FAQ Category: Lumbar Spine

Finding out your pain and activity levels can help the therapist decide what tests to do. The goals and plan of care for you are based on your current symptoms and level of function.

This gives the therapist a baseline for you. The baseline helps measure when progress is being made. Is the treatment working? Are you getting better? There’s no sense in continuing treatment when there’s no improvement.

Ninety percent of a doctor’s or physical therapist’s diagnosis is based on information received from the patient in response to questions. The tests and measures used to make the final diagnosis only make up 10 percent of the examination.

Back pain is common among adults aged 65 and older. In this age group the cause of back pain is often linked to degenerative processes. The discs start to wear thin, bone spurs develop, and the spinal canal starts to narrow.

The forward flexed position opens up the space around the spinal cord and spinal nerves taking pressure off these structures and reducing painful symptoms. Sometimes exercise and anti-inflammatories can help. Surgery may be an option when conservative care doesn’t work.

A medical examination may be needed to sort this all out. Find out first what the problem is in order to determine the best treatment. Early treatment usually brings the best results. Waiting too long may result in permanent postural changes.

It is not uncommon for older adults to have a change in mental status or to go through a stage of confusion after a general anesthetic. The cause of deterioration in mental ability is unknown. In some cases dementia appears to be triggered by the shock to the body of anesthesia and surgery. It may be a passing phase with complete recovery, although this can take weeks to months.

Mood change after surgery has been reported in adults aged 85 years and older. Sometimes impaired thinking occurs, too. In fact, one out of four adults in this age range have both depression and decreased mental processes.

esearchers aren’t sure why this happens. It does seem as though patients with many other health problems have poorer result after surgery. Talk to his doctor about your concerns. Medical treatment may help.

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 report up to 80 percent of all adults will have back pain at some time in their lives. Physically active and fit adults are less likely to have back pain.

Athletes do report low back pain from time to time. The rate of back pain is higher among athletes who are involved in several sports events. It’s lower than in the average adult population.

Triathletes involved in football, track and field events, distance running, tennis, weight lifting, skiing, gymnastics and/or wrestling have reported back pain in up to 63 percent of the athletes.

Back prevention is always a good idea in all ages and for all occupations. Physical activity and exercise, proper posture, and using safe ways to lift may help reduce back pain.

Physical activity and exercise are advised for back pain, but this usually refers to chronic back pain (lasting three months or more). In acute back pain following an accident or injury, rest and light activity are more appropriate.

Most ski instructors lift, carry, reach, bend, and push/pull equipment and people during work hours. In the acute phase of a back injury, any of these activities can lead to further injury. In addition, it’s common for some ski instructors to spend long periods of time standing. This type of inactivity can cause muscle spasm and increased symptoms.

You might want to take a day or two off if you have sick leave available. Rest and recover before hitting the slopes again. If possible ask for a reduced workload when you first come back. This may help ease you safely back into a full-day schedule. Take some time to get warmed up before jumping into your regular activities.

A study from the early 1980s reported back pain in about 66 percent of truck driver. This is less than the average of 80 percent in the general adult population. A more recent study in 2000 reported a 50 percent rate of back pain in over-the-road truck drivers. The reduced rate may be attributed to improved seat design in today’s modern trucks.

Fatigue, vibrations, and prolonged sitting are risk factors for back pain in truck drivers. There may be muscle or tendon damage rather than structural changes to the discs or spine. Drivers who are unhappy with their jobs are at increased risk for back pain.

In a recent study from the Perth Pain Management Centre in Australia, researchers made some surprising findings about back pain sufferers. After successful treatment of disc problems, patients still used the same amount of medication. Like your husband, the patients did not return to work as expected.

These two findings prompted the researchers to make two suggestions. First, chronic pain
sufferers may have some drug behaviors that require medical or psychologic treatment. Second, there might be factors besides pain and physical function keeping patients from
returning to work. Again, psychologic or behavioral intervention may be the best way to approach this problem.

Conscious sedation means you are awake but calm and free of fear or anxiety. This type of sedation occurs with the use of oral sedative agents. The result is to reduce pain and discomfort. The patient is able to speak and respond to any requests made by the surgeon. If any pain occurs the patient is able to report changes to the surgeon.

Conscious sedation is used when minor operations are performed. In the case of disc surgery, sometimes the surgeon needs to know if the nerve is being touched or pressed. The patient is awake and alert enough to report any increased pain sensation.

In deep sedation the patient is unable to breathe without help and unable to respond to physical stimulation or verbal commands. A general anesthetic given intravenously is used to achieve this state.

Current thinking is that the back is protected by muscles whenever it is pushed off balance or overloaded. The concept of spinal stability, a “steady spine” is in the forefront of research today.

Injury can occur any time the muscles don’t protect the motion segments of the spine. Exercise is important for three reasons. It improves strength, endurance, and coordination of each muscle.

Recent attention has been placed on training the “core” muscles of the spine and pelvis. These include the abdominals, hip flexors, and back extensors. The jury is still out as to whether or not a core-training program really makes a difference. Studies are underway even now.

Even if the core training program doesn’t accomplish all three reasons for exercising, you’ll likely benefit in one or more ways. A physical therapist or qualified fitness professional can help you find areas of muscle weakness or imbalance and design a program to meet your specific needs.

Disc degeneration is a common and troublesome source of low back pain for many people. When conservative care fails, spinal fusion is often the next step. As you pointed out, there are many advantages to spinal fusion.

owever, sometimes it doesn’t work. In fact, up to half the spinal fusions fail to fuse leaving the patient in pain with ongoing disability. Pain at the donor site is a problem. Bone taken from the pelvic bone is often used in the fusion. Some patients have more pain along the donor site than where the fusion is done.

Other pitfalls include bone spurs around the area of fusion or disc degeneration above or below the level of fusion. An unstable spine may be the final result.

Some studies show the longer the fusion, the worse the results. Others claim that choosing the right patient determines the outcome. For a successful fusion of any length, there should be no history of psychologic problems. Patients with a spinal fracture, infection, or tumor should not be fused either.

There are two factors to look at: 1) patient satisfaction after the operation and 2) success rate of the fusion itself. Doctors agree that a successful fusion doesn’t always mean the patient is happy. Pain and loss of function can occur even when the fusion appears perfect. Quality of life (QOL) goes down for most patients in pain who can’t resume their normal activities.

A new study compared two groups of patients with lumbar spinal fusion. One group had a short fusion (one to two levels) while the second group had a long fusion (three to five levels). Both groups had the same good results when reporting on QOL. The long fusion
group had fewer successful fusions and needed a second surgery more often.

You may find the warmth and buoyancy of the water soothing and relaxing. Your pain level may even come down. But even if it doesn’t, it won’t get worse. In the meantime you can be preparing for major surgery by strengthening muscles. You’ll also be improving your overall health and fitness.

Patients who show themselves committed to an exercise program before surgery are more likely to have a successful outcome afterwards. This may be because exercise improves health AND mood. It may also show your doctor which patients are truly committed to their own recovery.

There are many ways to fuse the spine depending on the condition of the bones, number of levels involved, and training of the doctor. All methods involve putting bone graft between the vertebrae. In general terms the three-step process you are asking about probably refers to an interbody fusion.

Interbody fusion means two vertebral bodies are fused together. The steps include: 1) remove the damaged disc material, 2) insert cages and/or graft material in between the two vertebrae, and 3) support the healing spine with screws, plates, or rods to hold it together.

The last step is called instrumentation. Instrumentation can be used to fix a deformed or curved spine. For a spinal fusion it’s acting like a splint inside to hold the bones together while the bone graft heals.

Most people sitting for long periods of time tend to slouch or bend forward. Taking the back of the chair off won’t help in that type of situation. Sometimes having a lumbar support across the low back can put the spine in a position of slight extension. This position may help reduce low back stiffness.

The chair you sit in is important, but so is your workstation. Even more importantly take frequent breaks and move around. Even if all you do is stand up and stretch and then sit back down again, this can help reduce fatigue and prevent injuries.

A popular new desk chair without a back is the use of a Swiss ball designed for this purpose. Some people use it without a stand, but a supportive base is available and keeps the ball from moving out from under you.

We hope to see some studies in the near future to show whether or not such a chair design is beneficial.

A seat belt fracture (also known as a Chance fracture) occurs during a car accident. Usually this happens when the pelvis is anchored by a lap-strap without a shoulder harness.

When the driver slams on the brakes or is hit from behind, the victim is thrown forwards against the belt. The vertebral body may be split and severely displaced away from the rest of the bone.

Ligaments holding the spine together are also torn or damaged. A severe enough injury can cause damage to the spinal cord, even resulting in paralysis or death.

There are two main kinds of spinal fusion based on where the bone graft is placed. The first is a posterolateral fusion. Bone graft is placed along the back of the spine joining the transverse processes of two vertebrae. The transverse process is part of the
bone that sticks out to the side and attaches to the rib.

Screws and rods are used most often to hold the vertebrae together while this type of fusion is healing.

The second type of fusion is called an interbody spine fusion. In this fusion, the bone graft is placed in between the vertebral bodies. The disc is taken out and the bone graft goes in its place. This fuses one vertebral body to the other.

The graft can be placed in between the vertebral bodies from the front or the back of the body. Using an incision in the abdomen to get to the spine is called an anterior approach or anterior lumbar interbody fusion (ALIF). The graft can also be placed from a posterior approach through the back. This approach is called a posterior lumbar interbody fusion or PLIF.

Using both kinds of fusion at the same time increases the chances for a solid fusion. This type of surgery is referred to as a 360-degree fusion. It’s like using a belt and suspenders to hold the spine together.

Make an appointment to see the surgeon again. You’ll likely need an MRI to see what is going on. It could be a re-herniation. If that’s the case, then you may be a candidate for a discectomy–the removal of the rest of the disc.

Treating disc herniation with conservative measures may be an option. Sometimes physical therapy and anti-inflammatories can help re-align the disc during the healing process. When these fail, then surgery is the next best option.

Back and leg pain with numbness and weakness are signs that the disc is pressing on the spinal nerve. See a doctor soon because nerve damage can cause permanent disability.

Actually, it is possible to have a sequestrectomy. That’s the medical term for taking out the free-floating disc fragments. This isn’t usually done because of the concern for a second herniation of the damaged disc.

But doctors are starting to re-think the standard discectomy or removal of the entire disc after herniation. Taking the whole disc leaves a narrow disc space. The ligaments and nearby capsule are affected by the change in disc height. The spine can become unstable without the disc.

A recent study compared discectomy with sequestrectomy. Patients with just the fragments removed were happier with the results. They also had fewer second herniations. More studies are needed to follow patients long-term before a change in treatment will be made.