FAQ Category: General Spine

Pain at the donor site is a common side effect of bone graft taken from patients. Increased pain at the recipient site is also common but less often reported. This may be because there is a generalized increase in pain and soreness at the surgical site from the incision and the surgery as a whole.

Doctors are looking for a way to alleviate donor site pain. Postoperative pain control is well-recognized as an important way to promote a faster recovery from any surgery.

A recent study tried bathing the surgical site with anesthetic (numbing) drugs. This method might work by itself but most patients are already taking a systemic narcotic-based pain reliever. The systemic drug seems to offer equal pain control at the donor and the recipient sites.

Today we have wonderful imaging techniques that make it possible for the surgeon to see what he or she is doing during an operation. It’s important to make sure the fixation device used to hold the spine in place doesn’t poke a hole through the bone. Serious damage can occur if the screw goes into the spinal canal or cuts a blood vessel causing bleeding.

Surgical methods used depend on the location of the fractures. Some screws work better in one bone over the other. For example, transpedicular screws work well in the cervical spine. The screws are placed through the pedicle, a short, thick column of bone located between the main vertebral body and the side projections of bone called the transverse processes.

In the upper thoracic spine where the bones start to take on a slightly different shape, translaminar screws may be better. The shape, angle, and size of these screws can be criss-crossed through the lamina. The lamina is the bridge of bone between the transverse process and the back of the vertebral bone.

Fluoroscopy, a special type of imaging makes it possible for the surgeon to see what he or she is doing. Computer-assisted surgery systems make it possible to correctly place screws through bone that can’t be seen. No one leaves the operating room until everything is verified by X-ray, MRI, or fluoroscopy. Such are the benefits of modern technology!

A hematoma is a collection of blood, usually from internal bleeding. During any surgery, bleeding can occur when blood vessels are cut. Usually bleeding is controlled using special foam pads soaked in thrombin. Thrombin is part of the blood that helps form blood clots.

Surgeons also use electrocautery now to prevent blood loss. Heat is applied to any cut blood vessels to close them off right away. There is always a certain amount of fluid and blood loss with spinal surgery. Drains are usually left in place after the operation to prevent problems from fluid build-up.

In cases where patients had a second operation to remove the hematoma, surgeons were unable to tell where the bleeding originally came from. The body repairs the open or bleeding vessels.

It takes much longer to absorb the hematoma. During that time, the pressure on the spinal cord from the extra fluid in the spinal canal can cause pain, weakness, and even paralysis. Immediate treatment to remove the hematoma is required.

Chymopapain is an enzyme from the papaya fruit used to treat herniated discs. The chymopapain is injected directly into a bulging disc. It works by eating away the jelly-like inner core of the disc. The outer covering of the disc called the annulus stays the same. This treatment is called chemonucleolysis.

Chemonucleolysis works best on bulging discs that have not yet ruptured. By breaking down the inner disc, water is released, and the disc shrinks. This takes pressure off the nearby spinal nerve root, the source of the painful symptoms.

Chemonucleolysis is rarely done anymore in the United States. There were many problems and some serious side effects such as paralysis and extreme allergic reactions. It is still popular in Europe. Many studies showed it is less effective than other surgical treatments available here.

For patients who need surgery, there are new and better treatment options available. Minimally invasive discectomy can be done now. The disc can be removed with a small incision and minimal trauma to the tissues. Since the bone is not removed and the muscles aren’t cut away, today’s surgery leaves the spinal segment intact and stable.

Muscular or skeletal pain often comes from a mechanical source. This means something in the alignment of the bones and soft tissues is out of position or pinching a nerve. The way the head, ribs, arms and legs connect to the spine is very complex and quite connected so to speak.

Adjusting the spine to correct other problems is the center of chiropractic care. Studies show that the thoracic spine (middle of the back) is a pain generator. This middle area of the spine has quite a bit of influence on the rest of the spine, including the neck. The position of the thoracic spine has also been shown to affect the shoulders.

Treating the thoracic spine helps patients with a wide range of problems. Patients with complex regional pain syndrome, neck and shoulder pain, and pressure on the spinal cord or spinal nerves have all benefitted from this type of treatment. The same is true for anyone with rib problems.

If you’ve ever had a car accident or whiplash injury, the middle of the spine is often the fulcrum for the injury. As the head whips forward and back, the thoracic spine acts as the point of leverage for the rest of the vertebrae. Often the neck problems get addressed but the thoracic spine is ignored.

You were fortunate to have someone who understands the anatomical connections and treated the source rather than the effects of the problem.

As humans, we are definitely creatures motivated by pain. When we hurt, we do our exercises. If we don’t have any pain, we don’t do our exercises.

It may be worth a telephone call to the therapist to ask more about the exercises. Perhaps they were meant to be used short-term until your son was able to get back to his regular exercise program. If that’s the case, then he’s free to go about his business.

If the exercises were indeed preventive, then he may need a better understanding of what the exercises are supposed to do and how they will help prevent future injuries.

This age group (13 to 18 years old) are often non-compliant with a home exercise program. If the exercises are important, it may be helpful to involve his track coach. Perhaps it’s something that could benefit the entire team and could be incorporated into their regular warm-up exercises.

Spinal infection is an uncommon problem. It does occur most often in conjunction with some other infection such as the dental infection your father had. The bacteria has to be identified (usually staph or strep) so the right antibiotic can be prescribed.

Emergency surgery may be needed if the abscess is large enough to press on the spinal cord. The surgeon enters the spine from the front of the neck and removes the disc at the level of the abscess. This operation is called a discectomy.

A thin rubber tubing called a catheter is threaded through the space left open by the discectomy. The catheter goes into the epidural space where the pus is taken out. The space is then rinsed thoroughly to remove any bacteria or debris.

Antibiotic therapy is started right away. The patient is given a special collar to support the neck until healing occurs. Fusion of the spine is not usually necessary.

Self-assessed health is a strong and independent predictor of mortality (death) and morbidity (illness). People who rate their health as poor are four to five times more likely to die than those who rate their health as excellent.

Self-assessed health is also a strong predictor of functional limitations (what you can and can’t do). The doctor considers it a red flag anytime a patient chooses poor to describe his or her overall health. Your chances of a good recovery with treatment are less than if you graded your health as good-to-excellent.

Doctors may use this information to decide what’s the best treatment for each patient. They may also take a look at the big picture for all their patients combined together. They may look to see what can be done to improve health for everyone.

Patient education programs are often planned based on what patients’ needs are. Surveys of this type may help bring this kind of information to light.

Therapists use a tool or device called an inclinometer for these types of measurements. The idea is designed after the inclinometers used by engineers to measure angles of slope (or tilt) and elevation or inclination of an object.

A hand-held device that looks like a round clock is positioned along the spine. A needle shows the amount of spinal movement that occurs as you bend forward, backwards, or sideways. Any deviation from the true vertical or horizontal is measured in one-degree units of movement.

Readings are fast and accurate so you don’t have to stay in any one position too long. Some models of the inclinometer are held by the therapist. Others are strapped on with a velcro belt.

The therapist may also measure your hip and lower back flexibility using an adjustable Sit and Reach Flexibility Tester. You sit with your legs straight out and your feet against the device. Then you bend forward. Using your hands, you push a slide bar forward as you bend forward. The slide bar has units of measurement to show how far you can go.

The results from these tests will be compared with the movements needed and amount of motion required for your job. Therapists use other tests as well to make sure workers are ready and safe to return to work.

Spinal cord stimulation (SCS) usually involves the placement of electrodes inside the epidural space of the spine. This space is the area between the bony ring of the spine and the covering of the spine called the dura.

The dura is the sac that encloses the spinal fluid and nerves of the spine. In the cervical spine and thoracic spine, the spinal cord also is contained within the dura and the spinal sac. The SCS device is very small and fits inside the epidural space. It is composed of electrodes (leads) and wires and works directly on the spinal cord to stop pain signals.

A common problem with these units is hardware failure. The delicate wires can get broken allowing the electrodes to move away from their intended site. It’s difficult to design a device of this type that can hold up under the stress and strain of spinal motion.

If there’s breakage, the unit stops working and no longer delivers electrical impulses to the spinal cord. If the leads stay intact but the unit shifts location, it doesn’t have to move far to stop working.

Sometimes the X-ray doesn’t show a change in the location of the SCS device but pain is not relieved. In these cases the doctor may say there is “poor pain coverage.” For any of these problems, a second revision operation may be needed to repair or replace the device.

You may be referring to the treatment called epidural spinal cord stimulation (SCS). Programmable electrodes can be placed inside the cervical or thoracic spine. The goal is to stimulate the spinal cord directly and prevent pain signals from reaching the brain. Patients with complex regional pain syndrome (CRPS) are often good candidates for this type of treatment.

However, there are some problems with this treatment. Hardware failure is common and reported in up to half of all patients using the SCS device. The delicate nature of the device combined with the stress of movement in the spine can create problems.

In a recent study, doctors in the Department of Neurosurgery at Northwestern University (Chicago) reviewed hardware problems for 289 patients. There was an overall 33.5 percent rate of complications such as infection, breakage, or migration of the unit.

In almost half the cases, revision surgery to repair the problem was unsucessful. Hardware engineers are hard at work to find a way to implant a sturdy, effective pain control unit that will allow normal movement.

Lumbar injections of the nerve root have been around for almost 30 years. The injection is a mix of a local anesthetic and steroid. The anesthetic helps with the pain. The steroid reduces inflammation. Less swelling in the area means less pressure on the nerve and therefore less pain.

Studies at the Washington University School of Medicine in St. Louis have reported on the long-term use of lumbar nerve injections. They studied a group of 55 patients who had radicular low back pain from a herniated disc or spinal stenosis. Spinal stenosis is the narrowing of the spinal canal. The spinal canal is the tube or opening where the spinal cord goes from the neck down to the bottom of the spine.

Radicular pain refers to pain in the low back that travels to the buttocks and/or down the leg. It is caused by pressure or irritation of the spinal nerve as it exits the spinal canal. The results of the study showed that nerve root blocks decrease pain from both conditions. Patients with herniated disc were more likely to get pain relief.

If you obtained relief of painful symptoms with a nerve block for a previous disc problem, you may be a good candidate for a similar treatment for spinal stenosis. Once an orthopedic surgeon has examined you and perhaps ordered some imaging studies, then he or she will be better able to advise you. There is a broad range of treatment options for this problem.

Septic arthritis is another way to say that the joint is infected. Sometimes the condition is called infectious or bacterial arthritis. There is usually an underlying systemic cause of the problem.

A recent history of any kind of infection such as pneumonia or urinary tract infection is the most common cause. Bacteria in one part of the body move via the bloodstream to another part of the body such as the joint. This process is called hematogenous seeding.

Other risk factors include older age (over 80 years old), sexually transmitted infections, diabetes, or chronic joint damage from gout or arthritis. Anyone who has had a joint replacement is at increased risk for joint infection. The infection can occur years after the implant is inserted. Anyone with an indwelling catheter is also at increased risk.

Symptoms may be mild to severe with low-grade fever and slightly swollen glands. There may be a skin rash prior to any joint symptoms. Fingers, knees, shoulders, and ankles are affected most often and usually on both sides.

Damage to the joint can be sudden and severe. Anyone with a recent history of infection who develops any of these symptoms along with joint pain should see a doctor right away. Early treatment with antibiotics is needed to prevent or limit joint destruction. Arthroscopic debridement to cleanse the joint may be needed.

Scientists are busy trying to figure out just who are the best and worst candidates for back surgery. Identifying risk factors before the operation might make a difference. Reducing, modifying, or eliminating risk factors may reduce disability later on.

In general, research shows that pessimists who expect the worst have worse health outcomes. Having a negative attitude is linked with greater pain and more disability after surgery. Specific studies of patients who have a disc taken out because of lumbosacral radicular syndrome (LRS) show a trend toward greater disability when cognitive-behavioral factors are present.

There are three parts to cognitive behavioral factors: 1) fear of movement or reinjury, 2) passive pain coping, and 3) negative outcome attitude. Passive pain coping refers to retreating from activity and movement by sitting, lying, or resting for long periods each day. Having a negative view of the outcome is also linked with disability six weeks and six months after the surgery.

People who think that the surgery might not help are more likely to be disabled six weeks after the operation. The same is true after six months. Studies are now needed to show if changing the thoughts and behavior of LRS patients might reduce disability later.

Experts who say magnets can help don’t promise a cure, but relief from painful symptoms and an increased level of comfort. Used as directed around painful sites or over acupuncture points or trigger points, they seem to be effective for many people. However, there is no scientific proof that they do anything.

Magnets have been used by all kinds of people for all kinds of painful problems from arthritis to tendonitis. Football players tape them against their ankles and runners put them inside their shoes. Sleep-deprived individuals and people with chronic headaches can buy a special magnetic mask to wear over the eyes or forehead.

The magnets are worn until the patient gets relief from the symptoms. There is no apparent downside to wearing them all the time. Although there is no proof that the magnets work, there is also no evidence that they don’t work. For many patients, magnets offer a simple solution to using narcotics and other addictive drugs.

Magnets should not be used by anyone with a pacemaker, metal implants, or drug infusion pump without a physician’s approval first. Pregnant women are advised not to use them. Magnets should not come in contact with electric blankets, heating pads, credit cards, or computers.

Autogenous bone graft is the term used to describe donating bone to oneself. It is preferred over bone from a bone bank because there is no risk of rejection. However, the main disadvantage is just what you have experienced — pain at the donor site.

For spinal fusion, bone chips are shaved from the front of the pelvic bone. This is the bump you can feel in front of the hip below the waist. Bone graft pain may be eased by conservative treatment, most often with pain relievers.

In a small number of patients, the pain may persist for weeks to months, gradually going away as the bone remodels and heals. Sometimes the donor site remains painful for much longer. Treatment is fairly limited in such cases. If the bone has remodeled with sharp edges, the surgeon can try to shave it smooth again.

This doesn’t always work as the shaved bone will continue to add bone trying to heal the site. New bone isn’t always smooth and may cause more jagged edges to form.

A recent study of older men found that neck or back pain with numbness and tingling is more common among men with a history of diabetes mellitus (DM). This is probably because DM can cause clogging of the arteries, a condition called peripheral artery disease (PAD).

This is only one of many possible causes of back and leg pain in older adults. Seek medical advice and testing for these symptoms. At the very least, a baseline could be established. It will help you keep track of the big picture and a general trend of his symptoms. Any lasting change (better or worse) can be treated sooner than later.

More than 80 percent of the adult population will suffer back pain at least once in their lifetime. Usually symptoms are short-lived and go away in 10 to 14 days.

Pain that lasts beyond the expected time of healing is a red flag or warning. Other risk factors to pay attention to include age (under 20 or over 40), history of health problems, and smoking or the use of tobacco products.

Are you having any other symptoms such as fever, sweats, nausea, or vomiting? Are you having trouble finding a comfortable position? Does your pain wake you at night? Finally, even if none of these additional signs and symptoms are present, your own level of concern is an important factor. Whenever anyone has doubt about his or her condition, seeking medical advise is advised.

Fracture of the main body of the bones in the spine is called a vertebral compression fracture. The severity of this type of fracture is based on the condition of the bone after the fracture.

A mild fracture may be a single crack in the bone with mild changes in the shape of the vertebral body. The front half of the vertebra may start to collapse giving it a wedge or pie-shape when viewed from the side on X-ray.

With a moderate vertebral compression fracture, there is the same kind of wedging along with up to 50 percent loss of bone height. Severe fracture has a wedge greater than 30 percent and more than 50 percent loss of bone height.

In some cases the fracture starts from the center and moves out to the edges of the bone. This is called a sunburst fracture. The entire bone can collapse with almost complete loss of vertebral height. When that happens, the joints are compressed together causing pain. Traction may be placed on the nerves that exit the spine at that level also causing pain.

Level of pain isn’t always linked with the severity of fracture. A mild fracture can cause severe pain, whereas some severe fractures seem to cause no pain at all. The patient may not even know there is a fracture until an X-ray is taken for something else and shows the old fracture site.

Most patients with ankylosing spondylitis (AS) can be treated conservatively without surgery. Surgery may be the best option for anyone who is bent so far forward the chin rests on the chest. Patients who can no longer look up to see where they are going or who can’t lie down flat are also likely candidates for surgery.

Several surgical options are available. The type of procedure used depends on the condition of the spine, presence of nerve pressure, and age. Older patients have less flexible blood vessels. Surgery to change the angle of the spine and straighten the patient also straightens large arteries such as the aorta. Rupture of the aorta or its branches can occur. The risk is small but it can happen.

Usually straightening other structures such as the gastrointestinal tract is possible because the organs are soft and moveable. The lungs and stomach respond well to the reduced pressure and room to move and “breathe” so-to-speak.

It would be good to bring this question up with his surgeon. He or she will explain the type of operation planned and any steps that may be needed. Risks and complications will be reviewed, too. Don’t hesitate to ask questions and express your concerns during the doctor visit.