FAQ Category: Lumbar Spine

Up to 90 percent of all adults in the United States will have low back pain (LBP) sometime in their lives. Most of those people will get better within a few weeks without any outside help.

Only 10 to 15 percent of patients with LBP have chronic pain and disability. According to a recent study from Norway folks currently having back pain don’t think it will get better.

Anyone who’s had a past bout of LBP would disagree. They know that it will eventually go away most of the time.

Eight out of every 10 adults with acute low back pain get better in one to two weeks. The rest will get better slowly over a month to six weeks or develop chronic pain that results in disability.

There’s no sure fire way to predict who will recover and who won’t. Researchers are actively investigating this idea. It’s clear that fear and avoidance of movement will reduce or delay recovery.

General back care guidelines support the idea that patients with low back pain should rest for a day or two but then slowly resume all activities. In most cases of acute back pain the old saying “motion is lotion” is quite true.

There may be no way to convince your brother. He may have to live through the experience and find out for himself. As much as possible, encourage him to keep moving.

The effect of back pain on movement and function seems to be linked more closely with duration of pain than intensity. Pain doesn’t have to be severe to affect a person’s quality of life if it lasts long enough. In other words pain intensity doesn’t predict disability as much as duration.

A recent study from Spain surveyed back pain patients on their first visit. They repeated the survey 14 and 59 days after the first visit.

Quality of life declined over time for low back pain patients. Half the patients were rated as “disabled” by their back pain on day one. The percent of disabled patients increased to 65 percent by day 15 and 73 percent by day 60.

Treatment to focus on improving function rather than decreasing pain is advised. A referral to a pain clinic might be a good idea. Now might be a good time for re-evaluation by her doctor.

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.

Maybe this works in the short-term. In the long-run avoiding painful motion can set up a cycle called fear-avoidance. You may have less pain, but you could end up with
more disability later. Many studies have proven this now.

A program to promote active coping strategies along with increased movement is the best thing for you. Trust your therapist. Give it a try, and see if it doesn’t make a positive difference in the next six to 12 weeks.

Minor problems after spinal fusion including leg pain and numbness occur in 10 to 15 percent of all patients. Often these symptoms are “transient” meaning temporary. They do go away over time, usually between one to six weeks.

The most common nerve root affected by lumbar fusion is L5 near the bottom of the lumbar spine. The nerve must be moved out of the way during the operation. It can get pinched or stretched during this process.

If your symptoms last more than six months talk to your doctor about treatment options. Another operation may be needed to take pressure off the nerve. Results of this surgery are usually very good.

Despite best efforts at fusion sometimes it doesn’t work and the person has movement at the problem level. Studies are being done to find the best method to give the patient immediate stability with long-term fusion.

Researchers have found that using titanium implants along with bone graft gives a stiffer, more stable spine right after surgery. The more rigid the fusion, the more reliable the results. Combining materials and fusing front to back seems to work best.

Many studies have been done looking for the answer to this question. The success rate varies between 60 and 90 per cent. Success isn’t always defined the same by everyone. For example, the patient’s view of success and the doctor’s may be different.

Up to 40 per cent of all patients still have symptoms after disc surgery. This includes pain, loss of function, and weakness. Up to two out of every ten patients have a recurrence of the same problem. This means that although the first disc was repaired, now a second disc problem occurs. Most of the time, this happens within six months after the first operation.

When symptoms persist, there are some options. The patient can enter a physical therapy or rehab program. Intensive therapy does help these patients.

Researchers are aware of these problems. In fact, they take this into account when studying the patient’s answers. For example, remembering past information is referred to as recall. Scientists already know there is a certain amount of bias just based on answers that rely on memory.

The researchers also take into account the fact that every test has its own problems. Scientists know how to account for changes in the test score that are based on errors in the test itself. This is called the standard error of measure.

Patients are usually instructed to fill out the forms to the best of their ability. The math formulas used to analyze the data will do the rest.

The success of an operation depends on several factors. The doctor will see if it had the desired effect in the spine. Equally important, the patient will report if symptoms are improved.

Often, changes in quality of life (QOL) are weighted as heavily as decrease in pain. Sleeping more, better sleep, and more active sex life are examples of improved QOL for some patients.

Returning to work or sports activities is another measure of treatment success. It’s still a success if pain persists, but the patient may only describe the result as “better” rather than “much better.”

Intradiskal electrothermal therapy (IDET) is a new treatment for disk problems. This option isn’t for every body. Since it’s fairly new (it was first used for disks in 2000), doctors advise caution until further studies are done.

Right now, researchers suggest its use for patients with chronic low back pain from disk disease. This means the disk has worn away or been damaged from aging or injury. The pain has been present and unchanged by other treatment for more than three months.

You may not be a good candidate if you’ve had back surgery before. Likewise, pregnant women are not treated with IDET. Patients with other back problems such as stenosis or scoliosis aren’t accepted yet for this treatment. IDET is not advised for anyone with other serious health issues or medical conditions.

This is a complex issue. The actual source of the pain isn’t understood very well. It’s true that the center of a spinal disk doesn’t have a supply of nerve fibers. However, there is a thick, fibrous covering around the disk called the anulus fibrosus. The outer one-third of the anulus does have sensory nerves.

In the normal disk, these nerves don’t go any further. In a disk damaged by aging or injury, the nerves start to grow inward. A protein called substance P is released by nerve cells into the disk. Substance P isn’t very well understood, but it seems to send pain messages. This is one theory about the source and cause of disk pain.

Another theory is that small tears of the anulus allow fluid to leak out. The disk becomes dehydrated and starts to fray or tear even more. When this happens, new blood vessels are formed to bring blood to the area. Nerve cells come along with the new growth. This may also help explain painful disks.

Electrotherapy is a new treatment for disk problems that cause chronic low back pain. It’s also known as intradiskal eletrothermal therapy (IDET). IDET is a noninvasive operation. This means that the doctor doesn’t have to make a large cut or incision to open the back.

A small opening is made to insert a thin, rigid tube into the disk. A local anesthetic is used at the site of the insertion. The patient is awake, but sedated through an intravenous medication. This means the patient is conscious, but not alert. The disk is heated up to a high temperature using electrical heat.

The process takes less than 10 minutes. The procedure is done in an outpatient clinic and the patient goes home one to two hours later.

A neutral position for any part of the body is usually one in which the part is in the middle of two extremes of motion. For the back or spine, “neutral” means a place with the least rotational stiffness.

In the normal back without deformities or injuries, neutral consists of three natural curves. The neck is slightly extended, the upper back is flexed, and the low back is slightly extended. The “neutral” position can be assumed whether standing, sitting, kneeling, or on hands and knees.

Neutral position differs slightly for each person. There are two ways to teach neutral spine positioning. The therapist may use his or her own visual judgment. It’s also possible to use a machine that measures positions and angles of the spine. Most clinics don’t have this device and rely on tester judgment.

X-rays can show narrowing of the sacroiliac (SI) joint. This joint is subject to arthritis just like any other synovial joint. Narrowing of the joint space points to age-related degenerative changes.

The problem with these findings is that such changes can be seen in any patient over 30 years old. Such changes aren’t always linked to arthritis. Patients can have severe arthritic changes and have no pain. Others have no changes and severe pain.

X-rays can also show bone spurs, osteoporosis, or other changes in the bone itself. It can’t always show infection, inflammation, or instability. Doctors rely on other imaging and clinical tests to rule out more serious causes of SI pain.

There’s no way to be 100 percent certain about the source of painful symptoms. This is true for pain in the low back or the sacroiliac (SI) joint.

Clinical tests to provoke the SI joint offer useful information. The doctor may palpate or press on the SI and nearby structures. Putting the hip and leg in various positions and applying pressure can also help pinpoint the source of the problem.

One of the best tests is an injection of a numbing agent into the joint. Pain relief within 15 to 45 minutes is a positive sign that the SI joint is the cause of your symptoms.

Even with this test, researchers advise trying it two or three times to be sure. You should get at least 75 percent reduction of pain each time the joint is injected.

According to a recent study from Johns Hopkins University, SI fusion is safe and effective when done on the right patients. The key is to conduct all tests necessary including the joint injections.

The SI joint has been a topic of interest in medicine for over 100 years. Hippocrates described pelvic separation during labor. He said it remained so after birth. Other doctors in the early 1900s reported pain coming from the SI joint after childbirth.

The SI joint is a true joint. It contains cartilage and synovial tissue. It’s subject to the same age-related degenerative changes as any other synovial joint.

Large studies by well-known spine specialists report that SI dysfunction can be the main source of SI and low back pain. This can happen in women who aren’t pregnant.

A recent study from Johns Hopkins University Medical School reported five percent of their SI patients had postpartum instability causing their symptoms. The evidence weighs in favor of your physical therapist’s comments.

Cauda equina syndrome refers to the symptoms that occur when there’s pressure on the nerve roots below the level of the conus medullaris.

The spinal cord ends near the first lumbar vertebra. As it tapers to a point, it forms the conus medullaris. The bundle of nerve roots just below the conus medullaris is the cauda equina.

Cauda equina syndrome is caused by narrowing of the spinal canal. The result is pressure or compression on the nerve roots below the level where the spinal cord ends.

Cauda equina syndrome is usually a medical emergency. Surgical decompression is advised within 48 hours. The bone (lamina) is removed and then the disc is taken out to remove the pressure pushing against the spinal nerves. The goal is to reduce the chances of permanent neurologic injury.

Surgeons have tried to improve spinal fusion over the last 10 years. The goal is to reduce problems and improve fusion results. Using extra hardware helps stabilize the spine while it’s healing.

You were lucky to have a good result. Many patients with bone graft fusions ended up with a failed fusion. Motion at the fusion site caused problems with spinal instability and back pain.

A bone graft is still used today. Bone removed during the operation is shaved or ground up and placed inside the cage. Bone grows around the cage giving a good, solid fusion. At the same time the cage holds the bones apart like the disc used to do.

Overall results are better in the short- and long-run. Now researchers are trying smaller incisions for spinal surgery. The goal is less damage to the soft tissues and nerves.

Anterior lumbar interbody fusion or ALIF is used most often when patients have a single degenerative disc. The damaged disc is removed. Bone graft with or without implanted cages is used to fuse the two vertebrae together.

Some patients are surprised that they aren’t pain free right away. Most patients obtain pain relief in the first six weeks. They continue to get better during the first six months.

Studies show a success rate for ALIF between 73 and 86 percent. Success is defined as a solid fusion with pain relief. It doesn’t always mean the patient got complete pain reduction.