FAQ Category: General Spine

Work-related back pain accounts for billions of dollars in direct and indirect medical costs. Studies are ongoing trying to find what treatment is the best. Getting patients back to work is an important goal. Finding out why workers end up changing jobs or on disability is the focus of many research projects.

The Arizona State University Healthy Back Study (HBS) recently surveyed 1,831 workers who had filed Workers’ Compensation claims for occupational back pain. All participants in the study were employed by one of five businesses in 37 states.

Each worker was interviewed within one-month of filing a back injury claim. They were asked a series of questions about their level of satisfaction with care. The answers to the questions were analyzed to see what influences patient satisfaction during an episode of care for back pain. Everyone was contacted six months and one year later.

There may be many factors affecting how well people respond to rehab and how quickly they return to work (if they return at all). Some of the influences include level of satisfaction with health care for the injury. Patients who are very satisfied seem to return to work sooner and more often than those who are not satisfied with their care.

Other factors affecting recovery include socioeconomic status, work environment, injury and severity. Worker age, gender, and expectations about recovery don’t seem to be as important. Patients who receive by hands-on care by professionals such as a physical therapist or a chiropractor expressed a higher level of satisfaction and were more likely to return to work.

It sounds like you may have had a vertebroplasty procedure for a vertebral compression fracture (VCF). The surgeon injects a liquid cement that fills in the cracks of the fracture and hardens in place.

Spinal fusion, on the other hand, uses bone chips usually harvested from the iliac crest of the pelvis (or donated from a bone bank). To be a successful treatment, a bridge of bone must form between the two bones being fused together.

The harvested bone is no longer alive when it is placed around the area to be fused. But it provides a scaffold or framework for the body to fill in with new bone. And it stimulates new bone growth. The liquid cement used to fill fractures isn’t osteoinductive. This means it doesn’t have the ability to produce or stimulate bone growth needed.

There is a new option for bone graft called bone substitute. There are two bone substitute products on the market for use with humans. This implantable putty-like substance has the ability to induce bone growth in the area where it is placed.

Studies of its safety and efficacy are on-going. The protocol requires the patient to wear a rigid body brace for the first three months. A supervised physical therapy program is started about six weeks after the surgery.

Your back, which is made up of many parts, from the bones (vertebrae) that lie one on top of the other, the “gel” that lies between the bones (the discs), muscles, nerves, and so on, bears a very heavy load. It carries the weight of your body, must be able to turn in any direction you want it to, bear weight of items you are holding, and bend at will.

With so much pressure on your back, it’s no wonder that it can get hurt easily.

The most common injury is the slipped, or herniated, disc. This is also called a bulging disc. The gel that buffers the vertebrae, through injury, is forced from out between the bone and presses on the nerves that run along side the spine. This can cause severe pain.

Because people take their back for granted, it’s very easy for them to become injured.

Many experts have made the assumption that most back pain is work-related. But studies do show that back pain is just as common among children; nonworking groups; and older, retired folks.

This knowledge has led doctors, researchers, and scientists to rethink their approach to back pain. Maybe back pain is inevitable. Preventing it may not be the best goal. Perhaps more time and money should be spent figuring out how to help people once they have neck or back pain.

Work-related causes simply aren’t the only reason why back pain occurs. Even people up in their 90s and 100s report back pain — and in about the same amount as younger adults.

It may make more sense to focus on strategies that encourage rational behavior and relieve pain once an episode of back or neck pain begins. Research will continue to look for ways to understand the underlying mechanisms of back pain. But unless and until some dramatic discovery is made, people of all ages need help with their back pain.

The definition of expert can be problematic. Is it based on skill and experience in one area? Or does it depend on the fact that the clinician is trained to do more than one modality?

Some experts define an expert as someone who can apply their particular brand of treatment with skill and get results. That brings up the question of what constitutes results. For some patients, pain relief is the intended result. For others, improved function means better quality of life and that’s good enough.

It’s difficult to know if the best, most reliable treatment comes with someone who has more years of experience or someone who has specialized in treatment using one specific treatment approach.

Combining treatments such as acupuncture and spinal manipulation may be more effective than either approach alone. But there simply aren’t enough studies comparing one to the other to know for sure what works best.

In many cases, a clinician trained in more than one area will still depend more heavily on the area of treatment he or she feels most comfortable or most skilled in applying. It may not have to do with the patient’s specific needs at all.

Although it may seem obvious to operate on the back by the back, looks can be deceiving. In the lower back, for example, right near the bottom, it can be hard to access certain discs. While the surgery is possible, the degree of difficult is such that there could be problems with nearby muscles or discs.

Surgeons have learned that they can also approach the back from the abdomen, avoiding much of the problems associated with the lower part of the back. By accessing this way, the surgeons can reach the targeted discs with more ease.

An issue that the surgeons do have to keep in mind is that they want to avoid trauma to any of the internal organs in the abdominal area. They do this, however, with proper pre-operative preparation, so they can see where all the organs are and avoid them while the perform the surgery.

If your wife had disc surgery performed through her abdomen, the surgeon had to be sure that he or she doesn’t cause any damage to the internal organs.

Fasting before surgery is normal because the stomach needs to be as empty as possible. In this case, however, there’s more to the preparation. Because the surgeon is going in through the abdomen, it is essential that the organs, be easily seen and avoided. The best way to make the intestines noticeable, is to fill them with barium and easily detectable. This is why this procedure is necessary.

Care of the spine is developing rapidly over the years, but it was only as recent as the early 1900s that it was learned there were actual disorders of the spine that differed from one another.

Using this biological module, physicians were able to put a name to the issue and offer treatments. This is also when physicians knew that they could identify certain issues and ascribe them to certain groups of patients.

Before the discovery of disc protrusion in an autopsy in 1841, there were no clear cut ideas of how the back could be injured. This discovery sparked others and the idea of diagnosing spinal disorders grew. This idea that there was a biological, proven reason for a back injury was fell into what was called the Biological Model.

That being said, it was only in the 1980s that researchers realized that they could no longer use a “one size fits all” approach to spinal care and that people were affected by many outside sources. This led to the Biopsychosocial Mode of care.

Of course, as technology grows, doctors are able to find more specific reasons for back pain and disorders, so the field shows signs of continuing to grow.

You ask a very important question, especially in light of the fact that studies show a past history of neck or back pain is a strong risk factor for poor outcomes. Depression, drug abuse, and alcoholism are known to be linked with prolonged illness and pain severity.

Likewise, a history of mental health problems is also a risk factor for poor prognosis. Patients with a history of depression, anxiety, or bipolar disorder fall into this category.

Patients may not be deliberately misleading you with the information they provide. They may be distracted by the current accident when filling out the paperwork. As a result, they may forget important information about their health. To protect themselves, they may fail to report the use of alcohol or other drugs before, during, or after the accident.

The question of validity and accuracy of patient self-report after motor vehicle accidents has been brought up. Researchers at Stanford University School of Medicine have done some preliminary work in this area. What they found supports your suspicions. Up to 68 per cent of patients denied the presence of any of these risk factors.

Getting an accurate assessment of risk factors is important when setting up an effective treatment program. Preventing future accidents is important both in terms of personal and societal costs. More research is needed in this area.

There may be some people who do try to manipulate the compensation process. They may withhold information or deny a past history of previous accidents. In fact, a recent study from Stanford University showed that more than two-thirds of the patients with neck and/or back pain from a car accident hid such information.

But social scientists suggest that there may not be a desire to deceive as much as other factors at work. For example, there may be the worry of losing driving privileges if it’s found out that this wasn’t the first accident. Or there may be an undisclosed problem with alcohol or other drugs. The person may be afraid of exposure.

It’s also the case that people with serious psychologic problems don’t always have the emotional maturity or ability to admit to fault in situations like this. They have fewer social skills needed to deal with the financial problems that occur. Traffic fines and increases in insurance rates are just two examples of the fall-out they may have to cope with.

Sometimes people who have a lawyer representing them are just following the advise of their legal counselor. If you have concerns about your brother’s use and abuse of substances, it may be worth finding out more about how to do an intervention. An intervention is an attempt to “get help” for someone with an addiction or other problem.

It’s a well-known fact that people with a history of substance use have an increased risk of another accident. This is especially true for those who have a previous history of motor vehicle accidents. Intervening now could save your brother from another accident and more serious (even fatal) injuries.

More and more, people in the Western world are developing upper extremity disorders (UEDs) and/or complaints of shoulder, arms, neck and/or shoulder (CANS).

According to a large survey done in the Netherlands, people who are employed and women tend to have these problems most often. Researchers theorize that this is because many types of work involved repetitive motions, and many of these jobs are done by women.

Your shoulder doesn’t have to be injured by a sudden trauma or accident in order for there to be something wrong. By seeing a doctor, he or she can x-ray the joint and do other tests to see if a diagnosis can be made. At this point, you might be able to get relief from treatment aimed at the particular problem.

The term adjacent segment degeneration (ASD) is used to describe changes that occur at the next vertebral level. There are any number of changes observed on X-rays. These can include disc herniation and/or a faster breakdown of the disc.

Sometimes a tiny fracture occurs in the column that supports the vertebra. This causes a condition called spondylolysis and spinal instability. Arthritic changes are also seen in the facet (spinal) joints.

Any of these changes can be referred to as signs of ASD. Studies show that increased disc pressure and load on the spine occur with fusion. The more segments fused, the greater the risk of ASD. And a more recent study from Korea also showed that pain increases and function declines when ASD occurs.

Fusion in the low back alters the axis of motion. This shift in the load placement leads to deforming forces in the spine. Disc height decreases putting more pressure on the facet joints. The joints start to thicken and form the bone spurs mentioned.

These are all degenerative changes normally seen with the aging process. But ASD accelerates or speeds up those changes. The end result can be disabling. The final outcome may be another surgery.

A wedge fracture means the front part of the vertebra is compressed down. The diagnosis is made by X-ray. From the side, the bone looks like a wedge-piece of pie. The middle and back portion of the bone remain unchanged.

The fracture is graded as mild, moderate, or severe. Mild means that 20 to 25 per cent of the vertebrae is compressed. With moderate compression, the vertebral height is reduced by 25 to 40 per cent. Severe compression is anything more than a 40 per cent loss of bone height.

As the front of the bone collapses, there is a tendency for the entire spine to curve forward. This gives the person the characteristic humpback posture. Even older adults can benefit from treatment. Bracing is often advised but so uncomfortable, the patient stops wearing the corset or brace.

Pain relievers may be helpful. The new bone building drugs like Fosamax or Boniva may be prescribed. A minimally invasive procedure called percutaneous vertebroplasty (PV) is quickly becoming the standard treatment for this condition.

A long, thin needle is inserted through the skin down into the bone. When the tip of the needle is in the center of the vertebrae, the surgeon injects enough cement to fill the space. Once the cement hardens, the bone is stable and pain may be relieved. If the compression is too severe, kyphoplasty may be tried.

In kyphoplasty, once the needle is inserted, a balloon is placed inside the center of the bone and inflated. The balloon is deflated and cement is injected inside the space made by the balloon. This procedure helps restore the height and shape of the vertebra to a more normal position.

If possible, make an effort to discuss treatment options with her doctor. Consider going with her to a follow-up appointment to find out what can be done. Her age, general health, and any other risk factors will be taken into consideration. Seniors don’t have to suffer needlessly. There are ways to help manage this problem successfully.

Most patients can expect partial pain relief (if not complete pain relief) 24 hours after a percutaneous vertebroplasty (PV). PV is the injection of cement into a fractured vertebrae. A needle is inserted through a tiny hole or incision cut in the skin. The cement is injected into the center of the vertebrae.

If pain is not relieved after two weeks, a follow-up visit is advised. The surgeon may still want to try analgesics (pain relievers), bed rest, and/or bracing. Sometimes a short course of physical therapy is helpful.

If conservative management is not successful, a second PV can be done. There are very few (if any) adverse effects of this procedure. Too much cement can cause leakage and irritation of the nearby spinal nerve root. Not enough cement can result in a failed procedure.

A small study of 15 patients with persistent pain after a primary (first) PV had good results after a second PV. Three-fourths of the patients got complete relief of pain. The rest had partial pain relief. There were no complications or problems from the injection.

There is help for patients with painful vertebral compression fractures. Consult with your father’s surgeon to find out what is the next step.

Your surgeon may be able to give you a more precise answer. We know it is possible to improve and even recover from injuries of this type. Studies report complete resolution of symptoms for some patients. This type of recovery can take weeks to months.

To avoid further damage to the sensory or motor function of the body, the surgeon uses intraoperative monitoring (IOM). But the methods available aren’t fool proof even when two or more are used together. Sometimes this is because there is already so much pressure on the spinal cord or spinal nerves before the surgery.

In such cases, electrical impulses through the nerve pathways to the muscles have been blocked by the tumor. Monitoring the neurologic function during the operation then becomes very difficult. Most of the time, a baseline measure is possible. When it is present, the surgeon must work very carefully to avoid further injury.

In a small number of cases, permanent partial or complete paralysis does occur. This can happen even with IOM. Research is ongoing to find better ways to monitor the nerve tissue and prevent this from happening.

Removing a tumor surgically is called surgical debulking. In most cases, the tumor must be removed in order to avoid pressure on the spinal cord or spinal nerves. Pressure or compression of the tumor on these tissues can cause major neurologic problems. Surgery may be needed to prevent paralysis.

The surgical team will use intraoperative monitoring (IOM) of spinal cord function to prevent further neurologic damage than is already present. Consistent use of IOM by the surgical team ensures good and constant communication between the monitoring and the surgical teams. This is the key to good success.

The monitoring team will alert the surgeon when a decline occurs in the function of the spinal cord. Changes can be made right away in how the procedure is being done. Sometimes a surgical instrument that’s being used to pull some tissue out of the way is released for a short time. Or the surgeon looks for a better way to remove the tumor without traumatizing the spinal cord or spinal nerve roots.

Using IOM alerts the doctor to the risk of postoperative problems, including paralysis. But it doesn’t identify who will have permanent damage. Paralysis may be present when some patients come out of recovery. Steroids are used to reduce the swelling and minimize these effects on the spinal cord. For some patients, only time will tell for sure how much function will be recovered.

An epidural steroid injection for back pain is a common treatment to try to relieve the inflammation and irritation of the nerve root in the spine. The medication that is injected is a corticosteroid that is used in medicine to help relieve inflammation. By injecting it directly into the right area of the spine, the medication can work directly on the problem.

Usually, there is a type of local anesthetic also in the injection, along with the steroid.

Steroids can be dangerous if given for the wrong reason or taken incorrectly. However, this type of steroid does not go through your system (from swallowing it, for example) so is generally not a dangerous procedure. Of course, you should always discuss all the risks involved in a procedure like this before giving your consent.

As with all procedures, there are some risks to epidural steroid injections. This is really an issue you should discuss with your physician before consenting to the injections.

Some possible problems are pain (from the injection), infection, worsening of symptoms, and nerve damage. Some patients experience a headache after the procedure.

You may be referring to a procedure called intraoperative monitoring (IOM). It is used to monitor the patient for any possible neurologic damage during the operation.

Post-operative muscle weakness can occur after spine surgery. This only happens if there has been some damage to the spinal cord or spinal nerves. Paralysis is very rare and not as likely as muscle weakness.

IOM is a relatively safe way to monitor motor function of the muscles during spine surgery. Any warning sign of change in muscle function and the surgeon can take care of the problem right away. There are many different IOM methods used by neurosurgeons and orthopedic physicians.

All of these methods are fast, painless, and inexpensive. Recordings are taken before the procedure begins. This gives a baseline against which other readings are compared. Measures of electrical activity in the muscles give the surgeon real-time (immediate) feedback.

IOM is a safe and effective way to prevent or reduce nerve tissue damage during surgery. Side effects of this monitoring are minimal to none. Needles are placed through the skin, so there’s always a very small risk of skin infection. The skin is cleaned and disinfected before needle placement. This step helps reduce the chances of local infection.

All needles used are sterile. They are only used one time (for you) and then thrown away. Some patients report mild soreness where the needles were inserted. That’s about it. The method is very successful with very few possible side effects.

There are several ways to remove the inner portion of the disc. The procedure is called a nucleoplasty. Using heat to destroy the tissue is a commonly used method. None of these methods of surgical decompression actually removes the tissue exactly behind the protrusion.

Part of the reason for the lack of precision is the difficulty of getting to the inner portion of the disc. The neurosurgeon can use an anterior (from the front of the spine) or posterior (from the back of the spine) approach. But with either technique, it’s important to avoid damaging nearby soft tissue structures.

The surgeon doesn’t always remove nuclear material within the protrusion. This only happens when the protrusion is right along the path used to access the disc. Getting to the exact area of protrusions may be possible in the future with more advanced technology.

Studies show that just reducing the volume of the inner disc is enough to alter tension in the outer covering of the disc. The overall result may be to reduce tension on the spinal nerve root. Removing the source of inflammation can have the effect of reducing painful symptoms. You have probably benefitted from this indirect effect of nucleoplasty.