FAQ Category: Lumbar Spine

The best way to answer this question is to see a medical doctor for an exam. You may need blood tests and/or X-rays to rule out a serious cause of back pain.

The doctor will also review your medical history, any medications you’re taking, and look for signs of a medical problem. You didn’t mention your age. The risk of something like cancer, infection, or fracture increase with age. A previous history of cancer is also a red flag.

Sometimes all that’s needed is a short course of conservative care like physical therapy. But if you get worse with this type of treatment then the doctor must recheck you.

A history of cancer does increase your risk for cancer recurrence. But before you jump to any conclusions, you’re right to ask about some tests.

One blood test called the sed rate or ESR is helpful. The ESR measures how far red blood cells fall after one hour in a column of blood. The test can point to cancer or inflammatory conditions.

Another test can be done to look at an enzyme called alkaline phosphatase. Increased amounts of this enzyme are found in the liver, gall bladder, intestines, and bone tissue with liver or bone disease.

Finally, a simple X-ray may be helpful. Changes in the bone don’t always show up on X-ray with early cancer metastases. A bone scan may be needed.

Don’t delay in getting a medical opinion. Early detection is still the key to the best results.

Disc space height (DSH) may be genetic but it hasn’t been proved or disproved. It does appear that patients in the tall disc group are younger males. They are more likely to have a higher body mass index (BMI). They are more often involved in work-related injuries compared to people with collapsed DSH.

Several studies have been done measuring disc spaces. Some researchers think this measurement can be used to predict the results of spinal fusion surgery.

INFUSE® Bone Graft is a bone graft substitute made from human protein. It is applied to an absorbable collagen sponge carrier. INFUSE has been shown to promote fusion after ALIF. Studies also show shorter operative times and less blood loss with INFUSE.

There are two main advantages to the INFUSE bone graft. By not being your own donor you avoid having a second surgical incision. Since bone won’t be taken from your pelvis you also won’t have the pain and recovery associated with a donor site.

Maybe. According to a recent study from Stanford University, psychosocial factors do impact the outcome of spinal fusion. In fact there are many other studies that show psychosocial factors significantly affect the results of various therapies.

Most surgeons suggest at least six months of conservative care before advising surgery. If your mother hasn’t tried some of these other treatment options, she might want to look into one or two. Antiinflammatory drugs, acupuncture, physical therapy, and exercise are just a few of the possible treatment choices.

There are several surveys used to measure physical and mental function before and after medical treatment. One in common use is called the SF-36 Short Form.

This survey has eight areas to assess health. These areas include how patients view their general health, physical function, and mental health. Pain, quality of life, and social function are also measured.

A recent study of 57 patients with single-level spinal fusion was reported. All had chronic disc-related back pain. Results of the SF-36 showed a definite link between mental status before surgery and results after. The SF-36 might be considered a good way to predict outcome based on mental status.

Researchers have used the Minnesota Multiphasic Personality Inventory (MMPI) to predict the results of back surgery. This test takes several hours to complete compared to 20 minutes for the SF-36.

Talk to your doctor about your interest in this area. A referral to a psychologist or social worker may be a good idea for you.

Pain and its mechanisms are very complex events. It’s not fully understood by the most knowledgeable researchers.

We do know that tissue damage causes the release of many inflammatory cells. The result is to get receptors going that pick up painful messages in the area of injury. The more receptors that get fired up, the quicker pain is felt.

Not only that, but the tissues are actually sensitive to psychosocial factors. Feelings of helplessness and loss of control are linked with increased pain. Injury and pain in a local area actually results in a global response. In other words, the person feels pain in other areas of the body far away from the spine with much less pressure or provocation compared to someone with no injury.

Many scientists are studying the process of pain. So far we seem to have more questions than answers in this area.

The pedicle screw is sometimes used in spinal fusion surgery to give an anchor point for connecting rods. The screws are placed at two or three places along the spine and then a short rod connects the screws. The rod and screws prevent motion at the spinal segments that are being fused.

The screws and rods are no longer needed for stability when the fusion is complete. The screws can be taken out but most surgeons don’t advise this unless there is pain or discomfort.

Sometimes the screw breaks off and moves inside the body. In such cases, removal may be a good idea because there is a danger of damage to nearby blood vessels and nerves.

Doctors usually order imaging tests done to show the location of the loose screw. It may not need to be removed and removal would be an unnecessary surgery.

Disc replacements are very new and still in the experimental phase. Disc replacement in the lumbar spine (low back) is possible but it’s not being used for spondylolisthesis yet. There is still concern that whatever is causing the vertebral slippage won’t be corrected by a disc implant.

It’s possible the force of the vertebral movement and load on the spinal joints could loosen the disc implant. There’s also some question about how well the implant and nearby bone would hold up.

Long-term results for use of the disc replacement in cases of disc degeneration are unknown. More studies are needed of this treatment idea before it use will be used for more complicated problems like spondylolisthesis.

Recent studies show various soft tissues with elasticity have a property called creep. This tells how much tightness or looseness there is in ligaments, discs, joint and capsules. There is also a certain amount of creep in joint capsules.

As tissues shorten from use, they loose elasticity and the creep increases. With repeated work loads or movements, creep doesn’t fully recover or return to normal after rest. Over time the amount of creep adds up. If the creep doesn’t fully recover from one work day to another, then the workers starts the new workday with too much creep in the tissues.

Creep causes damage to the tissues. The body tries to heal itself and sets up a cycle of inflammation. Continued motion keeps the spine from healing. The added creep results in chronic inflammation and disability.

Scientists are trying to find out just how many repetitions are needed to cause damage and injury to the spine. The goal is to give workers a work-to-rest ratio for safety in the work place.

Experts in the area of repetitive work-related injuries do advise frequent breaks. Many doctors and therapists tell patients to take stretch breaks every 20 minutes. Others use the one-hour mark. The perfect number of breaks isn’t really known.

Engineers at the Occupational Medicine Research Center in Louisiana report that the elasticity of soft tissues doesn’t go back to normal even after seven hours of rest. They used cats in their research but the results were similar to other studies done in
humans.

Studies are being done around the world to find out just how many repetitions of movement it takes to cause an injury. Number of hours of rest needed for tissue recovery is also under investigation. Finding a safe work-to-rest ratio would go a long way in preventing soft tissue trauma from repetitive activities.

This is a good question. Finding the optimal work-to-rest ratio needed to prevent soft tissue injuries would save many workers from discomfort and lost wages. Some engineers are studying the spine’s response to repeated loads.

t’s been proven that repeated motion does put the soft tissues at risk for injury and trauma. It’s not clear exactly how many movements and what conditions lead to soft tissue damage.

Another factor scientists are looking at is a concept called creep. All soft tissues that have some elasticity can stretch or “give” a little. They can also contract or tighten up. The amount of elastic movement of the soft tissues is referred to as creep.

Repeated motions cause the tissues to lose their creep. The muscles around the joints contract to increase stiffness. This is a way to protect the joints from too much load in a loose position. Unfortunately the body doesn’t always get the creep back it needs with rest.

A recent study using cats showed that even after seven hours of rest, creep wasn’t restored. The cats started the next day with less creep than they had the day before. It’s possible in the human body that the more creep is lost, the greater the chances of a disabling injury.

More studies are needed to fully answer these questions in humans.

Each doctor or clinic will have their own criteria for patient selection. The number of prior failed back surgeries isn’t as important as other factors. For example you may not be considered if there are too many degenerating levels. Some doctors limit patients to three or less abnormal levels. Others will treat patients with more than three.

Severe osteoporosis or a previous bone infection may prevent you from having this type of spinal fusion. Tumors are also a problem. Current alcohol or drug abuse will put a patient at risk for a failed surgery. Heavy tobacco users also have slower and sometimes failed healing.

The use of fusion cages isn’t standard everywhere. Some doctors aren’t using these at all yet. Start with finding a surgeon who does use these devices and ask for an evaluation.

Most scientists are very concerned about the final outcome of any study. As you’ve probably seen from the news, lawsuits costing millions of dollars can occur when a new drug or device isn’t researched fully.

Before new ideas are ever tried out on humans, the researchers use cadavers and animals. Once the product is shown to be safe, then it can be used on humans. Usually, a small number of people are involved in the first studies. If proven safe and effective, the same study is conducted using a larger number of people.

Fusion cages for the spine were approved by the FDA in 1999. From 1991 to 1993 studies were done on humans using this device. A recent study reported the 10-year results of the FDA clinical trial. They found a high rate of success in the experimental group.

Long-term results are of vital importance to science. It’s likely the people in charge of your study have a long-range plan for follow-up. Be sure and ask what is this plan and how often and for how long will you be contacted.

Constant pain in a young athlete that doesn’t go away with treatment does raise the suspicion of a more serious problem. What kind of tests have been done and what kind of treatment has he tried so far? If he hasn’t been seen by a medical doctor, that’s the first place to start.

Groin pain can be hard to diagnose accurately. Athletes who use kicking motions and who change directions quickly on the field are often prone to chronic groin pain. X-rays or other imaging studies may be able to show signs of stress at the pubis symphysis where the two pubic bones come together. Imaging studies would also show any signs of bone tumors.

Once a medical doctor has ruled out more serious bone or joint problems, a physical therapist might be able to help with other soft tissue or muscle injuries. Sometimes after an injury, the muscles must be given some help to get back to normal.

The “tailbone” or coccyx at the end of the spine can become extremely painful in some people. Women are affected more than men for several reasons. One is trauma that occurs during childbirth.

The child moves past the coccyx as he or she descends down the vaginal canal. A large baby or awkward, twisted presentation can push the coccyx out of its normal alignment.

The second is the difference in pelvic anatomy between men and women. In females the opening where the sciatic nerve passes through the pelvis is wider than in men. The result is for the entire sacrum and coccyx to tilt backward. This angle puts the coccyx
at greater risk for injury.

In males the narrow sciatic notch tilts the sacrum and coccyx forward. There’s more protection for these body parts with the sacrum and coccyx tucked under.

When you sit straight up, you can feel the pressure on the ischial tuberosities on your bottom. These are commonly referred to as the “sit bones.” These bony prominences on the pelvis are further apart in women compared to men. When sitting, the coccyx is positioned
between these two points. A wider distance between the sit bones means more pressure on the coccyx.

Finally there may be some people who have instability of the coccygeal segments from birth. Over time abnormal motion occurs causing pain. This could be a hereditary trait but it hasn’t been proven yet.

Coccygodynia refers to pain in the tail bone when sitting and sometimes while standing. The problem is most common in women from trauma during childbirth. Other causes in men and women include trauma such as a fall at an early age. There have been some reports of sexual abuse linked to coccygodynia.

More serious diseases such as infections and tumors must be considered, too. A medical exam will rule out herniated disc, prostatitis, hemorrhoids, and cysts. Anal fissures are reported among the male homosexual community as a possible cause.

Even if your boyfriend won’t discuss the problem with you, encourage him to see a medical doctor for a diagnosis and treatment. This is a treatable condition.

Physical therapists are doing studies of athletes with chronic groin pain. They are trying to find out which muscles might be the problem. Perhaps an exercise program to
restore normal function of muscles could help patients with groin pain.

A recent study of Australian football players showed a link between poor motor control of the transversus abdominis (TrA) muscle and groin pain. The TrA is one of several abdominal muscles. It seems that lifting the leg normally activates the TrA. With groin pain, the contraction of the TrA is delayed.

Therapists aren’t sure if the groin pain causes delayed muscle contraction or the other way around. Working to restore normal muscle function is the first step to answering this
question. There aren’t a lot of other options for treating groin pain. It may be worth giving it a try.

Studies of back pain haven’t been able to find an exercise program that works yet. This may be because the studies use the same exercises for everyone. It’s likely that a “one-
exercise-program-for-all” doesn’t address the needs of each person.

A new study from Canada showed that patients got better faster when they kept all their movements in the direction that doesn’t cause pain. For example if bending forward hurts
then their activity and exercises were geared toward the opposite direction (extension). If bending to the left increases painful symptoms, then exercises moving to the right
were taught.

This approach to back exercises is called the McKenzie Method. Some physical therapists have training in the McKenzie Method. The therapist examines the patient to find which movements cause painful symptoms. Then an exercise program is devised to help
the patient move in the preferred (painfree) directions.

Ask your doctor about trying this program. He or she may know someone in your area with this type of training. You should be able to see if it will help you in a very short amount of time.

A recent study from the Department of Orthopaedic Surgery at Massachusetts General Hospital suggests removing the coccyx or tailbone is a safe and effective way to treat this problem.

The operation is called a coccygectomy and gives permanent pain relief in 90 percent of all patients.

Other more conservative treatment includes injections of a numbing agent with a steroid. This is only successful in about 20 percent of all patients. Physical therapy can bring relief in some cases. Chiropractors can manipulate the coccyx if malalignment is the problem.