FAQ Category: Lumbar Spine

Research is ongoing into the area of low back pain. So many people are affected by it each year, it’s become a major focus of researchers around the world. Finding specific solutions to the problem hasn’t happened yet. But there’s been some good progress.

We know more about what doesn’t help back pain. That’s an important start. There’s no sense in wasting time and money on treatments that really don’t make a difference. As a result of poor results using traditional treatment, many back pain sufferers are seeking alternative options.

Treatment such as acupuncture, massage, and manual therapy/manipulation are becoming more popular. And there are some studies that support the use of these new therapies. Future research will focus on who responds to each type of treatment modality. It’s possible that certain groups of back pain patients get better faster with one type of treatment over another.

For now, we are seeing a shift in how health care professionals view back pain patients. Consideration is being given to the psychologic, social, and emotional factors linked with back pain. Patient beliefs, coping stategies, and emotional reactions are part of the new model of treatment for back pain. Taking a broader approach to this problem may lead us to new and improved treatment methods.

Progress has been made in the lab and in the clinic trying to find successful ways to treat back pain. Scientists say they haven’t made a lot of forward progress yet. But they have been able to figure out what doesn’t work.

First, inactivity and bed rest are not advised. Patients are strongly urged to rest for a day but then get back on your feet and moving. There doesn’t appear to be one individual treatment method that works best for all back pain patients. A wait-and-see/keep active approach is the first line of treatment.

If symptoms don’t resolve in 10-14 days, then it may be necessary to see a physician. A medical doctor can evaluate you and make sure there isn’t something more serious going on. Most of the time, the cause of back pain is multifactorial. This means the back pain is the result of many factors. They may be present at the same time or add up over time.

Several studies have supported the use of manipulation, massage, and acupuncture for long-standing back pain. Specific exercise called core training may be helpful. These exercises improve muscle tone and strength in the trunk (back and abdomen). They go a long way to support and stabilize the spine.

Since there’s been no work injury or trauma, you may want to consider other factors such as emotions, mental health, and overall general health. Your social situation can also be a contributing factor. Addressing each one of these with changes in behavior and lifestyle may be helpful as well.

Up to 95 percent of chronic lower back pain is never understood. Unfortunately, unlike a fracture or a ruptured appendix – for example – an injury to the lower back is most often not obvious and very difficult to pinpoint as to what exactly is causing the pain and what will help relieve it.

It is very discouraging to live with the pain and not know what to do about it. Have you looked into local pain clinics? They may be able to guide you through the process of pain control if you’ve not been able to reach that stage yet.

Referred pain is something that can occur in most parts of the body. A good example is if someone is having a heart attack. The pain can refer to the left arm, jaw, even the back.

With lower back pain, the injury can be around the waist level – for example – but the actual pain felt along the sciatic nerve and down the leg. This happens when the damaged part of the back presses on the nerve and the nerve relays the pain further down.

Chronic back pain is one of the most difficult issues to deal with because most often, there’s no identifiable cause.

Researchers have been trying to find ways to make up “models” that will help doctors understand the different steps that a patient may go through, and then be able to come up with a reasonable prediction of success. This is done in many medical fields.that a model has been impossible so far.

The problem is, however, patients with chronic back pain are so different in how they were hurt, the injuries, their progress and their own role in healing, that a model has been impossible so far.

There are many measurement tools in use around the United States. Two of the most common surveys are the 36-Item Short-Form Health Survey (SF-36) and the Oswestry Disability Index (ODI).

The SF-36 has eight scales that measure physical and mental functioning. It is not specific to neck or back pain patients. But it can be used with a wide variety of patients.

The ODI measures pain intensity; level of personal care; and travel, social, and sexual activity. It is specifically for low back pain patients but has been used by some health care professionals with neck pain patients as well.

Recently, a group of physical therapists from Canada investigated the use of a shorter version of the SF-36 with neck and back pain patients. They used the 12-item Short-Form Survey (SF-12). The SF-12 is a one-page, series of 12 total questions. It is easy to complete and doesn’t overburden the patient with paperwork.

It takes about two minutes (instead of 10 minutes with the SF-36) to complete. Best of all, it can be used with patients who have spinal disorders affecting both the neck and the low back.

It’s true that abnormalities of the sacroiliac joint (SIJ) don’t show up readily on radiographs. X-rays will show obvious signs of fracture and possibly bone tumors.

But computed tomography (CT) scans are the best way to detect early changes in the SIJ. There are several things the radiologist looks for on a CT scan to indicate SIJ degeneration. These include joint space narrowing, sclerosing (hardening) of the ligaments, and bone spurs or uneven joint surfaces.

Studies of normal adults without symptoms of SIJ problems often have signs of degeneration early in life. It appears that a great deal of force or load is transferred from the spine to the SIJ. The effect this has on people starts in their 20s and progresses through their 50s and 60s.

Sacroiliac (SI) joint dysfunction is common in adults even without a spinal fusion. As many as 40 per cent of the “normal” adult population have SI joint changes observed on CT scans.

Seventy-five per cent of patients with a lumbar (L45) or lumbosacral (L5S1) fusion develop degenerative changes in the SI joint. The reason for this response is probably related to the location of the sacrum at the bottom of the spine. It is a wedge-shaped bone that sits between the two bones of the pelvis.

The sacrum distributes force transferred to it from the upper body. It is able to withstand six times the amount of shear (side-to-side) force applied to the lumbar spine. But the SI is not as resistant to rotational forces. When the lumbar spine is fused, the shear and rotational forces on the SI joint increase dramatically. This is especially true for anyone who has had a L5S1 fusion.

Spinal stenosis (narrowing of the spinal canal) causing disabling back and/or leg pain is a common problem as we get older. Many degenerative changes occur in the spine creating this condition. When conservative care fails, a surgical procedure called laminectomy can be done.

During this operation, the surgeon removes bone that is pressing on the spinal nerves. The surgery is much less invasive today than it was even 10 years ago. Improved surgical technique and surgical instruments have improved outcomes with fewer complications.

But older adults do have an increased risk of complications and even death just based on age. And age often brings with it other health problems referred to as comorbidities.

Conditions such as hypertension, thyroid disease, and cancer are just a few of the comorbidities seniors face. Any of these problems can increase the risk of surgery. Having three or more comorbidities raises the risk of complications after spinal surgery.

Surgeons are well aware of these risks. The surgeon will carefully assess your mother to see if she is a good candidate for surgery. Age and comorbidities are two important factors to consider when deciding on the best treatment approach for spinal stenosis.

There has been some debate about the safety of this surgery in the older adult (especially over 85 years of age). You didn’t list your age, but here’s what we can tell you.

Many studies urge caution in choosing spinal surgery for older adults. The risk of complications and even death increase with each passing decade. For adults between 65 and 84, have a complication rate of almost 12 per cent.

That risk goes up even more if the person has three or more comorbidities. Comorbidities refers to the presence of other health problems. These can include heart or lung disease, thyroid dysfunction, and anemia or other blood disorders. The list is endless and most patients have at least one or two other health issues.

The biggest drawback in some patient’s minds is the risk of discharge to a nursing home or extended care facility. The odds of going home directly from the hospital are low in this group. The effects of age and comorbidities can work against you.

But the good news is that more and more people who are discharged to some type of institution (other than home) are going home later. Rehab and home health care are making this possible (not to mention the determination of this age group to get home).

When making your decision about surgery, talk with your surgeon about all of the potential risk factors. Ask him or her to review with you your own unique risks and the chances that you could have an adverse outcome.

Yes, studies do show that emergent surgery for cauda equina syndrome is appropriate and has better outcomes than delayed surgery. Compromise of the nerve roots can be permanent if prolonged.

Cauda equina syndrome, CES, is caused from compromise of lumbar and sacral nerve roots in the spine. It often is due to a herniated disc. The most common symptoms of CES include sensory loss in the saddle region and sometimes legs, and compromise of bladder, bowel, or sexual function. Other symptoms include weakness of the legs, and pain in the low back or legs.

It sounds like you may have a condition called spinal stenosis. Narrowing of the spinal canal puts pressure on the spinal cord causing characteristic low back and leg pain.

Extending the spine and walking make this problem worse. Bending forward and stopping activity seem to make it feel better. The leg pain or discomfort with walking is called intermittent claudication.

A laminectomy is the surgical removal of the lamina. The lamina is part of the bony ring of the vertebra that encircles the spinal cord. Removing the lamina can take the pressure of the spinal cord and reduce painful symptoms.

But 30 to 40 per cent of patients having a laminectomy still have back pain after the operation. Sometimes the pain goes away for a while, but then it comes back. It can be mild to severe.

Doctors think this is caused by the angle of the lumbar spine. A natural curve called lordosis usually exists in the low back area. Flattening of this curve may contribute to continued back pain. Loss of lumbar spine motion before surgery is also a predictor that residual back pain may be a problem post-operatively.

X-rays of the spine and preoperative testing of spinal motion may be helpful. The X-rays may be able to offer a clue as to whether or not you are in the group more likely to recover after decompressive laminectomy.

The lamina is the portion of bone along the back of the vertebrae that helps form a circle of bone around the spinal cord. This circle of bone is called the vertebral arch.

During a laminotomy, the neurosurgeon removes part of the lamina of the vertebral arch. Taking this piece of bone out takes pressure off the spinal cord. Complete removal of the lamina is called a laminectomy. If the spinal (facet) joint next to the lamina is removed, it’s called a facetectomy.

The foramen is a small opening for the spinal nerve. Once the spinal nerve leaves the spinal cord, it travels down to this opening in the bone. It passes through and goes down the trunk and/or leg.

A foraminotomy involves making the foramen larger or removing any tissue inside or around the natural opening. Bone, disc, scar tissue, or enlarged ligaments can compress the spinal nerve as it exits the spinal foramen.

These procedures are usually done with an arthroscope. The surgeon makes the smallest incision possible. The scope is used to give the surgeon a view inside and around the foramen. There are many variations to the operation. The surgeon decides how much bone (or other tissue) to remove based on what he or she finds at the time of the procedure.

Not necessarily. Movement at a fused site can create what looks like (and acts like) a joint. This is called a pseudoarthrosis or false joint. It’s unclear just what constitutes a pseudoarthrosis. Is it any amount of motion (one degree)? Two degrees of motion?

Some experts suggest more than five degrees of movement seen on side views of X-rays may be considered a fusion failure. But it’s difficult to tell how much motion is really present without an open incision. And most surgeons are not in favor of operative exploration to confirm a pseudoarthrosis.

Studies show that lumbar fusions often deteriorate over time. Long-term fusion is not always maintained. Up to 25 per cent of all cases eventually deteriorate. Patients may or may not be aware of any problems. They may not have any symptoms to alert them of a problem. Or they can suffer from back pain and loss of stability requiring additional surgery.

Your surgeon is the best one to advise you about your current status. Dynamic X-rays taken of the moving spine are often helpful in making the diagnosis. Short of doing exploratory surgery, it isn’t always possible to tell what’s going on at the fused site.

Chronic pain is a problem many people face every day. Back pain sufferers are among the most common chronic pain patients in the world. People with chronic back pain often experience an associated movement disorder. It is often overlooked and may account for the fact that the pain doesn’t go away no matter what you do.

Studies of low back pain have made some interesting new discoveries. For example, with low back pain, there’s more that’s affected than just the muscles. In addition to physical factors, there are psychologic, social, and emotional factors that must be considered.

From a strictly physiologic point of view, pain and fatigue can occur as a result of inefficient and/or dysfunctional movement. Muscles start to contract together at the same time in a pattern called cocontraction. The result is that the muscles experience a decrease in motion, force, and endurance.

Movement dysfunction and altered motor control can occur resulting in a pain-spasm cycle that just won’t quit. We don’t have a perfect answer yet, but we do know that addressing the motor control component of low back pain is helpful. Physical therapists are especially equipped to test for this problem. They can set up a program to help you overcome inefficient habitual movement patterns.

Lower back pain is incredibly common. In fact, it’s estimated that everyone in the United States will experience at least one episode of lower back pain at some point in their life.

According to statistics, the most common reasons for doctor visits are for colds and the flu, followed by back pain.

Acute back pain, what most people experience at some point in their life, is sudden and for a period of less than a month or so. Chronic back pain lasts for three months or more.

TENS stands for transcutaneous electrical nerve stimulation. TENS uses electrical impulses, applied to the skin around the area where the pain is located. The electrical currents stimulate the nerves but researchers aren’t quite sure how it relieves the pain.

Two theories are that the electrical stimulation of the nerves blocks the sensation of pain sensation or that the stimulation triggers the release of endorphins, the body’s natural painkillers.

Small electrodes are place over the area where the pain is and the machine is turned on. As the nerves are stimulated, you should feel a tingling feeling. Your doctor or the physiotherapist will determine how long the treatment should take place.

Minimally invasive surgery to decompress the nerve pressed by a herniated or protruding disc is state-of-the-art now. The procedure is called a microdiscectomy. The surgeon makes a tiny incision in the skin and places an endoscope through the soft tissues to the affected area.

The endoscope is a rigid tube with a tiny TV camera on the end. It allows the surgeon to see the area being operated on without making a wide, open incision. Special surgical tools can be passed down through the tube as well. These tools are used to ream out the foraminal space (where the nerve root passes through the bone).

In many cases, removing only the loose fragments or protruding disc material has replaced complete removal of the disc. But the remaining disc can re-herniate requiring a second operation.

This can happen in any patient of any age from months to years after the first discectomy. Recurrence can occur at any lumbar spinal level but L45 and L5-S1 are the areas affected most often. Studies show the recurrence rate varies between five and 18 per cent. The reported rates may depend on how long patients are followed up after the primary (first) operation.

There are blood vessels along the nerve root that pulse with each heart beat. For a successful nerve root decompression, the surgeon must be able to see the nerve root pulsing freely. That indicates the decompression has been complete.

This is important in decompression procedures for both disc herniation and for spinal stenosis (narrowing of the spinal canal or nerve root opening). Removing disc material pressing on the nerve root is the goal of nerve root decompression. Restoring blood flow to the area at the same time helps with the healing process.

In the case of spinal stenosis, interruption of blood supply is the major problem. In both cases, restoring free arterial blood flow is a good endpoint for decompression.