FAQ Category: Lumbar Spine

Chronic low back dysfunction (CLBD) is a label for a group of disorders. The causes and symptoms vary from patient to patient. Men and women are affected equally.

Low back pain is a key feature. For some patients, the pain is disabling. More often, the pain is “manageable.” In other words, the pain doesn’t stop the patient from working, engaging in sexual activity, or hobbies.

Weakness of the back muscles is also a major part of this disorder. A major focus of research right now is looking for ways to reduce the painful symptoms of CLBD with muscle strengthening.

We’re still not sure about this. Recent studies show that disc herniation and the back pain that comes with it affect balance, muscle control, and posture.

Pressure from the disc on the spinal nerve roots affects the nerve’s ability to control the muscles. The muscles, in turn, help control movement and balance. A quick reaction time by muscles is needed in response to sudden movements. All of this is damaged by disc herniation.

Nerve recovery takes months. Recovery after surgery may be expected to take as long or longer. Apparently, regaining full control of muscles isn’t automatic.

Lumbar disc herniation occurs in the low back when the inner part of the disk (nucleus) pushes through its covering (the annulus). The nucleus can push against the spinal nerve root causing problems like numbness and tingling or muscle weakness.

Muscle wasting or atrophy is common in the low back muscles and legs with disc herniation. It can occur quickly. New research suggests that early exercise may be the key.

Muscles are made of two types of fibers: Type I and Type II. Both types are affected by disc herniation. The size, number, and direction of muscle fibers change in the multifidus muscle of the low back.

Two kinds of exercises are advised. The muscles must contract isometrically (without moving anything) and isotonically (muscle contracts and causes movement). A physical therapist can set you up with such a program.

This varies from person to person. You may have less joint mobility after the fusion, but the flexibility of your muscles can make it seem like you have full motion. Further stiffening should be obvious once complete healing occurs.

Spondylolysis is a fracture of the bone that holds the upper and lower facet joints of the spine together. The place where the separation occurs is called the pars interarticularis.

Research shows a direct link between strenuous, intense sports activities and spondylolysis. Doctors think fatigue fracture is the most likely cause of spondylolysis. Athletes between ages 5 and 15 are affected most often.

Early treatment is the key to healing this bone defect.

Spondylolysis refers to a defect in a vertebra in the lower back. The area of the bone called the pars interarticularis is affected. This are of bone forms part of a ring of bone around the spinal cord and spinal nerves.

When spondylolysis is present the back part of the vertebra and the facet joint aren’t connected to each other like they should be–except by soft tissue. The bone has fractured and tried to recover, but it never completely heals.

A recent study of young athletes (ages 12-20 years) showed that spondylolysis can heal when it only affects one side of the spine. Full healing can take up to three months and requires stopping any activities that aggravate the problem. Defects on both sides of the vertebra are less likely to heal. Greater motion across the defect reduces the chances of fusion even with treatment.

Conservative treatment is usually always the first step. Physical therapy,
exercises to stabilize the spine, and drugs to control pain and muscle spasm are first. A back brace or corset may be tried. Surgery is possible but usually only as a final option.

Some spinal conditions aren’t visible on X-ray during the early stages. More
advanced imaging such as CT scans can detect some conditions very early. Early diagnosis and treatment can make a big difference later on.

For example spondylolysis, a small fracture in one (or both) of the
columns of the spinal bone has a better chance of bony healing if found early. Older lesions are less likely to heal completely. Spondylolysis affecting both sides of the column can progress to spondylolisthesis. In this case the bone separates and the main body of the vertebra moves forward over the bone below it.

If and when this happens, pressure is put on the nearby spinal nerves. Pain,
weakness, and numbness can occur and interfere with function. As the old saying goes, “An ounce of prevention is worth a pound of cure.” Take your doctor’s advice. It’s a small price to pay for the chance to prevent the problem from getting worse.

It’s best to see a medical doctor before taking any kind of drug for a long-term problem. A serious source of the pain must be ruled out before treating just the symptoms.

Over-the-counter medications for back pain relief range from aspirin to Tylenol to ibuprofen. Each of these has one or more names depending on the company making it. They are all pain relievers.

Aspirin and Tylenol reduce fever. Aspirin may be taken in low doses for its anti-coagulation (prevents blood clotting) effect by some heart patients. This must be done with a doctor’s advice. Aspirin is an antiinflammatory. Tylenol does not reduce inflammation.

Ibuprofen also offers an antiinflammatory response. Aspirin and ibuprofen are called nonsteroidal antiinflammatories (NSAIDs). The effect as an antiinflammatory varies from product to product. It depends on how much and how often they are taken.

For example, aspirin has its peak effect in about two hours. Aleve (one name for ibuprofen) has a peak effect in two to four hours. The newer Cox-2 inhibitors (NSAIDs) such as Celebrex or Vioxx peak at two to three hours. You should ask your doctor or pharmacist for the best way to take these drugs for your case.

Materials handling is a challenging job physically. In addition to garbage cans, collectors also lift and swing plastic bags, boxes, and containers of all sizes.

The most common problems for the worker are judging the weight of the object being lifted and loads that shift inside the container while being lifted. You can’t change the size, weight, or shape of public trash.

You can, however, encourage workers to test the object before picking it up. This is especially important when lifting two refuse bags, one in each hand. Any size or weight different can increase the risk of back injury.

Even small changes in position can put pressure on the soft tissue structures of the low back. Lying on the side without a pillow to support the hips, knees, and ankles can affect the spine directly. For some patients, sidelying without support puts one or more segments of the spine in a bent or even a twisted position. When sleeping or resting for several hours in this position, the joint can be stressed.

At the same time, muscles and ligaments can be overstretched or tightened in an unsupported position. The goal is to rest or sleep with the spine in a neutral position. This avoids undue pressure or long periods in a mechanically stressful position.

Some patients change the way they think about moving after having back pain for a long time. When a patient tells the therapist, “Oh, I can’t do that … my back won’t let me,” it’s a sign of behavioral responses to the pain. In these cases, some special tests are needed. Such tests help point out when and how much a patient’s behavior has changed as a result of the back pain.

Treatment for chronic back pain tries to reduce the painful symptoms, but also increase function. Changing the way the patient thinks about the pain is an important part of this process.

Good question. The overall goal of this kind of testing is to find the trunk movements and positions that aggravate (make worse) or alleviate (make better) the symptoms. This gives the therapist some idea of how your spine moves and what factors add to your back pain.

>>From here, the therapist will teach you how to change the way you sit, stand, and move to reduce the stress on your back. For example, the therapist may find out that you have worse pain when trying to bicycle. Every time you bend your right leg, you lean to the side. This puts pressure on the ligaments and muscles around the spine. The therapist will teach you how to stop moving in a way that aggravates the soft tissue structures.

Screws and metal plates are used to hold a bone together after a fracture until healing takes place. There usually isn’t a joint involved and no motion at that site occurs.

In the spine, screws will hold the bones steady and reduce motion. However, studies show that this is only a partial fix. Motion is still possible because there are several joints that give the spine movement in the same area where the screws are placed.

Too much stress or load on the screw can cause it to break off or the bone to fracture. Sometimes, the screws “migrate” or move from where they are placed. This causes even more problems. Screws can be used on a trial basis for a week to see if relief from painful symptoms is possible. After the trial, the screws are removed and a fusion is done.

A group of researchers in Sweden have tried one method called external pedicular fixation. Screws are placed through the skin into the pedicles of the lumbar vertebrae. The patient is under general anesthesia when this is done.

The pedicles are part of the bone that connects the main body of the vertebra to a separate portion made up of the spinous process and joints. The spinous process is the “back bone” that you feel down your back. Between the vertebral body and the spinous process is a hole for the spinal cord to pass through. The pedicles form two sides of the arch around this hole.

Once the screws are in place, a brace or “frame” is attached on the outside of the body. This device gives the patient a chance to see what a fusion can do. If pain is reduced and function improved, then a fusion is likely going to be helpful.

The average cost of a spine fixation using screws with a frame attached to the outside of the body is around $3,000. A complete fusion costs around $12,000. If the temporary trial doesn’t improve your symptoms or your ability to function, you’ll have a much smaller bill.

It’s true that if the trial shows fusion will help, the cost of the two surgeries are added together. There are many other cost considerations in this approach. Some are direct (what you pay out of your pocket) while others are indirect (the cost to others and society).

For example, there are many costs to your employer if you are off work for three months with a fusion. The employer’s costs may be less if the trial shows the fusion won’t work and you are able to return to work sooner.

Reports so far show that lumbar fusion only helps about half the time. With odds like that, this is a pretty risky decision. A temporary trial using fixation may be worth it to some patients.

Titanium cases are very popular as an implant for lumbar fusion. They are placed in the disk space between the bones (vertebrae) of the spine. Screws hold them in place.

Studies show that motion still occurs in the spine with these implants. This may be just during the initial healing phase, but more studies are needed to find this out. In the meantime, doctors advise using a brace to prevent too much motion until the fusion takes hold.

Bracing to immobilize the spine isn’t used by everyone and there aren’t standard guidelines used by all. Each doctor will make this decision based on the patient, kind of surgery done, condition of the bone, and other factors. The first phase of bone healing takes six to eight weeks.

Full spinal fusion takes up to one year. Your wife may expect to wear the brace full-time for the first two months at least. The doctor may reduce wearing time depending on results of X-ray studies. She may be advised to wear it for specific activities or time periods for the next three or four months.

Doctors in Sweden have tried one method to predict success of spinal fusion. Under general anesthesia, screws are placed into the spine to hold it in place. A brace or external frame are attached to the screws on the outside of the body.

The frame is kept in place for one week. Patient’s pain and function are measured before, during, and after this week. Walking distance and speed are the measures of function used.

This method doesn’t show how much relief from pain is possible, but it does show if pain and function can be improved. Patients who aren’t helped by the frame don’t have a fusion. Those who do get help and have a fusion often find even better results with the fusion than with the frame.

Researchers continue to look for ways to predict success with spinal fusion. The high cost to the patient and to society of a failed surgery makes this a priority.

The tailbone (coccyx) can be very painful. This may be caused by some other problem in the spine, or it may come directly from a problem in the tailbone itself.

Coccygodynia (painful tailbone) is not uncommon during pregnancy or after the delivery. The pressure of the child on nearby tissues or damage to the nerves that travel to or through the coccyx can cause this condition. Falling on the tailbone, fracture, or tumors can all cause coccygodynia.

It’s not very often that falling is a helpful treatment for this condition. However, cases have been reported and doctors jokingly call this “therapeutic falling.” A mechanical problem is the most likely cause of coccygodynia when a fall reduces painful tailbone symptoms.

However, it would be best to have a doctor review your case. Other, unseen damage from the fall should be ruled out.

The tailbone or coccyx sits at the end of the spine. Just above it is the last part of the spine called the sacrum. The joint where the coccyx and sacrum meet is called the sacrococcygeal joint. Inflammation or other problems at this joint is the most common cause of tailbone pain (also known as coccygodynia).

Coccygodynia may occur after a fall or injury to the joint, but there may not be any history of injury at all. Other causes of pain from the coccyx include fractures or tumors. It’s also possible to have coccygodynia from a problem in the lumbar spine. For example, a disc problem in the low back area can send pain down to the coccyx.

It’s best to have a doctor look for the cause of this new symptom. There is treatment for this problem depending on the cause.

Yes, a coccygectomy (removal of the tailbone or coccyx) is a known treatment for this condition. In fact, a recent study reports that about 20 percent of the patients with coccygodynia (painful tailbone) don’t get relief from non-operative treatment.

In many of these cases, removing the tailbone brings long-term relief of painful symptoms and increases sitting time. There is one test that must be done before the operation. The doctor injects a local numbing agent into the area. This is done while using a special X-ray imaging called fluoroscopy. Fluoroscopy helps guide the injection to make sure it gets to the right place.

If the patient gets more than 75 percent relief of symptoms, then surgery to remove the coccyx is done. There’s a chance that you won’t get better. You may even get worse, but most patients report good results from this operation.