FAQ Category: Lumbar Spine

There is a series of noninvasive tests called the McKenzie assessment that can be done by a physical therapist trained in this technique. There are eight basic movements the therapist will guide you through to find out what makes the pain better or worse. Making the pain better is called centralization.

A recent study showed that centralization of pain can predict when a discography would be positive. In other words, the McKenzie assessment can predict pain originating from a
problem disc. The therapist can then give you a treatment program specifically for your type of disc pain.

This same study showed that the test results aren’t accurate with patients who are extremely distressed or severely disabled. Discography may be the only option for these patients. You can always try the McKenzie program and see if it works. If you don’t get
better, your doctor may consider the discography as the next step.

Exercise programs often focus on extension since we spend much more time in a bent or flexed position. Back pain from disc problems is often helped at first by forward flexion. The spinal canal opens up and gives the bulging disc more space. Too much flexion too often can make the problem worse over time.

Back pain experts advise moving in the pain free direction first. This is called directional preference. Go as far as you can before having any symptoms. A physical therapist can help you find the exact movement to focus on. The exercise is repeated several times, sometimes as many as 10 to 15 repetitions once or twice each day.

It’s not advised to repeat a motion every hour unless a doctor or therapist has examined you and determined what’s best for your situation. Patients are told to expect some increased low back pain. Directional-preference exercises help patients overcome fear of pain. Movements that cause pain in the buttocks or down the leg(s) should be avoided.

First, don’t panic. Keep breathing when you feel the pain or start to worry. Worry and stress have a way of increasing muscle tension, which won’t help you out. Having said that, let’s look at what the latest research has to say.

Experts advise a few days of rest after the initial injury, then activity and gentle exercise. A recent study from the United States Spine and Sport Foundation in California looked at the effects of heat and exercise together.

They used low-level heat wrap therapy along with a specific program of exercise. The results were very good. Patients had less pain and more function, returning to their pre-injury level of activity within a week. Heat and exercise together worked much better than either one alone.

Light-weight disposable heat wraps are available at department and drug stores. They are activated by exposure to the air and give constant low-levels of heat for up to eight hours. They are self-sticking so you can keep active and moving.

Disposable heat wraps can be worn for hours and even worn to bed. This differs from precautions given when using a heating pad or other heating device. The heat wrap gives gentle, controlled heat just slightly above body temperature (104 degrees F).

The patient can move around and remain active while wearing the heating wrap. These features make it safer than moist hot packs that start off hot and cool off or a heating pad that can get too hot when lying on it.

Movement will also help prevent fluid build-up from the heat. A gentle increase in the temperature of muscle tissue decreases pain and increases tissue stretch. A warm muscle contracts more smoothly. A warm muscle is more resistant to tearing or further injury. Wearing the wrap while exercising also gives a slight support to the lower back.

So far studies have shown favorable result with the low-level continuous heat wraps for painful conditions without swelling.

Safety is always a key concern whenever spinal surgery is done. Damage to nerves or even the spinal cord is possible. The result can be permanent loss of sensation and/or motor function. Surgeons do everything they can to avoid neurologic problems.

Surgeons doing disc replacements should have a lot of practice with spinal surgery before replacing discs. The anterior approach (from the front) is better than a posterior approach (from the back). Using the anterior approach, the surgeon is less likely to damage the blood vessels, nerves, and spinal cord.

Some surgeons ask for help from a general or vascular surgeon to prevent these kinds of problems. They can also use a special device to monitor for any changes in spinal cord function during the operation. The overall complication rate is very low for this operation.

It’s true that most patients have one or two levels fused for most spine problems. In the aging adult degeneration, stenosis (narrowing of the spinal canal), and disc herniation are the most common reasons for spinal fusion.

Fewer patients have four, five, or more fusions. Some conditions such as scoliosis may require many levels to be fused to gain the stability needed. In cases of multiple level fusions, rods are often used along with bone grafting to help support the spine as it fuses.

Further problems can occur if the spine is unstable above or below the level of a fusion. This is true for any number of fusions whether single, double, or more. The surgeon wouldn’t recommend a five-level fusion if the spine was stable at any of those levels.

This is the very question a group of doctors at the Cleveland Spine Clinic asked in a recent study. They compared the results of spinal fusion for spine degeneration in two age groups. One group was younger than 65 years old. The second group was 65 or older.

Patients in both groups had a posterior fusion by the same surgeon. Type of fusion varied based on age. Older patients had a more conservative operation. Older patients had more medical problems than younger patients. Hypertension, diabetes, and heart disease were at the top of the problem list.

Even so, the older group did just as well as they younger group. They stayed in the hospital longer but had fewer second or repeat operations.

The researchers concluded that age shouldn’t be the deciding factor in spinal fusion surgery.

More and more adults over age 65 are having spine surgery for degenerative conditions that occur with age. Conservative care without surgery of any kind is always the first choice. But if you’ve tried this for six months or more without relief, then spinal fusion may be for you.

Today’s more advanced technology and improved anesthesia has made spinal fusion safer. The operation itself has changed and improved in the last 10 years. Patient care is better, too. All these things have made it possible to treat older patients using more complex and extensive surgical methods. Spinal fusion is one of those procedures.

Except for the fact that older adults have more health problems, age doesn’t seem to be a real issue. Older patients don’t lose any more blood than younger patients. Operative time is about the same. They may stay in the hospital a few days more: average of seven days versus five and a half for younger patients.

Demographics refer to the study of human population groups. Commonly collected information includes age, gender, income, and race. What’s collected depends on who’s collecting the data. For example, whether you rent a home or are buying one may be of interest to a realtor. Car sales staff may want to know if you buy new or used.

Health care studies look at age, gender, weight, level of education, and activity level. They may also look at marital status, living situation, social support, and income level.

Chronic back pain has been strongly linked with psychosocial factors. Demographics collected might include level of education, income, and family make-up. Some studies have shown job demands may be linked to work-related use of health care services and sick leave for back pain. These factors include level of supervisory support and control over job tasks.

With this information you should be able to look the article over and find out which demographics were reported.

Artificial disc replacement (ADR) is a major change in the way spine surgery is done these days. Since the FDA gave approval for the Charité ADR, 2500 surgeons have been trained to do this operation.

Records show that another 120 surgeons are trained every week. The course for this training is full for the next six months. Being in a rural area may not be a problem. If there’s even a handful of surgeons who are interested, training is available.

Contact your nearest orthopedic surgeon and express your interest. If the physician is aware of local interest, he or she may seek the needed training sooner than later.

Artificial disc replacement (ADR) is the latest treatment option for some back pain patients. Use of ADRs is limited to patients with degenerative disc disease at one level between L4 and S1. There can’t be any deformity of the bone or neurologic problems.

The advantage of ADR over spinal fusion is the restoration of motion. ADRs are designed to allow close to normal motion of the spinal segment. Yet data from studies done so far show that more than one-third have about the same motion as a spinal fusion. Such a result is considered a failure by some.

Pain relief isn’t always a benefit of this operation. According to a recent study, even patients with a successful result are often still on narcotic medication.

Despite all these warnings, you may be a good candidate. Seek out an orthopedic surgeon who is trained and qualified to perform this operation. Find out what your chances are for this treatment and for a good result.

There’s no known genetic cause of DDD. Tobacco use has a known negative effect on the disc. You didn’t mention your age. Degenerative disc disease (DDD) often occurs gradually over time with the aging process.

As we age, the water and protein content of the disc changes. This change results in a weaker, thinner disc. Wear and tear makes the problem worse. The gradual deterioration of the disc between the vertebrae is called degenerative disc disease. This condition is seen on an X-ray or MRI as a narrowing of the normal disc space.

Degeneration of the disc tissue makes the disc at risk for herniation. The disc doesn’t have much of a blood supply. Once it’s injured, it can’t repair itself easily. A small tear in the outer covering of the disc can lead to major problems.

Any of these changes can occur in adults, even those who’ve never been active in sports or heavy lifting.

You ask a very good question. You can always write a note on the survey itself giving them more information about what you think and how you feel. You can also send a separate note without identifying yourself. This is perfectly acceptable if you are concerned that a particular health care provider will be offended or hurt in anyway. That way it’s not
clear who was treated or by whom.

Surveys don’t always take into account the difference between service received and effect of service. A patient can be happy with the care received but unhappy with the results. In fact a recent study at the University of Florida looked at this with low back pain patients. They found that patients who had high levels of pain and minimal pain reduction were still happy with the way their pain was managed.

A good patient survey will ask questions to find out both satisfaction with service delivery versus results of services.

Each study may have a slightly different focus. Overall, patient satisfaction looks at how happy or satisfied the patient was with the quality of care and/or the health care
provider. Would the patient have the same treatment again? Would the patient want the same caregiver?

Other parts of patient satisfaction may have more to do with cost and convenience. Was the cost reasonable for the service provided? Was it easy to get to the treatment center? Did the patient have to wait very long before seeing the health care provider?

Results of treatment may be part of patient satisfaction. Did the person get better (fewer symptoms or better function)? Did the health care provider give clear and easy to understand instructions? Was the treatment explained?

These and other factors make up patient satisfaction in total. The study advertised is likely focused on one or two specific topics of patient satisfaction.

You’re quite right when you point out “back pain” is a symptom of a problem–not the real problem. Many patients with back pain don’t have a known cause of the problem. There’s no
infection and no fracture.

Mechanical back pain may help further describe or isolate where the problem is located. This diagnosis suggests a dysfunction in the way the spine moves. Perhaps the joint is arthritic or the ligament is stretched out. There may be degenerative changes in the discs or spine causing pressure on the spinal nerves as they exit the spinal column.

Researchers have actually isolated a direct link to mechanical low back pain in many patients. It turns out psychosocial factors of stress, poor work conditions, and economic
troubles may be more likely to start back pain than any real physical condition.

As it turns out, a very useful word. The term “bothersome” or “bothersomeness” has been used to describe disability caused by asthma, migraine headaches, and urinary tract problems. Turns out the same word is a good way to identify risk for long-term disability in back pain patients.

One study showed that a single question about bothersomeness found 80 percent of patients severely disabled with back pain. It seems this word helps improve communication between doctors and patients.

It’s a practical and useful way to classify patients by severity of symptoms.

For most healthy adults who have low back pain (LBP), it is considered “benign.” There’s a good prognosis. The patient is very likely to get better. It won’t shorten their life or kill them.

But painful conditions that result in chronic loss of function and disability certainly aren’t “benign.” For some people ignoring back pain doesn’t help. It doesn’t go away and can wreck havoc in their lives.

There’s still hope. If you haven’t been to a pain clinic, give it some consideration. New ways of treating pain and managing the stress are available today. If nothing else you may be able to increase your function while living within the confines of your pain.

Studies show that 80 to 90 percent of back pain patients do get better on their own. Most do so in the first six to eight weeks. Three months seems to be a cut off point for some patients.

According to a study from the Netherlands there isn’t much change in patient outcomes between three and 12 months. Two of the main factors used to predict outcome were duration of pain and having a paid job.

It seems that waiting too long at the outset of pain leaves the patient at risk for chronic pain later. Patients who didn’t have a job were three times more likely to have continued pain at the end of 12 months.

Doctors and patients may use different measures to gauge recovery. For example the physician may be using improvement in pain to declare you recovered. You may be using
return to normal function to define recovery.

It’s true pain shouldn’t be the only measure of outcome. Is the patient satisfied with the results? Has the patient returned to work and previous level of recreational activity? Health care professionals rarely ask patients if they have recovered their sex
life.

Sometimes patients are fatigued and depressed. They may not be coping well with the changes their back pain has brought. The psychologic aspects of back injury and pain or loss of function must be addressed for complete recovery.

Good question. Many studies over the last few years have shown that back pain is more about stress, anxiety, and other psychosocial factors than it is about a specific back problem.

The first week or two after a back injury is focused on reducing pain and inflammation. It’s been shown that after 14 days the acute back pain patient becomes more subacute. The next step is in a downward decline is to become a chronic back pain patient.

The therapist must focus on movement and function to prevent chronic pain and long-term disability. It sounds like your therapist is up to date on the latest research findings. Give it your best effort and see if you don’t get better.