News Category: General Spine

If you’re a dairy farmer, is it better to have more cows, or cows that produce more milk? If you ever need a bone graft to fuse your spine, the same question applies. Is it better to have more bone cells, or cells that produce more bone cells?

This is the focus of a research study at the Orthopaedic Research Lab in Denmark. Animals were used so that cells could be counted three weeks after the fusion operation. The same amount of bone graft was used in each animal.

The amount of new bone growth in a grafted area is called fusion mass. Computed tomography (CT scan) was used to estimate the bone cell volume. X-rays were also used as a second means of looking at the fusion mass.

The scientists found that the number of bone cells is more important than how fast each cell can make more cells. They conclude that the amount of bone graft used is the most important factor in creating a solid bone fusion.

Neck and arm pain with numbness and tingling can be caused by a cervical rib. This is an extra rib attached to the lowest bone in the neck or cervical spine. There are seven bones in the neck. Normally, there aren’t any ribs attached to these bones, and ribs are attached to the bones of the spine (vertebra) starting in the thoracic (chest) region.

The first rib normally attaches to the eighth vertebra in the spine. This is the first vertebra in the thoracic spine. The first rib comes around from the spine, under the collarbone. It attaches in the front to the breastbone.

In the case of a cervical rib, the lowest bone in the cervical spine has an actual rib attached. Sometimes, the cervical rib is formed by extra bone growth of the transverse process, which juts out on each side of the vertebra.

For the first time ever, doctors in Turkey have measured the transverse process in a large number of adults. They did this to identify when a transverse process is a normal length and when it is long enough to be called a cervical rib. They found that more people have cervical ribs than expected.

Before this study, it was reported that one percent of the adult population has a cervical rib. This new study shows that six percent is more accurate in Turkey. Even more startling is that when someone has a cervical rib, there is a much greater chance of having another condition called sacralization. In sacralization, the last bone in the base of the spine is fused or connected to the sacrum. (The sacrum is the triangular “tailbone” situated between the two pelvic bones.)

People with neck or low back pain may have a cervical rib or sacralization of the lumbar spine. The presence of one condition alerts the doctor to the possibility of the other. These conditions can be found with a simple X-ray. This may save the patient from more expensive, high-tech testing.

Osteoporosis is on the rise. This condition of fragile bones is a disease that can be prevented and even cured. It is important that people at risk for osteoporosis learn about the condition so they can take steps to avoid painful bone fractures.

These authors did osteoporosis screenings on 325 patients who came to a spine clinic for various reasons. All the patients had risk factors for osteoporosis. The tests showed that about 22 percent of them had osteoporosis–a rate much higher than the national average of nine percent.

The authors suggest that spine and other orthopedic clinics have a responsibility to screen their patients for osteoporosis. They recommend that orthopedic doctors be aggressive about giving their patients education and testing to help fight osteoporosis.

Car and motorcycle accidents cause all sorts of serious injuries. These authors studied how traffic accidents injure the spine. They looked at the medical records of almost 4,000 patients in England who were seriously injured in car and motorcycle crashes. Of that total, 126 people on motorcycles (11.2 percent) and 383 people in cars (14.1 percent) had spine injuries. The authors found a number of interesting facts about car and motorcycle crashes and their effects on the spine.

In motorcycle crashes:

People with ankylosing spondylitis (AS) have to be careful not to hurt their backs. There is an increased risk of vertebral fracture. In fact, people with AS are four times as likely to fracture their spine compared to adults without AS.

AS is an inherited condition. It is a type of arthritis that causes the spine to fuse together. It affects young people most often. Symptoms first show up between the ages of 15 and 30. AS is rare after age 40. Men are affected two to three times more often than women.

Even minor trauma such as a fall from standing or while walking can cause a serious spine injury among people with AS. The spine can fracture anywhere in the mid- to low back. Treatment depends on the location of the fracture and whether the spine is stable. If the bones aren’t stable, movement can occur and cause dislocations and deformities.

Some patients get better with rest and don’t need surgery. Most patients have surgery to hold the spine in place safely. Anyone with dislocation of the spine or symptoms of nerve damage will likely
need surgery. The spine is usually fused together at two or more levels. To prevent injury or future fractures, patients are also shown how to lift properly. Preventing spine injuries is important for anyone with AS.

It has been proven that twice-a-week supervised exercise for back pain is helpful. Would three times a week would be even better? This is an important question when trying to cut health care costs without hurting patients.

Doctors at a spine center in Boston decided to study this question. They chose patients with moderate back pain who were still working. The pain had been present for more than three months. Two groups were formed. Both groups received an intensive exercise program. One group had two sessions each week. The second group met three times a week.

Treatment sessions were two hours long. Sessions included stretching, low-impact aerobics, strengthening exercises, and exercise on endurance equipment. Patients came to their sessions for six weeks. No hands-on treatment or other physical therapy was offered.

At the end of the rehab program, there were no differences between the two groups. This type of exercise has the same result when done two or three times per week. The authors of this study report that fear of injury and change in muscle function caused by pain are the key problems in recovering from back pain. The exercise program appears to help patients overcome these problems with only two sessions each week.

Reducing treatments to twice a week is not advised for patients who are too disabled to work, however. A twice-weekly program seems best for otherwise healthy adults who are still working in spite of pain.

Tobacco products cause damage to the spine in animal studies. Nicotine, the active ingredient in tobacco, causes the discs between the bones of the spine to break down more quickly. This happens because nicotine indirectly kills the disc material.

The disc is made of a soft, spongy material that does not have its own blood vessels. Instead, many blood vessels surround the disc to bring blood to the area. This network of blood vessels bringing oxygen and nutrients to the disc is divided into two parts. One section goes to the center of the disc (the nucleus pulposus). The other blood vessels supply the outer disc (the annulus fibrosus).

A recent study in Japan used rabbits to study the effects of nicotine on the spine. The rabbits were injected with nicotine levels equal to a heavy smoker. Nicotine killed the cells of the blood vessels, especially the vascular buds. Vascular buds are new growths coming from a blood vessel already in the area. They are part of the blood supply to the nucleus pulposus. The tips of the buds actually touch the disc. Oxygen and nutrients normally pass from the buds to the disc.

According to this study, smoking reduces the number of vascular buds and narrows the opening of the blood vessels. Less oxygen and fewer nutrients get to the disc. The result is more rapid and greater damage to the discs and eventual death of the tissue.

What comes to mind when asked if you are satisfied with your health care after a back problem? Returning to work? Becoming pain free? Being able to return to all your usual activities?

Doctors and hospitals are asking patients to rate their satisfaction with the care provided. This can be measured by asking patients what they expected before treatment and comparing this to their responses after treatment.

Patient satisfaction is important because it is directly linked to cooperation and participation in treatment. For example, incorrect expectations about back surgery can cause problems after surgery. Most patients expect to feel no pain and to go back to their usual activities. The actual results can sometimes feel disappointing.

Expectations that are out of reach before back surgery lead to lower levels of satisfaction after surgery. Even so, patients at a large spine clinic reported they had made the right decision to have the surgery. Researchers suggest that patient satisfaction can be improved if patients are taught to set goals that can be reached. This can be done before surgery with classes and information booklets.

Anyone who has pain constantly and for a long time can become depressed. Pain has kind of a “wear and tear” effect on the mind. Depression is a common problem in adults with long-term back pain.

About a third of patients with back pain from spinal stenosis or disc herniation report depression. Spinal stenosis is a narrowing of the bony canal around the spinal cord. Disc herniation occurs when the spongy material between the bones of the spine pushes out of its space.

Doctors don’t know which comes first: the back pain, or the depression. This information is important because surgery is often the treatment for these back conditions, and depression is linked with poor results from surgery.

A new three-question survey helps identify people with back pain who are depressed. This will help direct treatment toward the mind as well as the body. The questions are easy to include in the patient’s medical exam. Knowing if the patient is depressed will help doctors know when to avoid surgery or try other treatment methods.

All of the major joints in the body can be replaced with a plastic or metal joint called a prosthesis. Shoulder, elbow, hip, and knee replacements are common operations. Now, scientists are turning their attention to the back — in particular, to the discs between the bones of the spine.

The disc is a soft cushion between each vertebra that helps cushion and spread out the load. The center part of the disc, called the nucleus, also acts as a pump to bring in fluid for shock absorption. The discs often wear away or collapse as the body ages. The most common surgery for this problem is a discectomy. A discectomy involves removing the disc. Sometimes, the bones are also fused together.

A discectomy isn’t a perfect solution to the problem, because the spine still needs the disc. Without the disc to cushion the bones, wear and tear increases in the spine. Nearby discs take up the extra workload. This puts them at risk for damage.

Scientists are now testing a nucleus prosthesis. They are loking at different ways to remove only the center of the damaged disc and replace it with plastic or rubber material. The new nucleus has to be acceptable to the body. This is called biocompatibility. It also has to last a long time and not leak while giving the spine the support it needs.

There are several nucleus prosthesis designs being tested in the United States. None is on the market yet. Studies are done first on cadavers (human bodies used for study) and then on living humans. In this case, animals are not good models because there are too many differences in spine load and movement. Nucleus replacement may provide another solution for disc problems that require surgery.

Infection can occur in the spine. It is most commonly by bacteria or fungus. Infection can affect the bones and the soft tissues in the spine.

Spinal infections happen in children and adults. Some people are at greater risk. For example, anyone having open back surgery is at risk. Older men, anyone using injected drugs, and people with other diseases, such as diabetes or tuberculosis, are also at greater risk for having a spinal infection.

Treatment depends on knowing what kind of infection is present. Specific antibiotics are matched to each kind of bacteria. The earlier the problem is seen, the sooner diagnosis and treatment can begin. Early treatment means fewer symptoms and less chance of needing surgery. Good nutrition is especially important for a quick return to health.

If spinal infections are not caught early and treated successfully, the infection can spread. This can lead to destruction of the bones and soft tissues in the spine. It can also cause pressure on the spinal cord or the spinal nerves, leading to even more severe problems. Back pain from a spinal infection can last for months and become chronic, even with treatment.

Returning to work after a back injury often depends on how much and how often the worker can lift (called lifting capacity). This is the main focus in deciding disability benefits. It is used by the Social Security system and many other large retirement programs.

These groups assume that the ability to lift shows how fit the spine is. But how true is this? Are there other factors that add to lifting ability? Researchers are starting to look at these questions for the first time.

So far, they know that the strength of the back muscles is important in lifting capacity. A new study reports that aerobic capacity is also needed. Aerobic capacity is the ability of the heart and lungs to supply muscles with oxygen. The amount of oxygen needed increases as the muscles work harder or longer.

Back strength and aerobic capacity are both needed for lifting. Both must be part of a return-to-work program after back injury. Exercises that include both will also cut down disability and prevent reinjury. This information can be used in choosing employees for jobs that call for lifting. This may become part of prescreening in jobs with lifting. It could also be used as a deciding factor for workers switching from one job to another.

Physical therapists help people with low back pain to retrain muscles and develop better posture. Different postures use different muscles. Sometimes the same muscle acts differently depending on the position of the body. Humans standing upright against gravity tend to slump forward. They relax their muscles, rather than use their muscles to hold them upright. This is true in the standing and sitting positions.

For people with back pain, these relaxed postures can make their pain worse. The old saying “use it or lose it” applies to muscle function and posture. The habit of slumping while standing or sitting actually deactivates muscles of the abdomen and back. These muscles are very important in protecting the low back. Without them, the load on the ligaments and discs of the spine is increased.

How much activity is normal in the muscles of the back or abdomen during erect sitting and standing? This is the subject of many studies. So far, it seems these muscles show slight to constant activity depending on the person. This may be caused by different natural postures unique to each person.

Studies show a clear link between muscles of the back and abdomen with standing or sitting up straight. Practicing good posture is important in keeping these muscles tuned and healthy.

Low back pain that lasts long after an injury is a mystery to researchers. A key to speeding recovery is to find out how the nerves and muscles work together to hold the spine steady and move the spine. If muscle control is changed by the injury, then perhaps it can be returned to normal. The right kind of exercise program may be the answer.

Many studies are being done to measure muscle activity with motion. Adults without back pain are compared to adults with back pain. How and when the muscles fire is measured during different movements. The most commonly studied muscles are the abdominal muscles and the spine muscles that extend the back (the erector spinae).

An important part of these studies is understanding proprioception. This is the special type of sensation that tells the joints where they are and how they are moving. The skin, muscles, and tendons also have this sense of position.

Proprioception may be changed in people with low back pain, causing the muscles to activate abnormally. Normal muscle activity is needed to keep the spine stable and to prevent injury. If muscles are not activated during certain movements, stress on the back could cause injury and painful symptoms.

It is clear that the deep abdominal muscles and the back muscles are delayed in firing with some back motions. This delayed activation may be from damaged proprioception. Scientists have found which muscles are involved but not necessarily the cause of the problem. More studies are being done to answer this question. This information will help direct treatment programs using exercise.

Electrical stimulation has been used for over 30 years to treat low back pain. Electrodes are placed over the skin to transmit electrical impulses to the nerves. This is called transcutaneous electrical nerve stimulation or TENS.

Last year, a study showed that there is no reason to use TENS for low back pain. The treatment did not reduce pain or improve function any more than not using it. This information sparked lots of discussion in the fields of physical rehabilitation. Other researchers did studies to confirm these results.

All of the studies came to the same conclusion. TENS does not relieve pain, improve motion, or increase activity for patients with long-lasting low back pain. But before TENS is thrown out completely, some medical researchers insist more studies are needed.

Researchers need to look at how TENS is applied. For example, what happens when TENS is used with vibration instead of being used alone? What happens when higher intensity stimulation is used? Researchers need to measure results in the same way and report the same kinds of information. This is called “uniformity in reporting.”

Recently, the use of electrical stimulation for control of chronic low back pain has come into question. Many studies have reported that TENS does not reduce pain or improve function. But before physical therapists stop using TENS for patients with back pain, more information is needed. Researchers have already begun to look at how TENS is used and ways to improve its success in treating back pain.

The use of computers has brought a new set of orthopedic problems. Sitting in front of a computer screen can put stress on the head, neck, and shoulders. Are some computers more body friendly than others? Does computer size make a difference? Are sitting postures different for people with larger (desktop) versus smaller (laptop or notebook) computers?
 
Researchers in Hong Kong wondered whether smaller computers cause more back and neck problems than larger computers. The researchers found that people who work on smaller computers don’t adjust their chairs or desks to see the smaller screen. Instead, people change their body posture. They slump forward and stick their heads out in a “turtle position.” They also type more slowly.

Desktop computers seem to be more body friendly than smaller models. Long-term use of laptop or handheld computers increases stress on the neck and back. People using smaller computers should adjust their workstations appropriately to keep good posture.

“Alternative health care” refers to care that’s different from traditional medicine. Alternative health care includes a wide variety of options such as acupuncture, Rolfing, yoga, naturopathic or homeopathic care, reflexology, visualization, and methods of relaxation.

Medical care in the United States is based on the idea that there is a cause for physical disease that can be explained by science or biology. The disease or condition can be treated and sometimes even cured. Traditional medicine is meant to rescue us from death or disease with the latest technology, therapy, or medication.

Alternative care is based on different cultural attitudes about health and healing. Most alternative approaches come from the idea that the mind and body can’t be separated. In this line of thinking, imbalances in the mind-body system allow diseases or disorders to begin. Instead of trying to find and treat symptoms, alternative care tries to restore the mind-body balance. This is thought to encourage the body to heal itself.

Chiropractic and massage are the two most popular kinds of alternative care. The number of people seeking chiropractic care has been steadily increasing. The number of chiropractors in practice has tripled in the last 30 years and is still on the rise.

Researchers surveyed over 1,000 patients from six different regions in the U.S. to find out who sees chiropractors and why. Not surprisingly, the researchers found that most chiropractic care is for neck and back pain. More than half of chiropractic patients are white, married women with good educations and middle-class incomes. Interestingly, chiropractic patients have poorer mental health and more depression than back patients who see medical doctors. Chiropractic patients also have more pain and poorer physical health than the general population.

Chiropractic care is most often the treatment choice of white, middle-class women who are depressed. What’s the link between choosing chiropractic and mental health? Researchers aren’t sure. It may be that chiropractic care is more open to mental or emotional problems. The high level of education of these patients suggests that they knowingly choose chiropractic over medical care. Users of chiropractic care are more likely to share an attitude toward health that is different from traditional medicine.

Aging adults face many problems from osteoarthritis and osteoporosis. Osteoarthritis (OA) is a disease of the joints that causes slow destruction of the joint surfaces and underlying bone. Osteoporosis means “porous bones.” With osteoporosis, there is less bone mass with many open spaces within the bone. People with osteoporosis are more likely to fracture or break their bones than the average person.

There is some question about why these two diseases occur together. Many reports have tried to explain the connection between them, but nothing has been proven. Doctors in Japan compared two groups of 42 women ranging in age from 64 to 83 years. One group included women with OA who had total knee replacement. A second group was made up of women with a break at the top of the thighbone (femoral neck fracture).

This study looked at how fragile the bones in the spine were for both groups. The researchers measured bone mineral density and used X-rays to examine the bones in the low back area. Specifically, they looked at how much bone had been destroyed, how much space was left between bones, and how much the bones had been pressed down.

Compared to women with osteoporosis, women with OA of the knee had more severe back problems. Women with OA had more fractures, were much heavier, and showed more bone changes in the joints and back. Doctors suspect these differences occur because women with OA have fragile bones all through the body. Women with osteoporosis may only have thinning bones in some areas.

This study shows that women with knee OA who had total knee joint replacement tended to be heavier and have less bone mass in the spine. This new information raises the question whether women who end up needing knee joint replacement surgery have a greater risk for fractures of the spine than women with osteoporosis.

Most adults lose height as they age. What causes this? Scientists have different opinions on the matter. Some say it’s the reduced height of the discs between the bones in the spine (vertebrae). Thinning and loss of fluid cause discs to lose height with age. Other scientists suggest that the true height of discs actually increases with age. With this thinking, loss of stature is mainly caused by the bones getting compressed.

Pondering this question, researchers in Germany studied X-rays of over 1,200 adults. Both the discs between the vertebrae and the vertebral bones were measured using a new, more accurate method.

The purpose of the study was to collect a bank of information called a baseline. This gives researchers a place to start when comparing one person to the next. It also tells them more about what happens to the height of discs and the shape of vertebrae with age.

The results of the study were surprising. The discs in the low back actually increased in height until people reached the age of 70. This was true for both men and women. At the same time, the main part of the vertebral bones got smaller with age. The middle of the bones actually appeared to sink in. This is referred to as increased concavity.

Data collected from a large number of back X-rays answered some important questions. The loss of height that comes with age is caused by changes in the bone, not changes in the discs between the bones. This information will help doctors compare patients’ X-rays to “normal” adults at various ages.

Back pain is costly, both in the expense of medical care and loss of time from work or school. This is true in the United States and around the world. It’s only natural to start looking at these children and wondering how to protect them from this problem.

Researchers want to know whether a back education program for children makes a difference. One research group reported that back education programs alarm children. Another group showed improvement in sitting and lifting postures used by children after only three lessons. Two studies found no effect of short back-education classes on lifting. Even with all this information, no one really knows if early back education makes any difference.

There may be good reasons for the limited success of these back education programs. Some programs only covered one or two aspects of back care. Sometimes the follow-up studies were too short (less than three weeks). Studies that lasted longer tended to find wider use of the information and fewer cases of low back pain.

In Belgium, a health insurance company sponsored a back education program for fourth and fifth-grade children. The program was based on the German Back School and articles or books on how the back works. The goal was to teach children good body posture and proper use of the back during various tasks. Each child received six 60-minute sessions with a physical therapist.

Each child was observed through a candid camera before the back education classes. This was repeated one week, three months, and one year after the classes. Children were filmed sitting in class while using a ring binder. They were also filmed taking off their shoes, lifting and putting down a heavy object, throwing small objects, and picking up a small object from the floor.

One year later, some of the children were still using healthy postures and lifting habits. Also, the rate of neck and back pain was much less on a week-by-week basis after the back education program.

Elementary schoolchildren can benefit from a program of back care tips. Learning how to hold books, lift properly, sit with good posture, and carry a backpack does result in fewer cases of neck and back pain. This effect lasts at least a year–maybe more.