FAQ Category: Lumbar Spine

There isn’t a test or special sign to predict back pain during childhood. Researchers have noticed a link between children and teens with asthma, headaches, and back pain. They think these conditions may all occur in children who are more frail and less robust in their overall health. This suggests a possible genetic basis, but it remains unknown what that is just yet.

Studies do show a rise in back pain as we age. In other words, the older we get the more likely we are to have low back pain. It’s also true that females of all ages are more likely to have low back pain than males. Perhaps there is a hormonal link as well.

You’re right. Studies have shown over and over that back pain is more common the older we get. Some of this is the result of aging, spine degeneration, and the arthritis that comes with both. But other studies also show that teenagers and young adults have a fair amount of back problems.

Between 30 and 40 percent of people under 25 years of age report mild back pain. Almost 90 percent of this group has more back pain later in life. The peak years seem to be around ages 40 to 50 and again between ages 70 and 80.

Finding ways to prevent back injury and pain is the focus of many studies right now. Keeping active, stopping smoking, and maintaining good balance and coordination seem to be the key tools in this effort.

Many parents struggle with offering the best advice to young adults. Common sense is often a good guide but in this case there are good arguments on both sides.

A recent study of university students reported an increase in back pain for students who were active but gave up their sport or activity at college. Many other studies show the benefits of regular exercise and activity for mood, sleep, and general health. These findings hold true for all ages from teens to older adults.

Finding ways to balance studies with activities is a key to success. Encourage your daughter to find the right blend that works for her without giving up one or the other.

Many studies have been done around the world to identify the rate of low back pain (LBP) among young adults. These same studies also looked for risk factors and ways to reduce LBP. It seems the following are possible factors:

It’s likely there’s a loss of blood supply to the foot on that side. This could be a vascular (blood vessel) problem. It could be caused by blockage of the blood vessels in the calf just above the foot. Atherosclerosis plaques and/or blood clots are the most common vascular causes of temperature and color changes in the foot.

Another possible cause of these symptoms is a tumor pressing on the spinal nerve to the foot. No matter what is causing this problem, a visit to the doctor is in order. Loss of blood supply to the foot can cause major problems. The earlier the problem is diagnosed, the better the results. If he has a primary care physician, call the doctor’s office right away. If he doesn’t have a doctor then call the emergency department, explain what’s happening, and follow their directions.

Your wife may have had anterior lumbar surgery (ALS). In this operation, the vascular surgeon goes through the front of the body to the spine. This avoids a posterior approach (from the back) and prevents damage to the spinal cord.

The ALS does put blood vessels at risk for compression and accidental cuts. Blood clots and bleeding can occur as a result. The vascular surgeon is an expert in moving the blood vessels out of the way without damaging them.

When problems occur during the operation, the vascular surgeon works with the spine doctor to treat the patient quickly and safely. Delays can result in serious long-term problems.

Any operation has the risk of complications. There can be blood loss, infection, poor wound healing, and even death. Most of these problems never happen. The most common risk with anterior lumbar surgery (ALS) is blood vessel compression, tears, or accidental cuts.

A recent study of 1,310 patients reported a low (less than two percent) rate of blood vessel injury. Most of these problems were seen and treated right away. Women having a lumbar fusion at L45 seemed to be at greatest risk for these types of problems.

Overall the operation is considered quite safe in the hands of a good vascular surgeon.

Good question. Strictly speaking, the answer is “no.” But in the big picture, scientists have to start somewhere. Using normal, healthy, young adults who have no history of injury or illness gives an idea of what is “normal.” The norm can be used to compare results to all others.

In order to use this information from normal adults to plan exercise programs, further studies are done. The researchers will need to repeat the same exercise program on different age groups. The response of different joints will also be studied. Then finally, groups with various diseases, illnesses, or injuries form the subjects of final studies.

Often useful information is collected studying a normal adult, good information that transfers well to other “less well” individuals.

This question is a chicken and egg question: which came first? We simply don’t know. Studies show an equal number of back injuries in wrestlers with and without X-ray findings.

According to a new study, it’s likely that muscle weakness is the real cause of back injuries, back pain, and disability among wrestlers. Strong trunk extensor muscles are needed to tackle, lift, and throw the other wrestler. Any weakness in this area can lead to back pain and back injury.

Specific studies by age haven’t been done yet to show what, if any, differences occur in younger versus older wrestlers.

Wrestling is a high-risk contact sport. Points are earned based on how the wrestler pins his opponent. More points are given for difficult moves. The more difficult moves like the lift or the tackle have a greater chance for injury.

There are no statistics for injuries in young wrestlers. Adult wrestlers have about the same amount of back injuries as weight lifters, gymnasts, and soccer players. High school wrestlers practice regularly, even daily for weeks at a time before and during wrestling season. Training is important, but overtraining adds risk.

The best approach is to talk with the coaching staff about your concerns. Or better yet, go to a few practices and see for yourself. A good coach includes warm-ups, stretching, strengthening, and balance exercises. Safety should be stressed at every practice.

A common fusion method used to hold the vertebrae together from the outside uses two things: (1) bone chips from the hip and (2) metal screws and plates. Research has come up with interbody fusion as a new way to fuse the bones together from the inside out.

A special sponge with bone growth protein is put inside a titanium cage. The cage is placed between the vertebrae where the disc used to be. Bone cells start to grow and fill in and around the cage.

The advantages of the interbody fusion are:

The FDA has approved the use of rhBMP-2 for spinal fusion surgery. These initials stand for recombinant human bone morphogenetic protein. This is a genetically produced biologic protein. It can cause the body to grow its own bone where needed. This new way
to do spinal fusions is less invasive and less painful. Patients also have a quicker recovery time.

Studies show that patients who are implanted with rhBMP-2 are able to get good spinal fusion even without the use of metal implants (rods and screws). These patients have shorter surgical time, less blood loss, and less pain after the operation.

Right now this method is being used for patients with degenerative disc disease, arthritis of the spine, instability of the spine, and spondylolisthesis. The protein comes in a powder form. It’s combined with saline and put on a tiny sponge. The spone is put inside a special cage inserted between two vertebrae in place of a damaged disc.

Cells that come in contact with the protein start to grow bone cells. After a short time the bone grows through the sponge and around parts of the cage. This is what fuses the vertebrae together.

The McKenzie Method is a way to treat neck and back pain from a mechanical cause. Mechanical means it’s not caused by cancer or some other disease. It’s more likely from a shift in the proper joint position, a problem with the disc, or damage to some other soft tissue structure.

The McKenzie Method works for many patients. You’ll need a physical therapist trained in this method to examine your back. Special tests and measures are taken before a specific program of movement and exercise can be prescribed.

The patient does these movements many times during the day. In many cases, it takes less than a minute. The idea is to find out what forces are causing tissue damage or injury and then remove those forces. Normal tissue healing takes place once the irritating forces have been removed.

The McKenzie program may be just what you need. First find out if you’re a good candidate. Then be willing to invest a small amount of time in your own back care.

The cause of back pain in many patients is unknown. Even with many tests and many opinions, it can remain a mystery. That’s why you can see five trained professionals and get five different answers.

Most diseases and illnesses are treated on the basis of what’s causing them. Back pain is more often treated based on the patient’s signs and symptoms. Each health care worker views those symptoms through a bias based on his or her own training.

It’s more than likely that all the opinions help piece together the whole picture.

It sounds like you already know what will be done in the study. If that’s not true, make a phone call and find out exactly what’s expected. Mention your concern and see what they say.

Researchers examining patients with low back pain report that repeated exams don’t increase patients’ pain. It seems that back pain is not as variable or changeable as we used to think.

Some scientists think the benefits of noninvasive research of this type outweigh any risks to the patient. They base this view on results of many studies already done. Some volunteers may have to drop out of the study because of increased pain or symptoms. The chances of this happening are very low and often can’t be predicted ahead of time.

You may be having signs of disc protrusion. The discs are located in between the vertebral bones of the spine.

Coughing and sneezing increases pressure in the disc. If it has already pushed out of its normal space, this increased pressure may be enough to press on the nearby spinal nerve causing your back and leg pain.

It might be best to see your doctor about this problem, especially if this is a new symptom for you. Early diagnosis and treatment of disc problems can prevent chronic pain and disability later.

The discs between the vertebrae of the spine are soft and act like a cushion for loads through the spine. The disc is sensitive to how much load it carries and for how long. Over time under a constant load, the disc loses water. This loss of water causes the disc to lose height. The disc flattens in an outward direction. These changes are called creep behavior.

Normal discs creep slowly. Studies show that higher loads produce faster rates of creep. Older discs start to degenerate. Damaged or degenerated discs creep faster than healthy discs in young people. There’s some research to show the contraction of fibers around the disc, not water loss or fluid flow, is the real cause of creep.

The disc regains its full size and normal shape when the load is removed. Research centered on what makes the discs creep less may help us find ways to prevent disc problems.

Studies show that overweight people have surgery for orthopedic problems more often than normal weight folks. Many things increase the risk for disc herniation. Most of these are
under our control. The top three of these include:

Spinal instability can mean different things to different doctors. There isn’t complete agreement on one single definition. Some doctors use patients’ symptoms as a measure of spinal instability. Painful “catching” during movement, blocked movement, or just persistent pain over time can point to an unstable spine.

Others doctors take X-rays and look for too much slipping or tilting of the vertebrae during movement. If you talk to physical therapists and other exercise specialists, spinal instability is defined in terms of muscle control. Poor posture and weak core trunk and abdominal muscles lead to an unstable spine.

A recent study in Japan used side (sagittal) views of X-rays to measure two things. The measured how much the bones slip or move forward and back while the patient was bending and extending. This is called translation. They also looked at how much the vertebrae angle or tip forward and back during the same motion (angulation).

Then they compared these two measures with patient symptoms. They found that symptoms are worse when there’s too much translation. Too much angulation by itself doesn’t seem to make a difference. Too much of both movements is linked with chronic low back pain from instability.

Ask your doctor for his or her definition of instability to get a better understanding of your own case.

Dynamic X-rays show movement in the spine. These can be done while bending forward then again while bending backward. Some are compared from sitting to standing. The idea is to see how much the bones move, tilt, slip, or slide during motion. Too much movement can mean the spine is unstable.

There are new MRI scanners now that can measure spinal movement while bending forward, back, and sideways. Sit-to-stand views can also be taken. Looking at the limits of spinal motion helps the doctor find areas where abnormal motion exists. Pinpointing the problem can help direct treatment more specifically.