FAQ Category: Lumbar Spine

Several researchers believe that back belts may lead to muscle weakness because they transfer the load from the back to the abdomen, pelvis, and legs.

Studies have shown that when a back belt is in place, the electrical activity of the back muscles is decreased. This means the muscles are not active or contracting. Over time, this can have a “detraining” effect on the muscles of the back. Once the belt is no longer used, the injury rate goes up. More research is needed to confirm this theory.

Health care treatments are being carefully evaluated. Doctors, therapists, and other health care workers are being asked to show evidence that the treatment they prescribe for low back pain is effective. This is called evidence-based practice.

There are many ways to look at whether or not treatment works. Sometimes doctors and therapists use a series of questions at the beginning of treatment. This type of survey is repeated during and after treatment as a way to measure treatment success.

Other ways to measure improvement include ranking pain and symptoms. From time to time, the doctor will ask you to choose a number on a scale from zero to 10. Zero means there are no pain or symptoms, and 10 is for the worst possible pain and symptoms. You should be moving closer to zero at this point.

Finally, you can step back and ask yourself, “Am I fully recovered? Improved but not fully recovered? Unchanged or worse?” Four months after your injury, you should be moving from improved to fully recovered. If you aren’t moving in this direction, talk with your doctor or therapist. It may be helpful to try some different treatments when symptoms have lasted more than two months.

Scientists have found that genetics do play a role in the occurrence of spondylolisthesis. Currently, it is estimated that if a family member has it, your chances of having it are between 30 and 70 percent.

Given your age, sport, and concerns about a stress fracture in the spine, it is likely you are referring to a condition called spondylolysis. This is a type of fracture that develops over time within the supporting beams of the spinal column. It is caused by repeated strains in the spine bones–strains that often come from doing back-bend routines in gymnastics. You have a higher risk of having a problem like this due to the demands of your sport. In fact, scientists estimate your risk to be four times that of other females your age who don’t do gymnastics.

You may get relief by sleeping with your spine in a flexed, or forward bent, position. You can do this by lying on your back and placing a sleeping bag, stool, or padded box under your knees. Or ball up on your side in the fetal position.

Because you are still having pain, your doctor will probably do more tests to get a better idea where the pain is coming from. Afterward, an injection could be suggested. But relief from an injection is usually only temporary.

Your results from the injection can give the doctor more information about what is going on. If the shot makes you feel better, the piriformis is the source of pain. But this doesn’t answer the question of why you have pain. The results will guide your doctor about what to do next.

This may not cause a disc herniation, but it could contribute. The shorter leg tilts the hip and pelvis down on that side. This tends to put extra pressure on one side of the disc, making it more prone to injury as time goes on. It’s much like the alignment on a car. Poor alignment won’t cause a tire to blow out right away, but after a while there may be enough wear and tear that you notice problems. Keep in mind, however, that no studies have been done to prove this.

Absolutely. In the past, health professionals encouraged smokers to quit before fusion surgeries because it seemed like a good idea. Recent scientific information says the benefits are worth the effort.

Smokers are more successful at quitting if they stop smoking before their surgery. And they have a better chance of staying smoke-free long after surgery. Heavy smokers (more than one pack per day) generally have a harder time quitting. Quitters show better results after surgery. They have more success getting back to work. They have fewer instances of the bones not fusing together (“nonunion”), and they’re generally more satisfied with their results than people who don’t quit. 

Choose a firm mattress. Keep your spine in a straight line, and support yourself with pillows. Don’t ball up in the fetal position, and don’t put a large pillow under your knees when lying on your back. These positions force the spine to bend forward, which can lead to extra pressure on the back part of the sore disc.

A loose fragment from an injured disc may push against the nerves within the spinal canal. Sometimes the symptoms from a disc fragment can be relieved and managed with a program of physical therapy and exercise. Also, these fragments occasionally scar down to the point that symptoms go away.

However, if you start feeling more and more numbness in the lower limbs or if you have pain that is too much to bear, surgery may be recommended. In some cases, a loose fragment can press against the nerves that control the bowels and bladder. This is a medical emergency requiring immediate medical assistance.

A recent study links a few factors to walking ability for patients with lumbar spinal stenosis (LSS). The study involved 43 patients with a median age of 74. Sixty-five percent were women. Sixty-six percent of the patients said they were unable to walk farther than two blocks.

Poor balance was related to difficulty walking. Balance was assessed with the Romberg test, in which patients tried to stand with their feet close together and eyes closed without swaying. Interestingly, age had nothing to do with balance or walking ability.

Patients whose pain got worse as they walked were more likely to say they had a hard time staying active by walking. More surprising was the finding that women were more likely than men to have difficulty walking.

This new problem may have to do with your mother’s low back. A condition called lumbar spinal stenosis–or LSS–is a common condition for people over 60. LSS is essentially a compression of the nerves in the base of the spinal canal. This compression causes a host of symptoms, such as numbness, tingling, and muscle weakness. However, two telltale symptoms of LSS that cause difficulty walking are low back pain and problems with balance.

A recent study showed that the majority of people with LSS had pain walking uphill. This may be due to added pressure on sensitive structures in the spine, such as discs.

A physical exam will give more specific information about your mother’s condition. She’ll want to see a doctor to find out what’s causing her pain and what she can do about it.

Lumbar spinal stenosis, or LSS, is a common, often disabling condition. It comes from compression of the bundle of nerve roots within the base of the spinal canal. LSS results in low back pain. It can also cause pain in the legs and feet, numbness or tingling, and difficulty walking. LSS is most common among people over 60.

LSS is a progressive condition, meaning it can get worse over time. What may start out as discomfort walking could eventually affect patients’ ability to do daily activities. This may in turn lead to even greater muscle weakness and other problems.

Your doctor may recommend an operation to remove the disc–the spongy cushion that sits between each bone of the back. This step is called a discectomy. (“Ectomy” means to remove.) If there is still too much pressure on the nerves within the spinal canal, the doctor may remove a section of the bone that covers the back part of the spinal column over the injured disc (the “lamina”). This part of the operation is called a laminectomy.

Depending on how long ago your accident occurred, you may just need more time for complete healing. It usually takes at least six weeks for any injured or sore tissue to repair itself.

It is important to continue your program of self-care. Proper lifting, good support during rest or sleep, and exercise or activity will help speed your healing and may prevent another injury. If it has been six months or more since your injury, you should see your doctor again. You might benefit from medication or physical therapy at this time.

Your son can return to all activities when his doctor releases him to do so. After any kind of surgery and time away from sports and activities, it is wise to warm up slowly and carefully with some stretching exercises. Your doctor can recommend a physical therapist to help show your son what to do. Gradually increasing how much and how hard your son plays soccer is also a good idea.

Recently the results of children and adolescents (ages nine to 18) who had this type of operation were reported. It seems that the immediate results of the surgery were very positive for most of the cases. Seventy-five percent were without pain and able to enjoy all activities. However, 12 years later, less than half (40 percent) remained symptom-free, and about half had to avoid some activities. The researchers recommend continued follow-up after back surgery for this age group.

To help explain the two steps of this operation, consider the vertebrae of the spine. Each one has a round hole in the middle for the spinal cord to pass through. The bumps you feel down your back are part of the vertebrae and are called the spinous processes. The part of the backbone on either side of the spinous process is the lamina. The lamina helps protect the spinal cord.

Between the vertebral bones is a spongy cushion called the disc. The disc acts like a shock absorber for your back. Sometimes it becomes injured and pushes against the spinal nerves inside the spinal canal. This can lead to pain in your back or down your leg. It can also cause nerve symptoms such as numbness or tingling in your leg or foot. Removing the disc is called a discectomy. (“Ectomy” means to remove).

To take pressure off the spinal cord or spinal nerves inside the spinal column, doctors may remove a portion of the vertebral bone (the lamina). This part of the operation is called a laminectomy. If the surgeon only removes the lamina on one side of the spinous process, the operation is called a hemilaminectomy. (“Hemi” means half.)

The first goal of surgery for low back pain is to reduce or eliminate the presenting condition, which is pain. But what’s the best way to tell if pain has been reduced?

There are many ways to gauge patients’ pain. Doctors often use a visual analog scale, or VAS, which has patients locate their pain on a scale from zero (no pain) to 100 (the worst pain).

A recent study found that pain scores on VAS were related to other measures of pain and to patients’ satisfaction with surgery. In this study, comparing before-and-after pain scores on VAS wasn’t felt to be as good as looking at VAS scores after surgery or simply asking patients about changes in pain. Finally, there may be no “best way” to measure changes in pain. Each method captures something slightly different.

According to a recent study, patients with different diagnoses have very different patterns of pain. Researchers asked 750 patients to rate their back and leg pain on a scale from zero (no pain) to 100 (the worst pain).

Patients with herniated discs had minor back pain but strong leg pain. Patients with narrowing around the spinal canal (“stenosis”) had moderate back pain and strong leg pain. Patients whose vertebrae had dislodged and were pressing forward (“spondylolisthesis”) had moderate back pain and minor leg pain. Patients who had degenerative disc disease had the most back pain of all the groups and minor leg pain.

Doctors were surprised just how distinct the patterns of pain were. Different patterns of pain may call for different kinds of treatment.