FAQ Category: Lumbar Spine

Because there is much variance in the way one researcher describes and documents low back pain regardless of which country they are in, it is very difficult to compare one study with another.

In most young people who are healthy, there usually are no physical restrictions within weeks following microdiscectomy surgery. This is particularly true when the microdiscectomy is done at L5-S1, when the pain is largely in the leg, and the disc is extruded.

Studies have found that those who smoked had poorer satisfaction and outcomes following surgery.

Back injuries and chronic back pain may cause hardship for the many people who live with it. Back pain can keep people from working in their usual jobs and if they do go to work, they may not be able to perform as they did before their injury.

In terms of helping your back feel better, only your doctor can help you and guide you through the treatment process as much of it depends on the back injury itself and what you can and cannot do because of it.

It is well-known that back injuries cost our society so there is more awareness among the medical community about this cost. Discuss this with your doctor to see what you can do to help yourself.

Many studies have been done and are ongoing for back injury and chronic back pain. These studies are so prevalent because back injuries are becoming increasingly common in our society. However, many treatments for back injuries do not work for all or some may work, but not for long periods of time.

The goal of the research is to find the optimal, or best, types of treatment depending on the back injury. Unfortunately, much of this requires trial and error, so what may seem like a promising treatment, may end up not being helpful after all.

There are many treatments and therapies that have been developed for the treatment of back pain. They range from lifestyle modifications to surgery, with many options in between. Some treatments are done by doctors, others by other healthcare professionals.

Because of the wide variety of treatments available, it’s important to discuss with your doctor the type of approach you would like to take. This discussion with your physician is important because some types of treatments cannot be done for certain types of injuries. Before choosing what you can do, you need to know what you can’t do.

For some patients, it takes trying different types of treatments and sometimes a combination of treatments before relief is found, so it is important not to give up.

Exercise is, in general, a good idea. However, if someone has chronic lower back pain, exercise should always be cleared with your doctor or physiotherapist first. Depending on the type of injury that is causing your pain, certain exercises could worsen the pain.

As for buying equipment, many exercises you can do to strengthen your body do not need expensive equipment. If you haven’t seen a physiotherapist, ask your doctor if you should. He or she could advise you on different techniques to help your back pain and prevent recurrences.

Only you can decide whether to see a chiropractor to help you with your lower back pain. However, if you do want to see one, you want to be sure you are seeing a licensed professional and that your particular back problem is one that will not be made worse by spinal manipulation.

Patients who have certain back problems are generally not considered to be good candidates for spinal manipulation. They include people with: cancer, an infection, spondyloarthritis, some neurological (nerve) disorders, fever, unrelenting night pain or pain at rest, pain with below knee numbness or weakness, leg weakness, loss of bowel or bladder control, direct trauma to the back, or unexplained weight loss.

The chiropractor should give you a thorough examination, including x-rays, before attempting any manipulation. If you feel comfortable with chiropractic and you don’t have a physical reason why you should not have it, then it is your decision as to whether to go with it.

Your doctor is the only one who can answer that question so it’s important that you tell him/her that you had this pain. Your doctor can then evaluate if it would be a good idea to continue the massages.

That being said, it’s not unusual for there to be some soreness after a massage because of the manipulation of the muscles and the pressure on certain points on your back. This should also be discussed with the massage therapist who did the treatment.

Only your doctor can advise you when you have reached the end of what medical therapy can offer you. Much depends on how your back pain began, what caused it, and why you continue to have it.

However, you don’t have to stop your medical treatment to take advantage of psychological counseling. In fact, the two work well together. By following a cognitive behavior program, for example, you could learn how to better manage your pain, which may, in turn, make the physical treatments more successful.

Although we can’t tell what non-addicting medications you have been prescribed, often pain relievers are either medications like acetameniphen (Tylenol), ibuprofen (Advil), or Aspirin. These are nonsteroidal anti-inflammatory drugs (NSAIDs).

Medications like morphine fall into the opioid or narcotic category, which can be addictive.

NSAIDs act on pain by reducing swelling at the site of the pain so the pain will be relieved. Opioids, on the other hand, interrupt how your brain receives the pain signals. If the medication is working, your brain will not feel the pain signals as they are sent from the injury to the brain.

As with any surgical procedure, there is always a certain amount of risk for adverse events. Infection, excess blood loss, poor wound healing, or delayed recovery can occur. On the more serious side, complications can include blood clots causing heart attack, stroke, or even death.

Studies also report major neurological effects. Burning leg pain, loss of strength and motor function, and nerve root injuries can leave patients with long-term, disabling results. In a small number of men having spinal surgery, retrograde ejaculation is always possible. In this condition, sperm is no longer released from the penis but moves back up the urethra toward the bladder instead.

There may be problems with the implant itself. Sometimes the device sinks down into the bone. This condition is called subsidence. The implant may also move or migrate. Either of these problems can change the disc height and load-bearing surface of the implant. Reoperation may be needed to correct the problem.

There is always a concern about adjacent-level disease. The hope is that disc replacement will reduce this common effect after spinal fusion. But there are a small number of cases of adjacent-level disease reported even with disc replacement.

Overall, disc replacement is reported to be a safe and effective way to correct pain and disability in patients with mild to moderate degenerative disc disease. The risk of adverse events is between 0.5 and 12 per cent depending on type of complication. Surgeon experience and technique contribute to some of these problems. Implant design may also be a factor. Research is ongoing to improve results and reduce problems with the various types of devices available.

Artificial disc replacements (ADRs) are still under investigational study. This means the FDA has approved their use but controlled, clinical studies are ongoing. As many as 14 investigational sites across the United States are involved in the FDA Investigational Device Exemption (IDE) studies.

Patients are selected carefully to ensure success. Only a small percentage of patients are actually eligible for an ADR at this time. Patients must be skeletally mature without evidence of osteoporosis (brittle bones). This usually restricts their use to patients between the ages of 18 and 60. Patients with severe degenerative disc disease are usually excluded at this time.

Older adults with serious health conditions who might be at risk of adverse events (including death) are not included. But whether or not age by itself should be a limiting factor was recently studied. Researchers from the Texas Back Institute compared adults 45 years and older to adults younger than 45. Each patient received a single-level ADR in the lumbar spine.

The results were measured based on levels of pain and function, range of motion, and patient satisfaction. Age was not a key factor in the results. Total disc replacement relieved pain and decreased disability in both age groups. Patients recovered at about the same pace no matter what age they were.

Patients will still be screened carefully but in the future, the acceptable age for ADRs may be extended for older adults. In other words, age may not keep older adults from benefitting by this treatment approach to relieve pain and preserve motion. Anyone with early signs of osteoporosis (called osteopenia) or known osteoporosis may not qualify at any age.

Patient selection for artificial disc replacement (ADR) is somewhat restrictive. Studies have shown that choosing the right patient can make the difference between success and failure. But studies are also ongoing to find out what factors are really important. Most recently, it was discovered that age might not be as important as was once thought.

And another study was done comparing patients who had a previous back surgery with those who had not. The previous surgeries included discectomy, facetectomy, and laminectomy. Using measures that included pain, function, return to work, and patient satisfaction, there were no differences between the two groups.

There was a slight tendency for patients who had not had any prior spine surgeries for faster healing. But the final results measured at the end of two years showed no difference. Some patients were not satisfied with the results of surgery but it was not based on clinical outcomes.

Although this one study suggested that patients who’ve had a prior back surgery could still benefit from a single-level ADR, it may be a while before the selection criteria changes. More studies are needed to verify these results. Many of the studies around ADRs remain investigational. That means patients are treated in large hospitals where the research is taking place. These operations are not available everywhere yet.

Studies have shown that mood disorders such as depression, and history of traumatic events in one’s life, can increase the likelihood that pain and disability can become chronic. Psychological treatment may need to be considered if this is the case.

According to the new low back pain treatment guidelines, spinal manipulation has a fair level of evidence with small to moderate benefit for acute low back pain, good level of evidence with moderate benefit for sub-acute and chronic low back pain.

Effective health care is still a very inexact science. Sometimes it is more art than science. And when it comes to chronic low back pain (LBP), we just don’t always have the answers.

There is a curious phenomenon that has been noted over and over. People with no back pain whatsoever can have X-rays and MRIs or CT scans that look like they should have problems. And some patients with severe, constant LBP can have perfectly normal looking imaging results.

No one really knows how to interpret this information. Except to say that either way (changes or no changes) imaging studies alone cannot be relied upon to make a diagnosis.

More and more, we are moving from a biomedical model to a biopsychosocial model of health care for patients with chronic LBP of unknown cause. The biomedical model focuses on the patient’s signs and symptoms. It was assumed that there was some disease or pathology present. Treatment was directed toward this disease process.

Over time it became clear that this model didn’t bring about the desired results. The pain persisted and without a known cause. Then in 1977, the biopsychosocial model was put forth. Instead of looking at mechanical and pathologic changes, it was suggested to pay attention to the patient’s social and psychologic factors.

Now, 30 years later, there still isn’t strong evidence of lasting effects on chronic LBP using this approach. Sorting out each patient’s unique factors can take time and many visits to multiple health care professionals.

Surgery is usually a last resort because there isn’t enough evidence that this approach works well enough to subject the patient to the trauma and expense. Your success in finding the right treatment for you is cause for celebration!

This is a very good question and one that is being reviewed by others as well. After 30 years of following the biopsychosocial model in managing chronic low back pain (LBP), many health care professionals are asking similar questions.

What kind of treatment is best for the patient who is depressed and has poor coping skills? Is it the same as for the worker whose case is in litigation with worker’s compensation?

Do the treatment results depend on recognizing and addressing these kinds of factors? And if any of these patients responds well to surgery, what does that suggest?

One must keep in mind there are three parts to this model: bio, psycho, and social. The bio or biologic part still refers to the spine, discs, soft tissues, muscles, and other involved body parts.

It’s possible surgery works because there really was a pathologic cause of the back pain. And it’s also possible the surgery had a placebo effect. This means the patient thought it would help and it did.

Perhaps some patients (for whatever reasons) respond to treatment directed at the biologic aspects. Others have a good outcome when the social stressors in their lives are dealt with. While others improve when psychologic factors are identified and addressed.

This is the question many scientists are trying to find answers to. Studies are underway with each type of device. There aren’t direct studies comparing outcomes based on whether the implant is metal or plastic.

However, overall results of implants are reported and some differences can be seen. These may or may not be based on the material make-up of the implant. Time and further study will tell.

For now, we know that results have improved for all implants from the very first one used. Advances have been made in the materials and in the design. At first there were problems with fractures of the implants. Sometimes they would sink down into the bone too far. Infection and loosening of the implant were also early problems.

Complications of this type occur much less often now. Movement of the prosthesis (implant) called migration is rare. Dislocation of the implant, more common in the early days, is also rare.

The metal-on-metal implants may reduce wear and creep that occur with the polyethylene (plastic) implants. Creep refers to the tendency of the implant to slowly move or deform to relieve stress or load.

But metal implants are more likely to cause tiny particles of metal debris to flake off. The debris can gather in crevices of the implant and cause problems with motion. Or these flecks may cause injury to the soft tissues in the area. Release of the metal debris is small but can still cause inflammation and toxicity.

The choice of implant used may be dependent on the surgeon’s experience with the procedure. There are pros and cons with each one. Ask your surgeon to review these with you and guide you in your decision-making process.

Degenerative disc disease (DDD) is a common cause of low back pain in adults. The condition can occur anytime from early adulthood through middle age. Some older adults are also affected.

It is an aging-related condition. The number of healthy, intact cells in the disc starts to decline as we get older. The amount of water in the disc also decreases. The outer covering of the disc, called the annulus may start to dry out, crack, and form fissures.

The inner portion of the disc, called the nucleus also becomes more fibrotic (hard or scarred). The normal pattern of collagen tissue in both sections of the disc starts to degenerate and lose its sense of tight organization. The result is even more cracks and fissures.

The disc starts to flatten. This flattening causes a smaller disc space. With a narrower disc space, pressure is put on the spinal nerves leaving the area. Back and/or leg pain can develop requiring treatment.

But not everyone develops symptomatic DDD. Scientists aren’t sure why this happens. Two people can have the same amount of change in the discs and spine with very different symptoms. One person may not even have any symptoms, while the other is in severe pain.

We don’t know yet how to predict who will be affected, who will need treatment, and what the best approach is to take in treatment. Specific steps to prevent DDD are also unknown at this time.