the spinal canal. Instead the damaged or worn disc moves out to the side in a lateral direction. There’s less resistance in the lateral region. Radiologists who know about the unusual location of disc fragments in this area are more likely to see this on the image.

You may want to ask your doctor about your suspicions. You can also ask for a second reading (second opinion) of your MRIs.

The perfect results would be full, pain free motion for the rest of your life. The artificial disc replacement (ADR) is designed to do everything a human disc does. This means normal motion in all directions. The ADR would also transmit loads across the disc spaces while protecting the joints.

Not only that but the new disc implants are expected to do all these things over and over for years and years. They should last without failure or wear for the rest of your life.

Do they really do all these things now? We don’t know yet. ADRs haven’t been used long enough to collect results years after implantation. You will be part of the early data collected and reported. Good luck!

This varies from patient to patient. A few patients wake up completely free of pain. Others have less back and leg pain than before the operation. For many patients, pain levels ease over time.

Post-operative pain levels depend on many factors. For example, some surgeons are using minimally invasive methods with small incisions through the skin. They use tiny tools and special imaging to see inside the body without a large opening. Studies show patients
tend to use fewer pain relievers with this type of operation.

Even with the more invasive surgeries, the amount of pain patients reported is different. Some people have a higher tolerance for pain than others. You’ll be encouraged to get up and move about as quickly as possible after surgery. Movement can help reduce pain levels too.

It’s not clear why some patients have these kinds of problems after this type of surgery. While patients question whether they did something wrong, insurance companies are asking if the surgeon is at fault.

It’s possible the nature of the operation and the patient’s tissues are the real keys. Rods and screws are used to hold the spine together and to add stability while healing and the final fusion take place.

In order to get the screws into the bone, the deep, stabilizing muscles of the back are cut and pulled away from the bone. At the same time tiny nerves to the joints are cut. Other supportive structures are weakened by the operation. Recovery can be slowed or complicated by problems because of these changes.

Expecting something to hurt doesn’t really produce pain, but it can affect how you breathe and how you move. These two factors can increase your awareness of pain that is already present. Muscle tension from holding your breath and avoiding movements can make your pain seem worse. Relaxation is an important key in cases like this.

Anticipating a pain response can also delay muscle contraction, or sometimes the muscle contracts too early for the intended movement. This kind of muscle imbalance can lead to spinal instability. Pain and injury is more likely when the spine is unstable.

That’s a good question that even the researchers don’t know the answer to yet. Studies are being done on patients in both situations. By comparing the results, scientists hope to be able to see how much difference there is in muscle strength before and after treatment.

They won’t know how treatment affects strength and motor control if these factors vary during periods of increased or decreased pain. It may be best to get a baseline during both phases.

Studies show that only 10 percent of back pain cases have a clear cause. That means 90 percent of chronic back pain has an unknown cause. CT scans, X-rays, and MRIs show defects in the spine when the patient doesn’t even have any symptoms. On the other hand
painful symptoms occur when nothing shows up on the imaging studies.

Many doctors and therapists think the muscles are a major part of the problem. This hasn’t been proven true yet. EMG studies have been used to measure the electrical activity of muscles during spinal movement.

EMG studies were recently used to compare the muscles of healthy subjects to people who have back pain. Researchers found that the muscles of back pain patients didn’t fatigue
as quickly as healthy subjects. This may be because patients with back pain hold back and don’t use their back muscles with as much force as healthy subjects.

The more we can find out about muscle function, the better able we will be to find a rehab program for back pain that works.

Studies show that only 10 percent of back pain cases have a clear cause. That means 90 percent of chronic back pain has an unknown cause. CT scans, X-rays, and MRIs show defects in the spine when the patient doesn’t even have any symptoms. On the other hand
painful symptoms occur when nothing shows up on the imaging studies.

Many doctors and therapists think the muscles are a major part of the problem. This hasn’t been proven true yet. EMG studies have been used to measure the electrical activity of muscles during spinal movement.

EMG studies were recently used to compare the muscles of healthy subjects to people who have back pain. Researchers found that the muscles of back pain patients didn’t fatigue as quickly as healthy subjects. This may be because patients with back pain hold back and don’t use their back muscles with as much force as healthy subjects.

The more we can find out about muscle function, the better able we will be to find a rehab program for back pain that works.

In some ways only your grandmother can answer this question. Pain relief often improves a patient’s ability to move around and improves quality of life. It’s hard to put a price tag on six months of improved health and increased function.

A recent study was done of patients over age 80 having surgery for spinal stenosis. Everyone got some pain relief. Many were pain free for the first time in months or years. They were able to stop taking pain medications.

This kind of improvement can actually preserve and prolong an older adult’s life. Less pain means easier movement and less chance of injuries or falls. Even at age 82 your grandmother could have lived another 10 or more years. Without knowing when life will end, some say quality of life is the guiding factor in making these kinds of decisions.

Surgery may be the next step. A laminectomy can be done when a patient has tried other methods of treatment and still has painful symptoms. In this operation a portion of the bone surrounding the spinal cord or spinal nerve is removed. This takes pressure off the nerve tissue.

Your mother may be a good candidate for this treatment. Laminectomy has been shown to be safe and effective even in adults 80 years and older. The best results occur in the “well-elderly.” This refers to older adults who don’t have significant other health concerns.

Many studies of spinal fusions are done on groups of all Caucasian men and women. No studies have been done comparing racial groups. Several studies show that whites are more likely to have disc removal and spinal fusion than any other group. It’s not clear if this is based on differences in ethnic background or not.

Does it mean Caucasians have more spine problems than anyone else? Does it mean whites are more likely to overuse surgery for this problem? Or does it mean black people don’t get the operation when they need it (underutilization)?

Cases of rare problems in the spine are being reported for a few black men. These new ways to use neuroimaging techniques has helped find these rare problems in African-American groups. Future studies may look at differences in rates and success of spinal fusion based on ethnicity.

The long-term benefits and results of interbody cage lumbar fusion (ICLF) are largely unknown. Research is limited. Much of what has been reported so far comes from the companies that designed and made the cages.

Doctors at Duke University recently reported on a group of 56 ICLF patients two years after the operation. The results were similar to low back pain patients who had other kinds of operations. They found the fusion worked just fine but the patients often had more pain and less function afterwards. Even two years later, a large number of patients were disabled and unhappy with the results.

The study found a strong link between surgery results and psychosocial factors. Depression, smoking, and a pending lawsuit are three factors most likely to cause poor results after spinal fusion. The researchers suggested patients who smoke or who are depressed should get treatment for these issues before surgery.

There are different ways to look at patient satisfaction. Is the quality of life better after the operation? Does the patient have less pain? More function? If they had to do it all over, would they have the same operation again? These are some common measures of patient satisfaction.

A recent study at Duke University of results after fusion reported many patients were more disabled after the operation. All patients had a spinal fusion using interbody fusion cages. Even so 64 percent of the patients said they would have the same operation again.

Researchers find this outcome puzzling. They suggest patients are so distressed by the time and money spent on the surgery, they feel obliged to say they would do it again. Or perhaps the results of the operation were disappointing but it was better than doing nothing about the problem.

A history of low back pain is really the most powerful predictor of future episodes. If you haven’t had back pain yourself yet, that’s a good sign. Whether there’s a genetic component to back pain or not remains unknown.

There are other risk factors to consider. Many studies now show social and psychological factors are the most important. These may be even more important than the condition of your spine.

People who are depressed or who tend to “feel” their pain more than others (called amplification) have more back pain. This is true in the short-term as well as over a longer period of time.

Findings on X-rays, CT scans, and MRIs don’t always match up with patient’s symptoms. Many times the spine is in a state of moderate to severe degeneration and the patient is pain free. Other times the patient is disabled with only mild degenerative changes in the spine.

Good posture, proper lifting, and daily activity and exercise are still the best prescription for preventing back problems.