News Category: General Spine

What can hold two structures apart, support hundreds of pounds of weight, and withstand millions of cycles of compression? Your intervertebral disc! Problems happen when the disc is removed due to injury or disease. Scientists have tried finding solutions. They’ve tried filling the space with bone chips, inserting mesh cages filled with bone chips, and attaching plates and screws to hold it all together.

Now there’s a memory coiling spiral to act as a nucleus pulposus implant. The nucleus pulposus is the center of the disc. It sits inside an outer shell called the annulus. Dr. J. L. Husson from France has been working on the design since 1990. The implant can be put in right after the nucleus pulposus is taken out. The annulus (the outer layer) remains in place. The coil is in the shape of a spiral. It fills the disc cavity without being tied down or glued in. A special manufacturing process allows it to hold its coiled shape
once in place.

The best placement for the coil is right in the center of the disc space. But it’s okay if it moves or twists inside the disc. The doctor puts the spiral right inside the disc to allow for a perfect fit. When the spiral fills the nucleus space, the annulus takes up its old functions. The risk of a new herniation is gone.

Researchers have tested this new implant using human cadavers. Up to 50 million cycles of force were applied in all directions. No wear and tear was seen. The next step was to test it in live patients. Results from the first five patients are the subject of this report.

After two years the implant hadn’t shifted or moved. Everyone had less pain and better function. Everyone was satisfied with the results, and four of the five patients went back to work. X-rays show that the implant is keeping the proper disc height.

The authors think this new implant will be a good way to treat disc problems without spinal fusion. Soon it will be possible to insert the implant with a tiny incision, making it an even less invasive operation.

Back pain occurs more often as we age. Some jobs or sports put people at higher risk of back pain even when they are young. This is true of the sport of rowing. About 32 percent of competitive college rowers develop back pain. These authors wanted to find out what happened to young rowers with back pain as they aged. Could they continue rowing and leading active lives? Were they more likely to have future back problems?

To answer these questions, surveys were sent to college rowers whose graduation dates ranged one to 20 years earlier. More than 2000 rowers returned the survey. The authors asked whether rowers had back pain lasting at least one week before college, during college rowing, at any time after college, or at the time of the survey. They were also asked whether they had ever missed work because of back pain and whether they were still rowing.

Results were used to compare rowers with back pain in college to rowers who did not experience back pain. The results were also compared to back pain in the general population. Highlights of the article include:

Back pain is hard to understand. It is also hard to predict who will get it, who will recover from it, and who will be disabled by it. The effort to better understand back pain is ongoing. Bit by bit medical researchers add to doctors’ knowledge about back pain.

These authors looked at hospitalization and health records for more than 900 workers in Finland. Because Finland has a national health care system, the records could be studied over a long period of time. The records went back all the way to 1973! The idea was to see if certain types of back pain were linked to lifestyle factors such as smoking, weight, exercise, or alcohol use. All subjects had filled out surveys about their health, lifestyle, and jobs.

Seventy-five people in the study had been hospitalized for back pain. The authors also looked for specific types of back disorders. They found that heavy smoking and being overweight were linked to problems in the intervertebral discs. (The discs are the spongy, gel-filled cushions between the bones of the spine.) Being overweight also seemed to be linked to other types of serious back disorders. Surprisingly, workers who did desk jobs had just as many problems as workers who did heavy labor.

The authors sum up the theories of why smoking and obesity cause problems with intervertebral discs. They conclude that future studies need to focus on specific types of back disorders. Such specific research may be the key to fully understanding back pain.

How do you know if a treatment for neck or back pain works? You measure and study it. But not all research is alike. Study groups may not look at the same thing. For example, when it comes to spinal joint pain, there are joints in the neck, mid-back, and low back. It’s hard to compare results if studies don’t look at the same joints.

It’s also hard to compare results if studies don’t follow patients for the same length of time. Choosing the same kind of patients is also important. Having enough patients in the study, or a large enough sample size, is also a key feature in research.

The authors of this study tried to review and compare studies on radiofrequency (RF) to treat soft tissue pain problems. RF is a form of energy that heats up the tissue and destroys the nerve. They report on their findings in this article. First they searched for RF articles on-line at various medical libraries. They went back as far as 1966 and found seven studies. All seven were from the last eight years. Six were thought to be good enough to include.

None of the studies had a large sample size. Success was measured in different ways. For one study success was complete pain relief. For another at least 50 percent pain reduction was required. Overall, the studies didn’t use the same measures, which made comparing them impossible.

Follow-up ranged from eight weeks to three months. None of the studies followed patients to see what happens after RF months to years later. No patient suffered any permanent problems from the treatment in any of the studies.

The reviewers say there is limited evidence that RF works. It gives short-term (less than three months) relief from chronic neck pain. This is true when the source of the pain is the joint. It doesn’t seem to matter if a high or low temperature is used. Not as much can be said for the use of RF in chronic low back pain.

Children often play the game rock-paper-scissors to see who goes first. Scissors always win over paper. Paper wins over rock. Rock wins over scissors. When it comes to chronic back pain, patients often feel like they are playing the same game. Drugs? Acupuncture? Manipulation? But in this case, there are no clear answers.

These researchers in Australia compared drugs, acupuncture, and manipulation in this clinical trial. They found that spinal manipulation was most successful for short-term relief of chronic pain, followed by acupuncture and then medication.

The authors reviewed results from other studies and point out the following:

Employers would love to have a cure for back problems. Back pain causes many people in industrialized nations to miss work. For most, back pain goes away with time, and people return to work with no problem. However, a small number of people with back pain don’t get better quickly. Sometimes back pain causes permanent disability.

This study from Norway tried to find a way to tell which back patients would have the hardest time getting back to work. All people studied had severe back pain that made them miss work and go to a special clinic. They all answered questions about their work, pain, function, and opinions about their health and how it would affect their jobs.

The authors found a few links to explain why some people needed a longer time to back to work: high pain, a low opinion of ability to work, and self-predictions of not returning to work within four weeks.

Beliefs that people have about their own pain and ability to function are important. They could be the key to knowing who needs the most help. This could give everyone involved a way to effectively use the limited resources that are available for helping people with back pain.

Spine X-rays are the key to diagnosing many spine conditions. They let doctors see the way the spine is balanced. But spine X-rays done from the side require a patient to raise the arms out of the way to provide a clear view of the spine. Does this position really give a true picture of spine position while standing and moving in everyday life?

These authors wanted to answer that question. They tested adolescent girls, a group that is at high risk for spine problems. Spine position during X-rays was studied in four different positions. The positions were then compared to relaxed standing and walking positions.

The results showed a range of natural standing spinal positions. However, there were differences of several centimeters between relaxed standing and X-ray positions. That means that the spine position changed to compensate for the change in arm position during X-rays. And that means X-rays don’t truly show how a patient’s spine is balanced.

This issue is especially important because there is no standard way that doctors do spine X-rays. Research like this could lead to developing a standard. Doing X-rays the same way would help doctors compare X-rays from different patients and from different hospitals, which would allow them to learn more about spine positioning. The authors recommend further research on using hand supports and ways of positioning the body to help make sure X-rays give a realistic picture of the spine.

As promising new treatments begin to be used, it is important that doctors continue to study how well they work. Follow-up research helps doctors identify problems and determine which patients will benefit most from the new treatments.

These authors did follow-up research on intradiscal electrothermal therapy (IDET). IDET is a new treatment for back pain that is caused by the discs of the spine. Discs are like little cushions between the vertebrae. When discs rupture or bulge, they can cause pain. IDET involves inserting a probe into the disc and heating it for several minutes. It is thought that the heating causes a healing response in the disc.

The goals of this study were to find out what kinds of problems patients had after IDET and to help determine which patients were more likely to have poor outcomes. IDET was used on 79 patients. All had back pain for at least six months and had gotten little relief from nonsurgical treatments. All the patients also had discs that looked abnormal on MRI scans.

Key findings include:

Glucosamine and chondroitin sulfate work for the knees; why not the back? Each of these supplements can be taken as a pill for osteoarthritis of the knees. They help the cartilage cells (called chondrocytes) stay healthy. At the same time, they slow the enzymes that can tear down chondrocytes.

Studies have already shown that patients who take glucosamine or chondroitin for knee pain don’t get relief from their back pain. But maybe injecting these substances into the disc space could help back pain sufferers with disc disease.

This theory is the basis for a pilot study by doctors at the Spinal Diagnostics and Treatment Center in California. A pilot study means something is being tried for the first time. Before spending a lot of money on an idea, researchers try it out on a small scale to see if it works. If the results are good, a larger study can be done.

Thirty patients with chronic low back pain were studied. All of them had many other treatments, and all failed to respond or responded poorly. In this study, everyone was injected with a solution made of glucosamine, chondroitin sulfate, DMSO, and Marcaine (a numbing agent like lidocaine).

The first injection went into the damaged disc. A second injection (without the chondroitin) was put into the facet joints at the same level as the disc. This was because previous studies showed that chondroitin is irritating to the joints.

Success was based on the patient’s report of pain and disability. The results were divided. Half the group got at least 50 percent better, while a third failed to respond. The remaining patients got some relief from pain but not enough. Everyone had some amount of pain after the injection.

The authors think the results of this pilot study are good enough to take the next step. They think that injections of glucosamine and chondroitin may help reduce back pain from disc disease. Another larger study is planned.

Back in the 1950s, one doctor began a study of the spines of first graders. Dr. Daniel Baker took spine X-rays of 500 six-year-old children in a northern Pennsylvania town over three years. He was looking for a condition called spondylolysis. Spondylolysis is a defect or fracture in the pars interarticularis (also just called the pars) of the vertebra.

The pars is an area in the protective bony ring on the back of the spinal column. There is one pars on the left and one on the right of each vertebra. A bony defect here can actually create a separation in the bone. If the condition happens on both sides of the bony ring, the vertebra can slip forward over the one below it. This slippage is called spondylolisthesis.

This study has continued since the 1950s. It has followed the children into adulthood over a span of 40 years. This gives an idea of the natural history of this condition over time. Doctors and parents want to answer several questions: Will spondylolysis always develop into spondylolisthesis? Can a defect of this type heal on its own? Are sports and physical activities allowed?

Out of the 500 children, 22 had spondylolysis by age six. Healing occurred in some children who only had the defect on one side of the bone. This is called a unilateral defect. Unilateral defects never slipped. Subjects with this type of spondylolysis only reported mild low back pain (if any at all).

Knowing if and when future slippage will occur is hard to guess. The authors report that having the defect on both sides (bilateral defect) increases the risk of slippage. Slippage, if it is going to occur, appears to occur at a faster rate before adolescence, and it tends to slow with age.

This study tells us that spondylolysis is usually a benign (not a serious) condition. Slippage can occur if the defect is present on both sides. However, most people with a pars defect live without pain and are able to do all activities. The authors say that doctors should not advise against sports just because a person happens to have spondylolysis or a minor slippage (spondylolisthesis).

The common wisdom is that back and neck pain are increasing in children. Yet research is unclear about exactly how many kids have such pain. Studies claim that anywhere from eight percent all the way up to 75 percent of children have had back and neck pain. It is also unknown exactly why kids have more back and neck pain. Recently, the focus has been on how backpacks and school bags affect kids’ spines. This issue has been especially important in Europe.

This study from the Netherlands looked at the weight of backpacks carried by 12- to 14-year-olds. It was found that the children carried on average about 15 percent of their body weight in their backpacks, although there was a wide variation in pack weights. The researchers also questioned the kids about their lifestyle and pain. What they found is that about 45 percent of the children complained of pain in the back, neck, or shoulder. (About six to seven percent had severe pain.) However, the weight of backpacks was not related to the severity of pain. And only about 13 percent of kids carried their packs in the way that was easiest on the back and neck.

Researchers found that pain levels had no relationship to sports, smoking, or time watching TV and using computers. The strongest link was seen in kids who reported vague feelings of poor health, such as headaches, fatigue, and stomach aches. There was also a link in kids who thought their packs were especially heavy, even though they usually overestimated the loads they carried. Girls had more pain than boys, and children from the city reported more pain than children from the country. The researchers had no theories about why this was true.

The authors found it alarming that almost half of the kids in this study reported having back, neck, or shoulder pain. Children with back or neck pain often become adults with long-term spine pain. It is a potentially serious problem that should be addressed. But this study suggests that backpacks can’t carry the whole load of blame for back pain in kids.

Does your child or someone you know carry a heavy backpack to school? Are you worried about back problems? Does your child complain of neck or back pain?

If so, you’re not alone in your worries. Studies from around the world reflect parents’ concerns over these issues. Researchers at the Dupont Hospital for Children report a direct link between backpack use and back pain.

Children from private and public schools (ages 12 to 18 years) were part of a survey about backpack use and back pain. The backpacks were weighed and compared to each child’s body weight and size. Three-fourths of the students reported back pain. More girls were affected than boys.

The students who carried their backpack from class to class had more back pain than anyone else. Carrying a backpack up and down stairs or while standing and waiting increased back pain. This study reported no difference in back pain from using a pack with either one or two straps.

Teenagers who watched more than two hours of TV per day and carried backpacks at school were more likely to have back pain than backpack carriers who watched less than two hours. Finally, researchers reported increased back pain in students who carry more than 10 percent of their body weight.

The authors conclude that backpack use can lead to back pain in teenagers. The weight in the backpack and the amount of time wearing the backpack are two major factors. With increasing numbers of children and adults reporting back pain, researchers at this children’s hospital advise limiting backpack use.

Organ transplantation has become very successful in the United States. Researchers are working in labs to bring this same success to the spine. Once again, monkeys are the volunteers. Their low back is similar in shape to the human spine. Their upright posture is more human-like than animals who walk on all fours.

Scientists at the University of Hong Kong took disc material from the spine of one monkey and grafted it into the spines of 12 other monkeys. This is called an allograft transplant. Disc material was frozen after removal from the donor. Freezing helps preserve the cells and reduce rejection of the transplant.

Three groups of monkeys were studied. Motion was measured using a three-dimensional motion analysis system. One group was followed for up to eight weeks. The second group was tested again at six months. Repeat measurements were taken for the third group for up to 24 months.

In all cases, the transplanted discs survived. There was even ongoing life and activity at the cellular level two years later. However, by the end of two years, the discs were breaking down quickly.

The authors conclude that using fresh, frozen intervertebral discs from a donor is possible in animal models. It will be some time before this concept can be used in humans. In the future, disc transplantation may help delay spinal fusion. This would be especially helpful for young patients.

What do pigs, gene therapy, and the human spine have in common? Until 10 years ago, exactly nothing. But now the field of gene therapy is bringing many things together in the laboratory. Gene therapy is the science of replacing genes or other defective cells. Gene therapy may be able to help heal injuries or replace worn-out tissue.

In the spine, disc degeneration from aging or injury can lead to chronic back pain. Today’s treatment for this problem is to remove the disc and fuse the spine. Bone graft is used to join two or more bones together. Metal plates and screws may be used to hold the bones together as they heal, or fuse.

This study looks at the possibility of fusing the spine using gene therapy. The gene for bone growth is injected into the disc space. The idea is for it to trigger enough bone growth to connect the bone on either side of the space.

In the past, rats were used to study gene therapy to fuse bones together. This is the first study to use mammals, an important step before studying humans. Two groups of pigs were used. One gorup received gene therapy, and a second group (the control group) didn’t receive gene therapy.

Within seven days, bone formed in the disc spaces in the group that got gene therapy. Solid bone formed across all the disc spaces in the treated group. No bone growth was seen in the control group.

Only a small number of pigs was used. The purpose of the study was simply to see if the gene therapy method of bone fusion would work. The next step is to repeat this study with a larger number of mammals. In time, researchers may be able to get similar results in humans. An easily injectable method of bone fusion could replace the costs and complications of spinal fusion surgery.

Spinal fusion is used to hold two or more vertebrae together and prevent motion at that level of the spine. When the fusion doesn’t take and too much movement occurs, the condition is called pseudoarthrosis, which means “false joint.”

Some people aren’t able to have a fusion. For example, patients who smoke or who have diabetes are less likely to heal and form a solid fusion. Fusion may not be a good treatment choice for these patients.

Doctors are looking for ways to improve bone fusion. Electrical stimulation of the bone may be the answer. It’s been used with fractures of long bones and has only recently been tried in spinal fusions. This report summarizes the results of many studies using electrical stimulation with spinal fusion.

There are three ways to deliver an electric current to bones. Electrodes can be placed inside the body, as is done when the spine is fused. Implanted electrodes bring direct current to the bones. Two other methods can be used outside the body. One device has to be worn with a brace for eight to 10 hours each day. How well it works depends on the patient’s using it daily for six to eight months. Another external method is computer controlled and worn 24 hours a day until bone fusion occurs, which can take up to nine months.

Researchers aren’t sure how electrical signals cause bone cells to grow. They think that the electrical current sets up chemical and biologic responses that foster bone growth. More calcium appears in the cells after electrical stimulation. The authors reported the results of all three types of stimulation.

The authors conclude that many studies show promising results using electrical stimulation to improve spinal fusion. However, there are problems with the studies, and so far no one has scientifically compared all three types of stimulation. Electrical stimulation is used on a case-by-case basis and isn’t for everyone.

For years, doctors have tried to find the best way to fuse two bones together. Bone graft is the accepted way to do this. However, taking bone from another part of the body or from a donor has definite problems. Researchers haven’t been able to find a substitute material better than natural bone–at least until now.

In 1965, a scientist discovered proteins called bone morphogenetic proteins (BMP) that make bone. In 2002, the Food and Drug Administration (FDA) approved a manmade version of this protein. It’s called rhBMP-2, or recombinant BMP. “Recombinant” means it’s formed by rearranging the genes.

More than 60 doctors at 36 different centers helped with this study. Together, they enrolled 679 patients. No single doctor had more than 10 percent of the cases. Thus, the results represent a wide range of doctors with different levels of experience.

All patients had a special cage filled with bone placed between two bones in the spine. Cages are becoming more common in spinal fusion. They spread and hold the two vertebrae apart where the disc was taken out. The bone material inside the cage binds, or fuses, with the vertebrae above and below.

Two methods of bone grafting were used in this study. The first is the standard bone graft taken from the patient’s pelvic bone. The second is rh-BMP called INFUSE Bone Graft. In all cases, the INFUSE recombinant bone had better results.

Patients getting the INFUSE graft had shorter surgery time, less blood loss, and a shorter stay in the hospital. This group also had a higher fusion rate, less pain, and returned to work faster. And there were fewer re-operations in the patients with INFUSE.

The authors of this study found INFUSE Bone Graft superior to human bone. INFUSE may become the new standard for spine fusions using cages.

Steroid injections have been used to treat pain from spinal nerve roots since the 1950s. Doctors injected blindly by relying on anatomy. They couldn’t actually see what was going on inside the spine. This all changed with recent progress in medical imaging.

With a special form of X-ray imaging called fluoroscopy, the needle is guided to the right spot. A fluoroscope is a special type of X-ray that allows the doctor to see an X-ray picture continuously on a TV screen. This method also makes delivery of drugs, such as steroids, safer and easier.

In this study, doctors from several pain clinics put their research efforts together. They used fluoroscopy to guide a needle and a thin tube to a specific spinal level. Electrical current delivered through this pathway was used to find the exact nerve causing pain.

This new method of spinal steroid injection does two things. It shows which nerve is causing the problem. It also allows delivery of steroid drugs to the correct spinal nerve root.

By guiding the medicine to the right spot, patients may get enough pain relief to avoid surgery. And it reduces accidental injection of the medicine into the nearby blood vessels.

Patients with chronic low back pain are sometimes treated with lumbar fusion. Two or more vertebrae are held together with bone graft. Metal plates and screws, called instrumentation, may be applied to hold the problem area still and help the graft heal. Fusion limits motion at that level of the spine. However, it may cause increased movement at the levels just above and below. Some researchers think that the fused spine causes degenerative changes in the joints just above and below the fusion.

Engineers, physicians, and scientists worked together in this study to measure forces on the fused spine. They used human cadavers (bodies preserved for study). Special technology was used to apply pressure to the spine at various levels. Range of motion was measured at each level during this testing. Pressure within the disc was also measured. They found there is increased tension on the disc at the level of the fusion in some (not all) motions. Movement at the level of the fusion was reduced, but not eliminated.

The authors also reported some motions are affected at the fused level. The spine is stiffer, but not necessarily blocked from moving. Fusion appears to cause increased motion in the segments above and below. However, these segments don’t move any more than other areas of the spine.

Current research shows that all spinal levels in the low back are affected by fusion in this part of the spine. Increased loading and motion can be measured as proof. According to the authors, the spine degenerates in sections. It is likely that the segments just above and below the fused level are prone to damage from the added motion. Parts of the spine that are already degenerated seem to affected the most, whether they are close to the fusion or farther above or below.

A recent study of lifting highlights some differences in the ways men and women lift heavy objects. When lifting loads in the workplace, men have greater pressure on their spine than women. However, this study indicates that women are at greater risk of injury when lifting heavy or uneven loads.

In this study, 20 healthy men and 20 healthy women lifted the same boxes from a shelf or from the floor. Measurements were taken showing the effect of gender on spine loading during lifting. A higher load was noted when an object was lifted from a set height from the floor. Lifting the object from knee height instead of from the floor put less pressure on the spine of everyone in the study. This supports the recommendation to adjust the shelf height to fit the individuals doing the lifting.

Men and women experience different loads on the spine when lifting. Workplace factors, including shelf height, also influence pressure on the spine. According to the results of this study, differences in gender, as well as in box weight and lifting height, must be taken into account when building or designing a workplace.

Low back pain (LBP) is common in pregnant women. In fact, up to 20 percent of women with LBP say that it started during pregnancy. No one is exactly sure why. Theories include the effects of hormones on the joints and ligaments and postural changes. But it is unclear physically what is happening to the spine in a pregnant woman with LBP.

These researchers took a step toward answering that question. It is known that lifting and carrying puts force on the spine. It is possible that this force causes the discs of the spine to lose fluid. Discs are fluid-filled cushions between the vertebrae. When they lose fluid, the spine actually shrinks a bit in length.

The authors measured spinal shrinkage in pregnant women with and without LBP. The control group was made up of women with healthy backs who were not pregnant. The spine length of all three groups was measured using special equipment. All the women then walked short distances with loads that gradually increased from nothing to about 13 pounds. Spine length was measured right after walking and again after 20 minutes of lying on the left side with the knees bent. The authors called this the “unloading” position.

All the women had about the same amount of spine shrinkage right after exercising. However, there were major differences in the groups’ spine measurements after the unloading period. The control group actually recovered more than 100 percent of their original spine length. Neither pregnant group got back to their original spine length. But the pregnant women with no LBP recovered more spine length than the group with LBP.

All the groups recovered spine length during the unloading period. The authors think that this means that resting in the unloading position for longer periods and more often could help pregnant women with LBP.