FAQ Category: General Spine

Ankylosing spondylitis (AS) is one of several inflammatory arthritic conditions in a family of related diseases called spondyloarthropathies. Chronic inflammation occurs at the place where ligaments and tendons insert into the bone. The body reacts to the inflammation and ends up fusing the joints by replacing the soft tissues around the joints with bone.

The spine and sacroiliac joints are affected most often resulting in a forward bent posture. The patient may lose the ability to lie down flat, stand up straight, or look where he or she is going.

Your brother may be a good candidate for surgery to fuse the spine in a more upright position. One operation called an opening wedge osteotomy may be helpful. The surgeon cuts several vertebral bones loose and rotates or tilts them backwards.

Metal rods and screws are used to hold the spine in this new position until the bone fills in and fuses. The effect of this operation is to extend or straighten the spine and give the patient a more upright posture.

Not everyone with AS is a good candidate for this procedure. Other methods of fusion may work better. An orthopedic surgeon is the best one to make this determination and answer your questions. Your brother may be more willing to see a doctor if a family member goes with him.

Research has shown that understanding back pain and staying active are two key ingredients to recovery from back pain or injury. Back schools were designed many years ago to explain to patients what to expect and what to do after back injury.

At first patients attended long sessions for many weeks. Anatomy, nutrition, and lifting techniques were some of the topics covered. The importance of good posture and daily exercise were also included. Ways to cope with pain was a key feature for chronic low back pain patients.

Today the information has been summarized and taught in one to two much shorter sessions. The concept of this kind of a “mini-back school” is very popular. It allows patients to quickly learn what to do and how to do it early in the acute phase rather than waiting until they’ve developed chronic pain months later.

Chronic pain patients can also benefit from a mini-back school. Information on anatomy of the spine and how things work (biomechanics) can be very helpful in preventing future problems. Likewise, optimal postures at work and at home can reduce stress and strain on the spine.

Spinal cord injuries (SCIs) are classified as complete or incomplete depending on how much damage has occurred. With complete SCIs, the patient is paralyzed below the level of the vertebra that is fractured. Incomplete SCIs have mixed results depending on what part of the spinal cord has been affected.

Many advancements have been made in the medical treatment of spinal cord injuries. Drugs to reduce and prevent inflammation have made a big difference. Without the added pressure of the fluid build-up from swelling, there is less damage to the spinal cord in the early hours and days following the injury.

Surgery is done right away to decompress the spinal cord and spinal nerves while stabilizing the spine. Her overall prognosis may depend on the level of medical trauma she sustained. Were there chest or abdominal injuries? Was there a head injury? Has she gone into shock? Other problems can occur after surgery such as infection, blood clots, or scar tissue that can affect the final results.

The good news is that prognosis for long-term function is much better with improvements in treatment. Death from SCI has been reduced by 50 percent. Stability is easier to achieve and maintain.

Earlier types of antibiotics were prescribed in 10-day increments. Most often, the patient would take a pill three times a day for the full 10 days. Then drug companies were able to make an antibiotic that could be taken once a day for just five days.

In cases like spine surgery or joint replacement antibiotics are used preventively. The goal is to reduce or prevent skin and wound infection. The best time to use antibiotics for this purpose is before the first skin incision has been made.

Doctors have found that the overuse of antibiotics has led to antibiotic-resistant bacteria. To avoid drug-induced adverse events, the suggested timeframe for antibiotic use is 24 hours.

Choosing the wrong patient, wrong site, or wrong surgery is one of several mistakes that can occur in surgery. Doctors and hospitals have started to set up systems to help prevent these errors from occurring.

Three of these systems are called:

Spinal deformity has been linked with recurrence of low back disorders in autoworkers. It’s possible that your scoliosis (curvature of the spine) may reduce your ability to move, twist, and turn freely.

Researchers aren’t sure if decreased spinal mobility is the cause or effect of work-related low back pain (LBP). For example workers who change jobs often in the same plant are at increased risk of LBP. It’s possible that a lack of training is the real problem.

Having a job with high physical demand may not be the best choice for someone with a spinal deformity. If you do take this job, keep up your regular physical activity and exercise outside work. This is the best-known prevention against lumbar injuries and low back disorders.

Pain associated with vertebral compression fractures isn’t fully understood. It’s likely there is pain coming from the bone and from the nearby nerves. Movement in either direction can compress the bone.

Bending forward puts pressure on front half of the vertebra. Extension compresses the back half of the bone and also narrows the opening where the nerves come through. In addition, when it hurts, the patient stops moving. The natural flow of motion and muscle activity actually helps keep the patient from getting stiff and deconditioned. Without movement the pain and stiffness increases.

As difficult as it may sound, movement and especially straightening up to full height helps with this condition. A physical therapist can help patients with this type of fracture learn the right activities and exercises to do to heal in the best spinal position possible. The therapist can also teach you how to use your breathing to reduce the pain and how to sleep at night for optimal healing.

Good question and one that medical financial analysts have also asked. Research shows that the trend for spinal surgery is on the rise. This includes all spine problems from disc to stenosis.

Older adults are more likely to have spinal surgery than ever before. In fact the number of patients who have had spinal fusion for stenosis increased four times (quadrupled) since the 1980s. This may be because Americans are living longer. And problems that come with aging like stenosis are causing pain and disability. Improved technology and better surgical methods make it possible to operate on older adults.

But studies so far don’t show that the added operations really make a difference. Your parents are probably a good example. Some patients show improvement but others don’t. More research is needed to find out who would benefit from each type of treatment.

Surgery is considered when all other options have failed to stop the progression of the disease. Morning stiffness, back pain, and loss of function begin to impair daily activities. Loss of chest expansion and spinal deformity can affect breathing leading to chronic respiratory problems.

Anyone with AS who has severe deformity that interferes with vision, breathing, walking, or digestion should consider surgery. Anyone with spinal instability would also qualify. Correction of deformities and/or spinal fusion may be helpful.

There’s one other nonsurgical treatment that may be advised first. The new TNF inhibitor drugs can offer improvements in your symptoms and even arrest or stop the disease process from getting worse. Long-term studies aren’t available but short-term results are very promising. Ask your doctor if you might be a good candidate to try a three or four month trial of these drugs.

You may have heard about the new disease modifying drugs made from tunor necrosis factor (TNF) inhibitors. These were discovered in cancer research but have worked very well for inflammatory conditions like rheumatoid arthritis and ankylosing spondylitis.

TNF inhibitors include etanercept (trade name: Enbril), infliximab (trade name: Remicaide), and adalimumab (trade name: Humira). These drugs are known to control pain and reduce stiffness. Patients are able to stay active and avoid deformities common with these conditions.

Not everyone with AS is a good candidate for TNF inhibitor treatment. A medical doctor must make this decision. It’s based on how severe and active the disease process is. Other treatment such as antiinflammtory drugs and physical therapy may also be helpful.

Nonspecific pain in any part of the body means the cause of the pain is unknown. The patient may be able to describe how often and how much it hurts. They may even be able to show the doctor where it hurts. But there’s no clear soft tissue or bony structure known to be causing the symptoms.

Nonspecific low back pain (LBP) is actually the most common diagnosis for LBP. Most of the time there’s no way to tell what’s wrong. Even with X-rays or MRIs the real cause may remain unknown. It’s easy to assume that a finding on imaging studies is the problem but many people without symptoms have the same kind of changes.

Until a better way of identifying or classifying back pain comes along, doctors will probably have to continue using “specific” versus “nonspecific” to describe the problem.

Each center that provides care for chronic pain offers a little something different. A multidisciplinary rehab (MR) approach means that the patient benefits from many different ways of coping. The goal usually isn’t to “cure” the patient. Many times the goal isn’t even to reduce pain.

The purpose of a MR program is to improve function and help patients cope with their pain. The team members teach the patients about their back pain and help lessen the fear and worry that comes with chronic pain.

The team is often made up of a doctor, nurse, physical and/or occupational therapist, social worker, and psychologist. You may find yourself practicing relaxations techniques, exercising, and stretching. You may be taking a class or two on anatomy. Stress management is often a key part of the MR program.

Individual plans are aimed at improving the patient’s attitude and improve self-care. In short the idea is to cope better with ongoing, bothersome pain. Studies show this type of treatment works well for many people. They have fewer lost work days and improved function. Many people also report an increased sense of well-being and satisfaction.

It’s possible the cancer could have been found before the operation. An MRI is a more sensitive test than a CT scan and might have shown something to suggest a problem. But if a patient’s symptoms don’t point to a more serious condition, then the more expensive imaging isn’t ordered.

Depending on your father’s age the prostate cancer might have been detected with the PSA screening test. This test is recommended for all men after the age of 50. It doesn’t always find everyone with prostate cancer but it’s a place to start.

It’s likely the surgeon couldn’t tell your father had cancer during the operation. Most cancer is diagnosed only after a pathologist looks at the cells under a microscope. Not all disc material is sent to the lab for testing so it’s a good thing your father’s surgeon adopts the practice of routine specimen screening.

The question about routine lab testing of tissue specimens like disc material has been brought up many times. There are arguments on either side. On the one hand only one in 1,000 disc is likely to have anything wrong with it.

On the other hand, the simple $25.00 test could alert the doctor to a possible infection or cancer. In these cases finding serious problems early gave the patient a jump on treatment for an otherwise unknown problem.

Would that one person think a $25.00 charge was worth saving his or her life? Probably. Some doctors think it’s worth the gamble. More research is needed to confirm these beliefs.

You’ve already taken the first step: seeing the problem. You may need some intervention to break the cycle. Medications to stop the pain-spasm cycle help some people. Specific exercises or manipulation are two other options.

Avoiding movements and activities for fear of setting off the pain is common after an episode of low back pain. This is called fear avoidance behavior (FAB). Patients often have FABs to avoid injuring themselves again, too. Back pain patients become fearful and start to change their activity level. They become deconditioned and depressed.

You may want to see a physical therapist who can test you for FAB and guide you through the process of regaining full motion again. Don’t let this fear factor keep you on the merry-go-round.

Many schools around the United States offer scoliosis screening. Scoliosis is an abnormal curvature of the spine. It’s found most often in older children and teenagers. It’s great to have this screening service but it can cause some anxiety in parents.

The Internet offers easy access to medical information. But like the old saying, “Buyer beware!” the consumer should also be aware that much of the medical information on the web isn’t accurate.

A recent study done on scoliosis in particular only came up with one reliable web site: http://www.srs.org. The Scoliosis Research Society sponsors this site.

Your doctor should review any information you download. He or she can point out any inaccuracies and let you know what applies to your daughter.

Researchers have faced many challenges with disc implants. They have to find a material that is biologically compatible with the body. It has to be able to withstand the forces of time and activity. Scientists are trying to develop an implant to last 40 or more years. They figure that adds up to 100 million cycles of movement just based on how far the average adult walks in one year.

The implant can’t fracture or fail due to fatigue. It must fit into the disc space easily without sliding around or sinking into the bone.

Each implant type is tested on human cadavers, animals, and then live humans. Complete disc replacements are being used now.

The latest designs are trying to just replace the center of the disc. This is called the nucleus pulposus. The goal is to develop an implant that mimics the human disc’s ability to change shape or size. Most discs absorb water when the body is at rest. The water helps the disc keep its height and hold up against loads and forces. As the human stands up and moves around, the excess fluid leaks out of the disc.

This type of device is implanted in a dehydrated state. A much smaller incision and less invasive operation is possible. Once the device is in place, then it can absorb fluid to restore its height. Studies have been done on rabbits but not humans.

There are some adverse reactions reported by patients. These don’t happen very often and aren’t severe. Some patients report increased pain and stiffness. Others have headaches, leg pain, nausea, and diarrhea.

Symptoms don’t last long and are all gone within one week. There can be long-term problems if a nerve is damaged. Nerve pain, changes in sensation, and leg weakness can occur. Otherwise, prolotherapy is considered a fairly “benign” treatment. In other words, it may or may not help.

Some studies show certain patients are less likely to benefit. These include patients who use tobacco products, alcohol, and illegal drugs. Patients with fibromyalgia or a previous history of back surgery are less likely to be helped by prolotherapy.

Size does make a difference, but leverage makes a bigger difference. Nurses and other health care workers are trained in proper lifting techniques. They work as a team with other workers so that they don’t have to lift dead weight alone. And whenever possible,
they use lifting devices to protect themselves.

Lifting is done by using both hands and keeping the patient close to the nurse’s own center of gravity. Patients who are too far away from the health care worker are at greater risk for falling. The nurse follows the rhythmic movement of the patient. If the
patient starts to fall, the nurse can quickly correct the weight shift and help the patient get back on track.

Sometimes, falls can’t be prevented. In that case, workers are trained in ways to break the fall and prevent injury during the fall. Rarely, the nurse may have to let the patient go in order to avoid falling on top of him or her.

Weight lifters spend hours training. They work up to their full capacity and avoid lifting a heavy weight before they’re strong enough.

Some also wear a special support belt. Depending on the type of lift, heavy weight lifters don’t put the weight down. After lifting the weight and holding it, they let it drop to the ground.

Studies also show that weight lifters have a high intra-abdominal pressure during weight lifting. This means their stomach muscles contract to hold the spine in place. It’s a protective measure that seems to work in extreme loading situations.

But even weight lifters can get injured. Fatigue, overload, and sudden weight shifts can lead to injury.