FAQ Category: General Spine

Scientists have found dense bundles of nerve tissue inside the bones of the spine (vertebrae). A group of nerves together is called a nerve plexus. Researchers think that the number and size of these plexus suggests many different functions.

We know that nerves release a chemical called substance P. Substance P sends the brain pain signals. Other forms of sensation may be sent through this nerve plexus. It’s possible that the nerve plexus inside the vertebrae also controls bone growth and function. The blood supply to the bone may be under the control of these nerves as well.

Finally, it may turn out that these nerves inside the bones of the spine cause back pain. If this is true, treating back pain may begin by altering the messages sent by the nerve plexus.

As with most operations, there are several ways to do this. Each doctor also has certain methods he or she likes to use. An operating microscope is used. A small incision is made at the level of the problem. A special tool is inserted that allows the doctor to see the area with magnification.

A small portion of bone is cut away to gain access to the disc. Part or all of the disc is removed. Loose fragments found in the disc are also taken out. Usually, the doctor decides what to do based on what is seen inside the disc space at the time of the operation.

Next time you see your doctor, ask him or her to explain exactly what will be done during the operation.

In medical terms, “post” means after. In this case, it means after an operation. A laminectomy is the removal of a piece of bone in the spine. The lamina helps support the vertebra of the spine. When all or part of the lamina is removed, it’s called a laminectomy.

Laminectomy is done when the disc material bulges out of its normal space. The bulge or herniation presses against the spinal cord or spinal nerves. The pressure on a nerve can cause painful symptoms down the leg called sciatica. Removing the lamina takes the pressure off the nerve root.

If the operation doesn’t work, the patient still has sciatica. There may also be numbness and tingling and even muscle weakness. Any time a group of symptoms occur together, it’s called a syndrome. This group of symptoms after removing the lamina is called a postlaminectomy syndrome.

A new study from the Stanford University School of Medicine may have the answer to your question. Almost 200 patients with sciatica (leg pain) from a bulging disc had the disc removed. One doctor did all the surgeries.

He found there are four types of disc problems. The disc is made up of two parts: the inner part called the nucleus pulposus and an outer ring of fibrous tissue called the anulus fibrosus. With a bulging or herniated disc, they may also be a bulging anulus, large defects in the anulus, pieces of disc material inside a normal anulus, or a normal anulus.

Patients with a bulging disc, but normal anulus have the best results from this operation. Patients with a bulging disc along with large anular defects (tears or cracks) have a poor result. These patients are more likely to have a second herniation and second operation.

It’s possible your second disc problem was one that doesn’t respond as well to removing the disc. Doctors are continuing to study the best way to treat all types of discs.

Magnetic resonance imaging (MRI) has been very helpful to doctors when looking at soft tissue problems. However, the MRI isn’t 100 percent correct. For example, the MRI doesn’t show areas of calcification or hardening of tissue.

Some conditions just can’t be clearly seen with X-rays or MRI. Sometimes, the doctor must remove the tissue and send it to the lab for final identification. This may be the only way to get a sure diagnosis.

Doctors often use antiinflammatories to treat these two conditions. If pressure from swelling or fluid in the area can be removed, pain can be controlled. Combining the drugs with exercise seems to help many people. Working with a physical therapist to find the right exercises is important. Doing the wrong exercises or doing them improperly can add to your problems.

Sometimes, surgery is advised. The doctor can remove bone that is putting pressure on the spinal cord or spinal nerves. A new, less invasive operation is also possible. This involves putting an implant between the spinous processes of the backbone.

The implant keeps the bone in a slightly forward bent position. It also decreases pressure on the disc at that level. Discs above and below the level of the implant aren’t affected.

Bracing is one treatment option for patients with spine fractures. Some doctors advise open surgery to repair the bone and fuse the spine. This helps restore posture and height, but can have serious complications in the aging adult.

A less invasive treatment option is called balloon kyphoplasty. The surgeon places a balloon-type device inside the bone and slowly inflates it. This helps the bone regain its former shape and size. The balloon is removed and the space is filled with bone material.

Patients remain in the hospital one or two days if no problems occur. They usually have much less pain and improved function. Many patients who were confined to a wheelchair can even start walking again. Problems with breathing and difficulty eating improve as the pressure from being stooped forward is taken off the trunk and abdomen.

Balloon kyphoplasty is used to repair fractures of the vertebra in the spine. Most of these are compression fractures caused by aging bone and osteoporosis. Bone loss weakens the structure. The pressure of daily movement can be too much causing the bone to break. Compression fractures can be extremely painful and disabling.

The operation involves placing an inflatable device into the bone. The bone is restored to its previous shape and height and filled with bone material.

Some patients do have more than one fracture. These can be treated all at one time, or in two or more stages. Sometimes, testing doesn’t show all of the fractures present. By completing a balloon kyphoplasty, the doctor can see how much pain relief the patient gets. If symptoms persist, further testing may be needed. A second, or even third, balloon kyphoplasty is an option.

In medical terms, the procedure is called vertebral balloon kyphoplasty. When a fracture occurs in the vertebral bones of the spine, the bone collapses. This causes deformity, postural changes, and a loss of height … not to mention extreme pain!

In a balloon kyphoplasty, the doctor makes a small incision in the patient’s back. A special tool is used to insert what looks like a balloon into the bone. The balloon is inflated. This helps the bone restore its natural shape and height.

The balloon is deflated and bone chips are placed in the cavity left by the balloon. Studies show that the benefits of this minor operation last even after a year.

Kryorhizotomy is a way to destroy the nerve to the joints in the low back. These joints are called facet joints. The facet joints allow movement of the spine such as bending forwards, sideways, or backwards. Rotation or twisting motions also occur at the facet joints.

Like all joints, the facet joints suffer damage with use and aging. The result is pain and loss of motion. By injecting the joint with a local anesthetic, doctors can make sure the pain is coming from the joint. If the test is positive, the nerve to the joint can be permanently destroyed. This reduces or eliminates the pain.

Kryorhizotomy uses a freezing agent to kill the nerve. It’s safe and effective when used with patients who don’t have any numbness and tingling. It’s best used with patients who haven’t had any previous back surgery.

You will be able to benefit from a twice-weekly exercise program. This will include stretching, strengthening, and endurance. The therapist can also help you learn how to stand, move, and lift safely at home and at work.

A recent study reports that exercise twice-weekly is just as good as three times a week. This was tested on adults with moderate back pain lasting more than three months. Each patient was still working, but had some limitations because of pain.

Exercise helps patients overcome their fear of reinjury. It also increases fitness and strength of the muscles. These two things combined together result in a return to more normal movement.

Many people lose height with age. There are several reasons for this. First, the effect of gravity over many years pulls us forward. Unless we make a conscious effort to stand up straight, our posture changes as we age. This affects our height or stature.

Second, the bones in the spine (vertebrae) change with age. This is true for both men and women. There is a general tendency for the vertebra to collapse inward around its edges. This is referred to as increased concavity. Keeping active helps prevent this from happening.

Third, loss of bone called osteoporosis can cause changes in the spine. The bones can collapse and shift forward, causing a stooped posture and loss of height. This can be prevented or at least managed with a doctor’s help.

Finally, discs between the bones can lose height, though this is less common. Discs do get stiffer with age, but they don’t usually lose fluid or collapse in the average adult.

Measuring the total number of fractures and how severe they are shows if the problem is widespread in the body. Systemic (whole body) bone fragility is a serious medical problem that should be treated. Treatment can help prevent more fractures and other problems.

Recent studies have shown that some women with knee osteoarthritis later develop vertebral compression fractures. Researchers think systemic bone fragility may have a “latent” effect. This means the overall bone weakness occurs much later than the osteoarthritis. Finding bone problems early is important for treatment.

That’s an excellent question. But before launching a national program that could cost millions of dollars, researchers want to find out whether such a program would work. They can do this by comparing children who receive back care education to those who do not receive any special tips.

So far, information gathered from this line of study has not been conclusive one way or the other. Some back care programs show good success in reducing back pain in children. Others don’t seem to affect how children sit, lift, and bend. Part of the problem is that the studies measure different things and don’t use the same research methods. Some of the studies are too short in duration (less than two weeks). Researchers really need to look at the effects of back care education over the long run.

More information is needed on who benefits from back care education, what guidelines should be presented, and when to begin teaching back care. Researchers are busy gathering this information.

The content of the class depends on who’s teaching and how much time is available. Most back care classes begin with a general awareness of posture while sitting, standing, and lying down. These classes often stress the importance of activity and exercise. They also demonstrate proper lifting and carrying techniques.

There may also be some discussion of backpacks. Children are encouraged to limit the weight in their packs to 10 percent of their own body weight. Back care classes may suggest ways to reduce the weight of backpacks, such as keeping books already used in desks or lockers.

Reports vary. Researchers in Belgium found that 30 percent of school-aged children report back or neck pain from week to week. Another group found that 23 percent of children ages six to 13 have back pain at least once during these childhood years. Some reports are even higher. It’s difficult to compare these numbers because each study is measuring something a little different.

It’s clear that back pain among children is a significant problem in the United States and around the world, and the problem seems to be getting worse. Researchers will be looking at this issue more closely in the next few years.

Stenosis means “narrowing.” With spinal stenosis, the opening or “canal” through which the spinal cord passes is too small for the cord. This can happen anywhere in the spine, but it happens most often in the low back. The neck is the second most common location for spinal stenosis.

There are many possible causes of spinal stenosis. The first is the structure of bone or size of the opening at birth. This is called primary stenosis. More common is secondary stenosis, which is caused by the aging process. Sometimes bony growths called osteophytes form and block the spinal canal.

Changes in the disc material between the bones of the spine may contribute to stenosis. These changes start with the disc and affect the surrounding ligaments and joints. The final result is to narrow the opening of the spinal canal.

Finally, trauma from a car accident, fall, or other injury can cause damage to the spine and surrounding structures. This can also lead to stenosis.

There aren’t a lot of studies to show how often negative outcomes occur. One study of several hundred children and teenagers reported a 19 percent rate of poor results. Most of these were caused by problems with the hardware used to hold the spine together. Sometimes a hook or screw loosens or just fails to do its job.

There has been some question of whether returning to sports or other physical activities too soon can cause problems. So far, there is no real proof that surgical failure occurs after returning to activities too soon. This is an area of new research, so perhaps more information will be available in the next 10 years.

Researchers are studying this question closely. One group surveyed over 1,000 patients from six different areas of the United States. They found that more than 70 percent of people seeing chiropractors had neck or back pain. These problems were not different from what a medical doctor would treat.

The health status of people in chiropractic care was different. In general, chiropractic patients had poorer physical and mental health. The reason for this is unknown. Perhaps chiropractors are more supportive and accepting of people with physical symptoms and depression or anxiety. This study found that users of chiropractic care were generally better educated and had a more holistic approach toward health in general.

There are two possibilities: a semi-squat with knees slightly bent, or a full squat using a deep knee bend. The semi-squat position is advised over the full squat.

In the semi-squat position, the center of the body is higher and the knees are straighter. This requires less work to lift as measured in laboratory studies. Using a semi-squat stance also reduces the pressure on the knees and allows for a faster shifting of the center upper-body. This means less chance of losing your balance and falling.

The semi-squat position does increase the load on the low back compared to the full squat. However, this doesn’t appear to be a problem or cause injury to the back, especially when safe lifting habits are used. On the other hand, using a full squat may cause knee injuries if the weight of the load is greater than the strength of the muscles around the knee.