FAQ Category: Lumbar Spine

Valsalva’s maneuver occurs when you hold your breath and lift something or bear down like when straining to have a bowel movement. It’s an increase in the pressure inside the chest and abdomen. It also occurs when lifting heavy objects or anytime you cough or sneeze forcibly.

The maneuver causes trapping of blood in the large veins, keeping it from moving into the chest and heart. When the breath is let out, the pressure drops and the blood moves quickly through the heart. This increases the heart rate and blood pressure.

Most patients are advised to avoid this maneuver after any major surgery. It can bring about a heart attack in anyone with heart disease. It can rupture a weak blood vessel. It can also disrupt the spine in patients who have just had back surgery.

Your husband should follow any instructions given about lifting. Whenever lifting he should contract his abdominal muscles by pulling his belly button in toward his spine. He should not hold his breath. A good way to lift is to take a normal breath, pull the abdominals in, and let the breath out while lifting while keeping the abdominal muscles tight until the lift is done.

Lumbar facet syndrome is a term used to describe a pattern of pain. The patient usually has:

What is a “graded return to activity?” My doctor wrote this on my discharge instructions after back surgery. I’m sure someone explained it to me, but there’s a lot I don’t remember from that time in the hospital.

“Return to activity” seems clear enough–getting back to your daily activities at home, school, or work. Graded simply means you increase what you do a little at a time every
day. How much you do, depends on how strong you feel, how much energy you have, or how much pain free movement is present.

Sometimes you won’t know you did too much until the next day. Then a painful flare-up can put you back where you started. That’s why it’s best to start slowly and add gradually, testing new limits each day.

More is known today than ever before about low back pain. Studies show over and over that not all back pain is physical. There’s a strong psychologic, behavioral, and social side to back pain.

The most common type of acute low back pain is called mechanical back pain. This means the moving parts are inflamed or involved but there’s no known disease or visible change in the tissue. Movement and staying active are the best way to treat this type of back pain.

Back pain from a disc problem may increase with certain activities and exercise. A general guide is called centralization of pain. This means the pain increases in the low back area but doesn’t go into the buttocks or down the leg. The activity or movement may cause increased pain but no further damage is done to the disc area.

Many studies show that acute back pain will go away in time without specific treatment. Staying active during the healing phase is most important. If the therapist can help you gain a sense of control over your pain then you’ll be more likely to keep active.

Most PT programs for back pain are designed for each individual. The choice of treatment is usually up to the therapist. It’s always a good idea to ask your PT to explain the program you’re following. If you understand why you’re doing what you’re doing, you’ll likely stick with it longer.

It’s true the longer we live the more likely we’ll suffer from a degenerative condition in the spine. Spinal fusion has become a very popular way to treat the problem. Medicare reports a 57 percent increase in the number of enrollees who have had this operation in the last 10 years.

Spinal fusion accounts for 30 percent of all operations done on the spine. This is up from 23 percent 10 years ago.

Not everyone with back pain can benefit from a spinal fusion. And studies show about a 50 percent failure rate. The most common problem is increased motion at the next spinal segment. Ongoing research is underway to find a way to prevent this from happening.

There may be other ways to treat your back condition before surgery. See your doctor soon for an evaluation and find out what are your options.

Spinal fusion has become a very popular way to treat spinal instability. Bone graft material and/or rods and screws are used to hold two vertebral bones together. The fusion keeps them from moving and stops the pain and disability.

The problem with this treatment is that the segments above and below the fusion are subjected to increased loads and stresses. Then they start to degenerate and become unstable.

Even if you have the L45 level fused, there is still motion where the last vertebra (L5) meets the sacrum (S1) and at the level above (L34). A study was done at the Oregon Health & Science University in Portland, Oregon to compare an L45 fusion with an L4S1 fusion.

They found overall spinal stiffness increased more for the L4S1 fusion compared to the L45 fusion. It could be that extending the fusion down to S1 is the answer. This was the first study done using cadaver spines. More studies will be needed before fusion extension is done routinely. Still, it’s worth asking your doctor this question. Perhaps it will be a good option for you.

Adjacent means “next to” and degeneration refers to a breaking down process. It sounds like your mother had a spinal fusion (two bones held together to prevent motion).

Adjacent segment degeneration (ASD) is a common problem after spinal fusion. The vertebrae on either side of the fusion can become unstable. Increased motion at these levels causes even more break down of the nearby segments. Adjacent segment degeneration
is the number one cause of spinal fusion failure.

This problem presents itself in many different ways. The vertebrae might slip forward closing off the space for the spinal nerves. This is called stenosis. The discs in
between the vertebral bones can start to break down. The facet joints in the spine are damaged. The vertebral bones can even break.

Up to 50 percent of all patients with lumbar fusion show X-ray changes linked to ASD. Not everyone with X-ray signs of ASD have problems. They may still be able to function fully. But many patients end up having a second operation when pain and disability occur.

Not at all. The demands put on the body during tennis can cause a wide range of injuries including low back, arm, and leg problems. Surprisingly, more nontennis players suffer from “tennis elbow” than actual tennis players. Tennis elbow can occur in anyone using the hand and forearm in a repetitive action.

Back injuries are far more common affecting up to half of all elite tennis players. Elite means the player is either a ranked player or plays in tournaments at the college or
professional level. The number of back injuries may be different for players in adult tennis leagues. No studies have been reported on this group.

Researchers are starting to look for reasons for these injuries. They hope to find ways to prevent back problems. Studies measuring the strength of trunk muscles in 27,000 normal, uninjured subjects (ages 10 to 79) report equal strength from side to side. Future studies will take the same measurements in injured tennis players and compare them. This may give us some ideas for preventing back injuries in this sport.

There are four measures used by many researchers when studying back pain. In fact these are considered the most important ones:

The very first “back school” was started in Sweden in 1969. The goal was to reduce pain and keep back pain from coming back.

Today there are many different back schools around the United States and even the world. Each group may be slightly different. Most include information on lifting, posture, and work efficiency. Back exercises and core training are usually a part of the program.

There are usually groups of patients who go through the back school together. A physical therapist supervises the activities and exercises. Groups meet once a week for one or two hours for six to eight weeks.

It might be helpful to know why your orthopedic surgeon doesn’t think the artificial disc replacement (ADR) would work for you. There have been enough studies done now to show some patients have risk factors that put them at risk for a poor result. You may be one of these patients.

For example congenital defects of the vertebral bones may make an ADR impossible to get in place. Researchers report the presurgical evaluation is the most critical factor for a successful result.

The condition of your bones as well as your overall health are also important factors. Severe osteoporosis may result in fracture as a complication. This could compromise the success of an ADR.

These are just a few examples of the possibilities. You really should find out more from your surgeon before making a final decision.

Probably not. Using X-rays, MRIs, and a special imaging study called fluoroscopy researchers have shown there are no changes in the height of discs directly above or below the implant.

Loosening of the implant, dislocations, or sinking into the bone can actually decrease the height of the replaced disc. Let’s hope you don’t run into any of those problems.

Adults have a high lifetime risk (80 percent) of having at least one episode of back pain. This figure is reportedly less in children and adolescents.

Increasing episodes of back pain in groups ages 14 to 18 years old have been reported around the world. Very little is known about back pain between ages 14 to 18 and young adulthood.

It appears that the rates of back pain are doubling in this age group. Doctors are concerned because a previous history of back pain is a risk factor for future episodes of back pain.

Studies seem to show that the major factors are psychosocial not physical. Emotional and conduct problems are strongly linked with low back pain in this age group.

Nurses seem to have a high prevalence of back pain and disability. Understandably, employers want to avoid having to pay mega-dollars for back care for so many of their workers.

Studies clearly show that a previous history of back pain is a risk factor for future episodes of back problems. A recent study of nursing students and nurses from Finland shows a direct link between nursing students with back pain (before they ever treated patients) and future disability from back pain.

Pre-employment screening is to protect the hiring agency before a problem develops. Pre-nursing school screening may be next.

Studies of back pain and occupational health have been done. One from the Institute of Occupational Health in Finland just looked at nursing students.

They followed 174 nursing students from the start of their nursing program through the first five years of their nursing career. They found a high number of nurses with back pain right from the start (before going to school).

The number of nursing students with back pain went up dramatically in the first year of school. About 30 percent of the nursing students reported back pain before starting school. At the end of nursing school this had jumped up to 72 percent. There was a slow but steady climb after that from 72 to 82 percent after five years as a nurse.

Back pain before starting nursing school is a risk factor for back pain and disability later.

A recent study of long-term outcomes after durotomies has been reported. Patients were followed for up to 10 years. The results of their surgeries were compared to an equal number of patients who didn’t have a dural tear.

The overall outcome was poor for those patients with the durotomy. They had all the same symptoms you’re reporting. They were limited in their daily activities. Some had to change jobs or even retire early because the pain kept them from doing functional activities.

There’s no question from a medical point of view that the operation is required if there’s a leak of the cerebrospinal fluid. However you may or may not have relief of your symptoms.

According to a recent study at Yale University, most patients report significant improvement by three months. They had less pain and more function. Some also reported decrease use of pain relievers as a positive result in the first three months.

Problems can occur after any surgery and disc replacement is no exception. Bone fracture, infection, or subsidence can occur. Subsidence is the sinking down of the implant into the bone.

If all goes well patients are completely satisfied with the results. Disc replacement instead of spinal fusion gives the patient motion and function. It also preserves the motion and function at the levels above and below the level of the implant.

The covering around the spinal cord (and brain) is called the dural sac. Dural tears during spinal surgery are fairly common. Studies report a range from one to 17 percent. A recent study in Germany of over 1,200 patients placed this figure at around three percent.

Most dural tears are repaired at the time of the original surgery. They are either stitched together or patched. Sometimes the tear isn’t visible and is diagnosed later on the basis of patient symptoms.

The covering around the spinal cord is called the dural sac. Dural tears are more common when there is scar tissue from a previous surgery.

The risk of dural tears also goes up when the surgery is complex or requires going back in to the same place surgery was done before.

Your husband may have some symptoms from the dural tear. Headaches, dizziness, and nausea are the first signs. Back and leg pain are also common with this problem.

The patient may have some continued symptoms and problems from the dural tear long after healing takes place. Researchers aren’t sure why this happens. It may be the way the tear is repaired. More studies are needed to help prevent long-term problems.