FAQ Category: General Spine

Yes, if there is heavy pressure and/or prolonged pressure on the nerve roots in the spine, it is entirely possible that the nerves become permanently damaged. If, however, the problem is removed as soon as possible, there is a chance that some recovery occurs.

A trigger point (TrP) is an area of hyperirritability within a taut band of muscle. When pressed or palpated these points create a pattern of local and referred pain. Referred means the pain occurs at quite a distance from the points of local tenderness.

Trigger points may be either active (they cause pain at rest or with activity of the involved muscle) or latent. Latent means they are not painful but cause loss or movement and muscle weakness. A latent trigger point may become active in the presence of an acute, sudden overload of the muscle or a more chronic strain.

Trigger point injection involves injecting a numbing agent combined with a steroid drug into the trigger point area. In some cases, the treatment uses dry needling (nothing injected) or the injection of an inert (not active substance) such as saline (salt solution). The treatment goal is to reduce pain and improve movement and function.

The mechanism for how or why trigger point therapy works remains a mystery. It makes sense that injecting a numbing agent into an area of pain would reduce the pain. But there are studies showing that just placing a needle in that same spot and twisting the needle (a form of dry needling) works just as well.

There is no numbing agent involved, so there must be a different mechanism by which this treatment is effective. Some experts suggest that the nervous system reponds to the noxious (painful) stimulation of the needles in a way that shuts down other (chronic) pain messages to the brain.

Although both forms of treatment involve poking the muscles, the actual treatment method, approach, and philosophy are very different. Acupuncture is an ancient form of Chinese medicine. Thin, tiny needles are placed in specific points along an invisible line called a meridian.

Meridians are pathways along which energy runs throughout the body. The belief is that the meridian pathways can be over-charged with energy, under-charged, or have areas of blockage. Placing needles at specific acupuncture points can help relieve energy deficits, areas of congestion, or blockage.

Once the needles are in place, the acupuncturist may gently twist or turn them to stimulate the point. The needles are left in place for a short period of time. This can vary from three to five minutes up to an hour. The average session is about 20 minutes.

The needles used in acupuncture may be dipped in herbs or natural pain relieving substances. But most often (at least in the U.S.), the needles are sterilized without the addition of any supplements. On the other hand, trigger point therapy also involves the use of needles. Areas of hyperirritability within the painful muscle (not necessarily along an acupuncture meridian) are injected with a numbing agent and antiinflammatory drug.

There is some evidence that just stimulating muscles with needles invokes some kind of healing response. Studies comparing patients who have had dry needling report similar results (reduced pain, improved function) when compared with trigger point injections.

More studies are needed to figure out what works and why it works. With the exception of some local skin irritation and the possibility of skin infection, both acupuncture and trigger point therapy seem to be safe, if not effective for chronic muscle pain.

Any type of surgery has its risks, back surgery is no different. If you have a surgery for a herniated, or slipped, disc, the risks involve a bit more than if you were having surgery on your knee though.

Infections, blood loss, and slow healing are a few complications that are universal to most surgeries. With back surgery, there is also the risk of nerves being damaged with either pressure from blood pooling, bones shifting, or even doctor error. However, it must be kept in mind that complications like this are not usual and that, in most cases, the benefits from back surgery outweigh the risks.

You should speak with your doctor about how you feel and ask for a better idea of what types of complications may occur with your particular type of surgery.

It’s always a good idea to make sure you feel comfortable with your surgeon. This means asking questions that may help you make your decision.

Some important questions are how often the surgeon has done your particular procedure, why this procedure is being considered for you, what the outcomes of the other surgeries have been, and how often he has complications. If you are ever unsure about a particular doctor, you may always get a second opinion. In fact, it’s often advised to get a second opinion when a major procedure is in your future. It allows you to be more confident in your decision and it does allow another doctor to weigh in and see if there may be another approach that may be better for you in the long run.

That’s a good question. Replacing damaged bone with healthy bone isn’t a new idea and in one way, it’s done already.

If someone has surgery for damaged vertebrae that can’t support the back any longer or they have moved out of place and are causing pain by pressing on the nerves, the surgeon has a few options. He or she can fuse the vertebrae together so they don’t move or do a graft. A graft can be done by grafting healthy bone to the vertebrae or by placing hardware (screws, wires, and so on). So, in a round about way, that’s already happening.

If your mother has had this discussion with her surgery and they both agree that this is the best thing, there may be no reason for you to try to talk her out of it. If you’re concerned about the surgery, you could try to convince your mother to go for a second opinion to A) see if the surgery would help and B) if the second surgeon would do the same type of surgery or maybe suggest another one.

As frightening as surgery can be, studies have proven that people with certain types of back pain do recover well and have a significantly improved quality of life after the surgery.

Many adults undergo surgery to correct spinal deformities like your mothers. The surgeries are called osteotomies and involve removing bone from the spine and, if needed, lengthening it in some areas.

When a surgeon evaluates the type of surgery that may be needed, he or she does take into account the patient’s horizontal gaze, which is how the person is able to look straight ahead, with the gaze parallel to the floor.

It would likely be a good idea for your mother to visit an orthopedic surgeon to see what options she has to make corrections to her back.

All surgeries, even the most minor, carry a risk of complications. Spinal surgery has these risks and a few others because of the location and the complexity of the surgeries.

The usual types of complications are infections, blood clots in the legs, pneumonia, and bleeding. But, because it’s spinal surgery, there is also the possibility of nerve damage from either the surgery itself, the instruments, bleeding during surgery, or several other factors. The best thing would be to discuss the possible complications and see what your mother’s doctor says about the different risks.

Burst fractures occur as a result of a compressive load down through the spine. The vertebra shatters into tiny pieces. Bone fragments can get lodged into nearby tissues, including the spinal canal and the spinal cord inside the canal.

Burst fractures are most often caused by car accidents or by falls. Burst fractures are categorized by the severity of the fracture (how much of the bone was splintered into tiny pieces), displacement (how much the pieces have moved or separated, and kyphotic deformity (how much the vertebral bone has collapsed).

The loss of vertebral body height, and (the amount of neurologic deficit, and presence of spinal deformity are all important factors in whether or not these injuries are unstable.

Once the fracture site has been reduced (bones put back in proper alignment), bed rest is a standard treatment approach. The body must be given time for the bone to heal. Under the best of circumstances, bone healing usually takes six to eight weeks. X-rays and CT scans will be used to observe how the bone is coming along.

Some patients are up and moving in as little as two weeks. Most are on bedrest for six to eight weeks. This time period is followed by another three to six months wearing a body cast or brace. Rehab and recovery are also affected by factors such as the use of tobacco products (which can delay healing), good nutrition (which can speed up healing), age (older age has a worse prognosis), and the success of the initial program to restore bone alignment.

But the good news is that studies show a very favorable response to treatment with some 90 per cent (or more) success rate. Highly unstable fractures can be treated surgically if conservative care is unsuccessful in reducing pain and stabilizing the spine.

Actually, you’ve missed a few terms! A herniated disc can be called a slipped disc, bulging disc, ruptured disc, or even a pinched nerve, all depending on the person. They all mean the same thing, but why there are so many names for it isn’t known.

The terms closest to herniated disc is bulging disc. Imagine the discs piled up one on top of the other. In between each disc is a gel that cushions the bones, or else they would be rubbing on each other. Through an injury, the gel can escape and leak out, putting pressure on the nearby nerves. This is what causes the pain.

Butterfly vertebrae are vertebrae (bone that make up your spine) that have a cleft, an indentation or opening, through the middle. If you look at it with an x-ray, the shape reminds you of a butterfly. Usually, this doesn’t cause any problems and goes undetected unless there is a reason to x-ray that part of the back. Sometimes, however, there may be pain, but not from the abnormality itself.

The fact that your brother has butterfly vertebrae is important to know because although the abnormality itself doesn’t cause harm or pain, if enough of the vertebrae sticks out, it can knock the alignment of the spine out of whack. This won’t cause pain right away, but as your back works to adjust for the misalignment, it can cause back pain. For example, you could have butterfly vertebrae in the lower part of your back, but you may have pain in the mid to upper part as a result.

Butterfly vertebrae are vertebrae (bone that make up your spine) that have a cleft, an indentation or opening, through the middle. If you look at it with an x-ray, the shape reminds you of a butterfly. A human spine is formed within the first few weeks of gestation. So, as the spine is forming, somewhere between weeks three and six of gestation, something goes wrong in the spine and the result is butterfly vertebrae. Usually, this doesn’t cause any problems and goes undetected unless there is a reason to x-ray that part of the back.

In some surgeries, there isn’t much of a choice as to how to do them. Some are straight forward. However, in several types, there are different ways to approach the problem, different tools to use, different techniques to use, as well as the actual preparation up to the time of surgery and the recovery period.

When a surgeon makes a decision on surgery, he or she has to be sure that the patient is a good candidate for surgery. This means that the physical condition has to be taken into account. Someone who is in poor health and who would not do well in a long surgery would need the quickest procedure that is possible, yet effective. If a more involved surgery is an option and the patient is healthy enough to undergo something like that and the patient would benefit more from the more detailed surgery, then most often that is the one that would be done.

That being said, there are other issues involved in deciding the surgery. The surgeon use the techniques they are most comfortable with, so they tend to lean towards those surgeries. Some surgeries need special equipment or personnel, so it depends on if this is available. The surgeon also has to weigh his or her desire against what is possible. For example, if the surgeon prefers to use a specific technique, but once the patient has been opened up sees that it won’t be possible, he or she must be able to switch quickly to another procedure.

Only you and your doctor can decide if you should have back surgery, but there are some things you can discuss to help you make your decision.

Ask your doctor what he or she plans to do and how long this type of surgery usually takes. Ask about how long the usual recovery period is and what types of complications are most common. You can ask how many times your doctor has done this procedure and if there are any other ways that it may be done. Of course, you are always welcome to get a second opinion from another surgeon. This is often recommended to help people understand what needs to be done and to be sure that they are doing the right thing.

Back pain is one of the most common complaints that doctors see. When they are told that you have back pain, they have to make several assessments to understand if your pain is caused by something that can’t be helped or if you have a severe problem that needs to be dealt with before it can cause much more serious problems than just the pain.

To make their assessments, doctors have to have an idea of your whole lifestyle. Do you exercise, eat well, smoke, drink too much alcohol, and information like that. It’s been shown that many people who smoke and drink a lot of alcohol have a harder time healing than people who don’t. Doctors also need to know if you have any chronic illnesses, like diabetes or high blood pressure, because sometimes chronic diseases also affect how quickly someone heals. This information is also very important for medications to be prescribed.

If you are overweight, don’t exercise, stay in bed too much, and smoke, that tells the doctors that you may be at high risk for many illnesses and that some lifestyle changes may actually help improve your back pain.

If you don’t have back pain, it’s a good idea to stay active and maintain a strong back and, equally important, strong abdominal muscles. Researchers aren’t sold on the benefits of any particular ergonomic chair for preventing back injuries or back pain. For that reason, even if you did get an ergonomic chair, there’s no guarantee that it would be helpful to you.

If you do end up with a sore back, it may be due to other issues, not related to work, such as the way you lifted something at home, an traffic accident or sudden stop in the subway, things like that.

It’s true that many newer treatments can be expensive. As technology expands and researchers learn how to apply the technology to people, the machinery and knowledge needed can be pricey. That being said, it’s important to balance out the cost versus the outcome. If a patient with severe back pain is being treated with a low-cost treatment that isn’t relieving enough of the pain to allow him to work or enjoy life, is this cost effective? Could it be better if this person received effective treatment from something that is more costly, but allows him to get back to work and be productive again?

When treatments are costly, research is usually done into the cost effectiveness of the therapy. In some cases, treatments can be expensive at the start but their costs can level off once the initial outlay has been put out.

No medical procedure is 100 percent foolproof so, yes, things can go wrong with a vertebroplasty, a procedure where a doctor injects a special cement into the spine to stabilize it.

One complication is one that can occur with any procedure that requires x-ray imaging to see where the injection needs to go. Some people are allergic to the dye or contrast agent and they may have a reaction to it. Another possible issue is infection at the injection site, but this is a rare occurrence. There have been some instances of the cement leaking away from the spine and into the spinal canal, and there are some patients who experience bleeding, back pain or numbness as a result.

Scoliosis or curvature of the spine is more common in older children and teenagers. For most of them, the condition is referred to as adolescent idiopathic scoliosis (AIS). Idiopathic means there is no known cause for the problem.

In older adults, the degenerative effects of aging on the spine are usually linked with scoliosis. In fact about 87 per cent of adult scoliosis is attributed to degeneration. Only 13 per cent remains idiopathic (unknown cause).

The development of scoliosis in adults over the age of 60 is actually more common than previously thought. According to studies, the incidence in this age group may be as high as 68 per cent. Women are affected much more often than men. And with the continued increase in life expectancy, experts expect to see even more cases of adult scoliosis.

Studies are underway to help patients like your mother. Identifying factors that lead to the development of the problem may make it possible to reduce the risk of age-related scoliosis. Research to find the best treatment approach for each patient is also ongoing.