FAQ Category: Lumbar Spine

There are many ways to fuse the spine depending on the condition of the bones, number of levels involved, and training of the doctor. All methods involve putting bone graft between the vertebrae. In general terms the three-step process you are asking about probably refers to an interbody fusion.

Interbody fusion means two vertebral bodies are fused together. The steps include: 1) remove the damaged disc material, 2) insert cages and/or graft material in between the two vertebrae, and 3) support the healing spine with screws, plates, or rods to hold it together.

The last step is called instrumentation. Instrumentation can be used to fix a deformed or curved spine. For a spinal fusion it’s acting like a splint inside to hold the bones together while the bone graft heals.

Most people sitting for long periods of time tend to slouch or bend forward. Taking the back of the chair off won’t help in that type of situation. Sometimes having a lumbar support across the low back can put the spine in a position of slight extension. This position may help reduce low back stiffness.

The chair you sit in is important, but so is your workstation. Even more importantly take frequent breaks and move around. Even if all you do is stand up and stretch and then sit back down again, this can help reduce fatigue and prevent injuries.

A popular new desk chair without a back is the use of a Swiss ball designed for this purpose. Some people use it without a stand, but a supportive base is available and keeps the ball from moving out from under you.

We hope to see some studies in the near future to show whether or not such a chair design is beneficial.

A seat belt fracture (also known as a Chance fracture) occurs during a car accident. Usually this happens when the pelvis is anchored by a lap-strap without a shoulder harness.

When the driver slams on the brakes or is hit from behind, the victim is thrown forwards against the belt. The vertebral body may be split and severely displaced away from the rest of the bone.

Ligaments holding the spine together are also torn or damaged. A severe enough injury can cause damage to the spinal cord, even resulting in paralysis or death.

There are two main kinds of spinal fusion based on where the bone graft is placed. The first is a posterolateral fusion. Bone graft is placed along the back of the spine joining the transverse processes of two vertebrae. The transverse process is part of the
bone that sticks out to the side and attaches to the rib.

Screws and rods are used most often to hold the vertebrae together while this type of fusion is healing.

The second type of fusion is called an interbody spine fusion. In this fusion, the bone graft is placed in between the vertebral bodies. The disc is taken out and the bone graft goes in its place. This fuses one vertebral body to the other.

The graft can be placed in between the vertebral bodies from the front or the back of the body. Using an incision in the abdomen to get to the spine is called an anterior approach or anterior lumbar interbody fusion (ALIF). The graft can also be placed from a posterior approach through the back. This approach is called a posterior lumbar interbody fusion or PLIF.

Using both kinds of fusion at the same time increases the chances for a solid fusion. This type of surgery is referred to as a 360-degree fusion. It’s like using a belt and suspenders to hold the spine together.

Nucleoplasty is a way to remove herniated disc material from between the vertebral bones of the spine. It’s considered a minimally invasive operation. Only a small incision is needed. A long needle is then inserted through the skin to the disc.

Radio wave signals are sent into the center (nucleus) of the herniated disc. The radio waves produce a low-temperature gas that breaks up bonds in the nucleus. This forms open channels in the disc. The disc material that is dislodged to form the channels is then removed through the needle.

Removing the nucleus relieves pressure on the outer portion of the disc. The bulge goes down so that the disc no longer irritates the nearby nerve root.

Patients with low back pain that goes down the leg seem to get the best results with nucleoplasty. The back pain may not go away but the leg pain seems to respond in many cases.

Discs between the bones in the spine can protrude and press on nearby spinal nerves. Back and leg pain is the most common symptom. Sometimes numbness and tingling occur, too. These can be very disabling.

The medical community hasn’t found a way to treat this problem that works for everyone. Using intradiscal electrothermal therapy (IDET) as you described is one option. The results of this treatment aren’t clear yet.

Studies show it gives short-term relief to some patients. Scientists are trying to figure out if only certain patients do well this treatment. If so, who are those patients? Are they in a particular age group? Do they have just back pain or back pain with leg pain? Is the disc protrusion small or large?

More studies are needed to say for sure who would benefit the most from IDET.

It doesn’t matter in terms of fusion results but it may make a difference in other ways. The doctor may prefer to use one side over the other depending on your position during the operation. If one side is harder to reach than the other then easy access makes the decision.

It may make a difference to you later. Sometimes patients have pain at the donor graft site. The pain can last months to years. If you tend to sleep on one side more than the other, then you may want to choose the side you don’t sleep on for the graft site. Lying
on a painful hip can make sleeping even more difficult.

Fusing the lumbar spine isn’t a simple operation. The vertebrae are difficult to get to and often require moving nerves, blood vessels, and muscles out of the way. Until
recently, spinal fusion was done with an open incision from the back of the spine. The muscles were stripped away and then reattached.

With this method of fusion there was the chance for a large blood loss and nerve damage leading to permanent problems. The term fusion disease was used to describe long-term problems from this kind of damage.

Current methods of gaining access to the spine are changing. New tools are making it possible for the surgeon to make a small opening and fuse the spine without cutting muscles or nerves. A tiny TV camera on the end of a long tube is inserted through a small incision. The surgeon does the operation while watching on an X-ray screen.

With this new minimally invasive operation, it’s expected that this “fusion disease” will become a problem of the past.

Most doctors assure their pregnant patients that back pain is normal and to be expected. Half of all pregnant women have back pain some time during the pregnancy. It’s a common reason why women miss days of work. The good news is that it will go away in nine months!

It’s always a good idea to report any changes during pregnancy, including back pain, to the doctor, nurse, or midwife. Your physician will make sure there isn’t something more serious going on.

Back pain can be managed with good posture and work habits. Sometimes a maternity support belt can help. There’s no reason to suffer needlessly if a few simple steps can be taken to assure comfort and support.

Spinal mobilization is one of many conservative treatments therapists use for low back pain. In this method, the therapist applies a low velocity, repetitive movement to the spine. It’s a passive treatment so the patient doesn’t usually participate in any way.

The theory behind spinal mobilization for back pain is that it can decrease joint stiffness and reposition joints that are slightly off center. Adhesions or fibrous tissue around the joints can keep the joint from moving. Mobilization can help free these up. Mobilization can also have a pain reducing effect.

The exact effect of spinal mobilization is unknown. Acupressure massage and trigger point therapy are applied in slightly different ways. These methods of treatment have different ways of affecting the tissues. In all of these techniques studies need to be done to show what works and why.

Meridians are energy pathways through the body. They are connected together. Energy flows through the body via these pathways. Disorders are caused by imbalances of the energy flow. Blockage of any meridian can cause problems. Acupuncture helps the body clear the blockage and restores the energy balance.

From a scientific point-of-view, the exact way in which acupuncture works is unknown. Western science suggests the body responds to the new (painful) input by paying attention to it and ignoring the original pain. This is called the gate control theory of pain. Back pain goes away when the nervous system starts to pay attention to the pain of the needles stuck in the skin.

It’s also possible acupuncture releases natural pain relieving chemicals in the body. These include endorphins, serotonin, and acetylcholine.

Acupuncture hasn’t been shown to be consistently effective in the treatment of low back pain. Most people get better faster with acupuncture compared with no treatment or even a sham treatment. But the effect is short-term and doesn’t last. Acupuncture combined with other forms of treatment seems to have the best results./p>

Effective treatment of low back pain by any one group of health care providers hasn’t been proven yet. Many researchers and scientists are looking for the best way to treat low back pain. Others hope to find factors linked with nonrecovery as a way to predict and prevent back pain.

There is much to show that psychosocial and emotional factors are a major part of the picture. Patients with high scores on tests for emotional distress and depression are three to five times more likely to have chronic low back pain.

The health care provider who pays attention to the physical and emotional signs and symptoms of low back pain may get the best results.

Not exactly but there are some guidelines that might help you. Some studies report 90 percent of patients with acute low back pain recover within 72 hours (3 days). Other patients take a little longer and recover within two to four weeks.

In a small number of people, recovery never occurs. Chronic back pain becomes a major problem. Factors linked with nonrecovery include age over 45, two or more neurologic signs, and depression.

Many studies agree that psychosocial factors seem to be the strongest predictor of outcome for patients with back pain. Depression, distress, work-related issues, and emotional factors seem to play a major role in long-term back pain.

Anyone who has just low back pain is likely to recover faster than someone whose pain radiates down the leg. Back pain patients with two or more neurologic signs have slower recovery than other patients without neurologic signs or symptoms.

A doctor should evaluate recurring back pain. If this is your third episode of back pain in as many months, a medical exam is in order. The physician will make sure there isn’t something more seriously wrong.

If a mechanical cause is found for your symptoms then the right treatment can be applied. The goal is to speed up recovery and avoid long-term, chronic pain patterns from developing.

There are many different kinds of pregnancy support belts these days. They are sold by different names such as maternity belt, maternity support belt, maternity girdle, or pregnancy support belt.

Some are just to support the back and take off extra strain from the lumbar spine. Others just support the abdominal muscles from the strain and weight of the growing abdomen. Such supports can help improve posture and prevent swayback.

Doctors recommend these supports most often for back or pelvic pain, abdominal strain, or pubic bone separation. For a smaller number of women, special belts are used for varicose veins or swelling (lymphedema) in the pelvic area.

Today’s women tend to be more active than in previous generations. They participate in exercise programs throughout their pregnancies. Proper nutrition, rather than avoiding weight gain, is stressed so they may carry more weight than women 20 years ago. And today’s women look for increased comfort while keeping up their busy lives.

Many women have back and/or pelvic pain during pregnancy. Studies to show which exercises work best are very few and far between. A recent study in Sweden compared three physical therapy programs for women with pelvic pain.

Group one received some information about changes in their bodies during pregnancy. They were given a nonelastic sacroiliac belt and advice about posture. Group two was treated the same as group one but with three extra exercises added. The exercises were to stabilize the spine. Group three was the same as group one plus they did four strength training exercises. Everyone followed their program until week 39 of their pregancy.

Using pain and activity as measures the researchers didn’t see any difference in outcome between the three groups. Exercise for pelvic or back pain may be more important after pregnancy. Improved posture and work habits along with the use of a supportive belt may be all that’s needed during the pregnancy.

Simply stated, it means your back pain is associated with movement. Certain motions make it better or worse.

Mechanical low back pain usually suggests there’s a problem with one of the moving parts. Perhaps the disc is damaged from trauma or degeneration. Decreased disc height results in a change in the way the spine moves and increases the load on the joints.

Or there may be arthritic changes in the joints making joint movement slow and painful. The ligaments are also affected by the aging process. Sometimes they get thinner but in some cases they get thicker. Such changes affect the way the joint moves, and again, changes the load through the spine.

Mechanical back pain is sometimes called nonspecific mechanical pain when the exact tissue(s) involved can’t be identified.

There is strong data to support the importance of exercise in the treatment of low back pain. But whether it should be aerobics, strength training, or coordination exercises remains unknown.

The new core-training program is used to strengthen the muscles that stabilize the spine. Core training is being studied with varied results so far.

Researchers haven’t been able to show whether one exercise, a specific order of exercises, or a combination of exercises makes the difference. In studies comparing groups of back pain patients doing different exercise programs, everyone gets better.

So for now it looks like a consistent program of exercise three to five times a week for 30 minutes to an hour is helpful–no matter what you do or how you do it!

Lumbago refers to pain in the low back or lumbar region. A simpler term for the same problem would be “backache”.

Backache or lumbago can be caused by muscle strain, arthritis, or disc problems. It’s not so much an old-fashioned term as it’s one that is applied to older adults who tend to have this problem.

The pain is worse with movement and often restricts movement even more. The person with lumbago complains of extreme stiffness, especially when trying to bend forward or backward.

Long-term studies of patients treated without surgery for disc herniation are underway. Some of the results indicate changes occur in the disc for up to two years after the initial injury.

Serial MRIs (several taken over time) show a gradual reduction of the bulging disc. Patients seem to improve over time at about the same rate no matter what size the disc was to start. Some patients had painful symptoms and some didn’t. Some patients had more than one disc involved. None of these factors seem to affect the healing disc.

Age seems to be the only deciding factor. Younger patients seem to have the worst results but it’s not clear yet why this occurs. It may be linked to a more active lifestyle in the younger adults.