News Category: General Spine

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.

You’ve all heard that smoking is bad for your health. There is a warning label on every pack of cigarettes and on every advertisement. The media continues to report ways in which smoking negatively affects health. We know that people who smoke live five to 10 years less than people who have never smoked. Smoking has been directly linked to lung cancer. Beyond the lungs, almost all tissues and body systems are affected by tobacco use.

If that’s not enough, we can add to the list an increased risk among smokers for:

• cardiovascular disease


• depression


• osteoporosis and bone fractures


• delayed healing of wounds


• degeneration of the discs in the spine

An organization called the National Spine Network (NSN) decided to take a look at this issue. The NSN collected information about back pain patients from 23 different health care facilities in the United States. More than 25,000 people were included, making this one of the largest studies on back pain and smoking ever done.

The results showed that smokers who have low back pain are younger than nonsmokers and more likely to have severe pain. Smokers report many more symptoms of depression. Smokers also have longer recovery times from surgery of any kind. These differences were significant across gender, age, and educational levels.

The bottom-line bad news is that people who smoke have poorer health outcomes and take longer to heal from surgery compared to nonsmokers. This is especially true for smokers who are depressed. The good news is that both smoking and depression are treatable. Today’s new medications and programs make these problems much easier to overcome than in the past.

Obesity and back problems are both public health concerns. Obesity is a serious medical problem that is on the rise in the United States. It affects millions of Americans no matter where they live. Obesity is not based on age, ethnic background, level of education, or gender.

Back problems also affect many people in this country. Back pain isn’t usually fatal. However, obesity adds to risk of death. Obesity is linked to heart disease, hypertension, diabetes, cancer, and stroke.

Not much is known about how obesity affects the ability of a person with back pain to do daily tasks. People who are obese seem to have worse back pain and symptoms than those who are not obese. And data collected from 15,000 patients at 26 different clinics showed that obese people with back problems have more day-to-day difficulties than obese people with other conditions. For example, someone with obesity and back pain is worse off than someone with obesity and shoulder or knee problems. Likewise, obesity and back pain have a worse outcome than obesity and cancer, lung disease, or lupus.

Obese patients are more likely to receive workers’ compensation. They are also more likely to have leg and nerve pain. This study showed that obese back patients are more disabled overall. They have more severe back pain and a greater number of other health problems. Other problems may include heart disease, headaches, arthritis, stomach ulcers, depression, lung disease, and diabetes mellitus.

Some scientists think obesity puts people at risk for other health problems. Other scientists suggest that obesity keeps people from being active and exercising. This in turn causes back and other problems.

Another theory is that obesity and back problems are both connected to depression. Maybe obesity and back pain aren’t directly related to each other. Instead they may both be the result of depression, anxiety, and stress. Studies show that obesity and depression tend to go hand in hand.

What difference does this make, anyway? Doctors would like to be able to treat obesity and back pain more effectively. This kind of information helps them set treatment goals. It’s important to recognize that obesity is a chronic disease that negatively affects back pain. Without treating the obesity, the patient may not recover from back problems.

From physical health to general well-being, regular physical activity pays off big for kids. And active kids are more likely to become active adults, leading to better health in the long run. Clearly, it’s important to get kids moving. But what determines whether kids take to physical activity? Do their movement skills make a difference in how active they are?

These authors studied the movement skills of over 1,800 high school students in Australia. About half of the students were in eighth grade (13 years old); half were in tenth grade (15 years old). The students were asked to describe their physical activity in a normal school week. From this, the authors determined how many minutes per week students did vigorous physical activity. Students were also scored on six basic movement skills. These were running, jumping, catching, throwing (overhand), striking (with the front of the hand), and kicking.

Students who had basic movement skills spent more time in organized physical activities, such as basketball, tennis, and soccer. The relationship between skills and physical activity was especially important for girls. Improving girls’ skills just a little might encourage them to do 50 more minutes of physical activity a week. For boys, the relationship was not as strong. Because it’s more socially acceptable for boys to be in sports, skills may not be as important to whether or not they participate.

Movement skills were not related to “nonorganized” physical activities, such as walking, cycling for fun, and pick-up basketball. The authors think that the skills measured in this study may be less important to these kinds of activities.

From this study, it seems that movement skills make a difference, however slight, in whether teens are physically active. It’s best to start working on these skills early, in preschool or early elementary. The authors conclude that improved movement skills could have even greater payoffs for girls than for boys. Mastering movement skills early on could lead to a lifetime of healthy habits.

Women are more likely than men to experience back pain. What is it that makes women more susceptible? Researchers have started to look at the role female hormones may play in back pain. Studies of pregnant women suggest that hormones, especially estrogen, may have a loosening effect on the joints. This is thought to be a cause of instability in the spine–and back pain.

Some studies have suggested that women who use estrogen replacement therapy may be more likely to have back pain than those who do not. However, these studies have been inconclusive. These authors wanted to look at the relationships between estrogen use, back pain, and back function in a large group of older women.

The participants were 7,209 women from four cities in the United States. All of the women were white and over age 65. They filled out questionnaires about their estrogen use, medical history, and general health. At the beginning of the study and four years later, women were asked whether they’d had back pain during the previous year. They were also asked whether their back pain made it hard to do daily activities, such as getting in and out of a car or bending to pick something up.

Fourteen percent of the women were using estrogen replacement therapy (ERT). Another 27 percent had used it sometime in the past. Compared to women who had never used ERT, women who used estrogen were generally healthier. They were thinner and more likely to exercise. They also had healthier bones.

However, women who used ERT had more back pain than those who had never used estrogen. Women currently using estrogen were especially prone to back pain. At baseline, 53 percent of women using estrogen said they’d had moderate to severe back pain in the last year. Meanwhile, only 43 percent of women who had never used estrogen reported back pain. Four years later, back pain went down a little for both groups.

Why would women on ERT have more back pain? It’s possible that this generally healthier group is more likely to speak up about back pain. It’s also possible that older women who have back pain start ERT, mistakenly thinking their back pain has something to do with osteoporosis. Still, the authors believe the relationship is more direct; they think back pain comes from something the estrogen actually does to the spine.

Women who used ERT had more problems with daily activities due to back pain. Again, this was especially true for those using ERT at the time of the study. At baseline, 12 percent of women using estrogen said they had problems with activities due to back pain. Nine percent of women who had never used estrogen had problems due to back pain. Four years later, these numbers went up slightly for both groups. Seventeen percent of women using estrogen said they hadn’t been able to do activities for one or more days during the last year. This was true for only 13 percent of those who had never used estrogen.

Notably, women who used ERT had fewer vertebral fractures than women who had never used estrogen. This means that the increase in back pain couldn’t be explained by vertebral fractures. Lifestyle and medical history also didn’t explain the increase in back pain. Women’s age, body mass, smoking history, pregnancy, exercise habits, arthritis, and diabetes didn’t affect the relationship between ERT and back pain.

Black women seem to have less back pain than white women. Research is needed to define the relationship between ERT and back pain for this and other racial groups.

Women currently using estrogen had more back problems than women who used estrogen sometime in the past. There was no clear relationship between length of use and back problems. These results suggest that estrogen may have a short-lived effect on the spine. Certainly more research is needed to show exactly how estrogen affects the back.

Horseback riding is one of the riskiest sports for serious spinal injury. This is especially true for horse riding as a profession. Jockeys often push themselves past their limits, and horses can kick with up to a ton of force and move as fast as 40 mph. One researcher has even observed that more accidents happen per hour on horses than on motorcycles.

In this study, the authors looked at the long-term effects of horse riding on the neck and low back of professional jockeys. Thirty-two jockeys in three different age groups were observed for 13 years. Though the jockeys’ number of years riding depended on their age, they all rode for an average of 5.5 hours a day. Most of them (75 percent) reported some injury during their careers. 

The authors examined the jockeys and took X-rays of their necks and low backs. The results were compared to those of “normal” adults, who were also divided into three age groups.

Nearly half of the jockeys reported some pain in physical activities because of horse racing. The jockeys mostly felt pain in the low back, or in both the low and upper back. The oldest group of jockeys (over age 35) felt pain in the whole back after physical activity.

The X-rays showed that jockeys showed more signs of abnormal, or degenerative, changes in their spines, than normal populations of the same age. This was especially true of the jockeys over age 35, who had more degenerative changes than any other group. Overall, jockeys’ degenerative signs tended to show up more in the low back than in the neck.

Horseback riding brings the risk of direct spinal injury from falling from a horse. This study shows that spinal deterioration may also happen in jockeys. This deterioration can result from both repeated injury and long-term stress on the spine. More research is needed to find out how these problems affect a jockey’s future, both professionally and with day-to-day activities.

Lumbar disc herniation can cause severe pain in the back and even into the legs. It can also affect the nerves going to the hips and legs. In extreme cases it can cause partial paralysis and loss of bowel and bladder control.

There are two types of lumbar disc herniation. Contained discs are still held within a ligament sheath and have not squeezed out and contacted the outer tissues. Noncontained discs have pushed out of the ligament enclosure and have come in contact with outside tissue. These authors did two studies on the different kinds of lumbar disc herniations to see if the two kinds of lumbar disc herniations had different outcomes.

In the first study, the authors looked at the records of 156 patients with lumbar disc herniations. Of these patients, 108 had contained herniations, and 64 had noncontained herniations. Conservative treatments of rest, medications, and a sacral epidural block (a special kind of anesthesia) were tried in all cases. Surgery was done when patients began to have problems with their bowels and bladder, when muscle weakness became worse, or when the pain became intolerable. About 67% (104) of the patients eventually had surgery.

Notably, the authors found that most patients with noncontained herniations who had surgery did so in the first two months. Most significantly, almost none had surgery after four months. This led the authors to believe that noncontained herniations might go away on their own if patients could wait that long.

So, in the second study, the authors used conservative treatments for at least two months on 390 patients with noncontained herniations. Only patients with severe problems had surgery without this period of conservative treatment. This study lasted for one year. In that time, the number of disc surgeries in the authors’ hospital went down significantly. More importantly, only one of the patients treated conservatively had complications.

A guest commentator cautions that conservative treatment of a noncontained disc herniation isn’t right for every patient. And if the pain lasts for longer than three months, surgery is probably the best option. But many patients might be spared going under the knife, if they’re willing to bite the bullet and put up with the pain for a couple months.

Most of us know that lifting a heavy box the wrong way can cause an aching back. For most of us, the soreness goes away. For an elderly person, or for someone with osteoporosis, lifting a box the wrong way can cause more than a back ache. It can cause severe low back problems, or even vertebral compression fractures. If an older person becomes unbalanced when lifting, he or she runs a higher risk of falling and possibly breaking a bone.

These researchers tested the body movements of 91 older people as they lifted a box that weighed a little over one pound and set it on a table. All of the subjects were over age 60 and had some functional limitations due to arthritis or other conditions. The idea was to see how this group naturally did their lifting. Then the researchers analyzed how the lifting styles related to the strength of muscles around the knees and hips.

The results showed that people who had stronger knee and hip extensor muscles tended to lift mainly with their legs, which is a safer way to lift. People with weak hip and knee extensor muscles lifted mainly with their backs, which heightens their risk of injury. The research also showed one more style of lifting: people with hip extensors that were weaker than their knee extensors used a combination of back and legs when lifting. This style was safer than lifting with the back alone, so the authors suggest it is a safer compromise when people don’t have the strength to lift mainly with their legs.

The authors also tested how stable the participants were when they lifted. Being stable during lifting lessens the chance of a fall. The results showed that those using their legs were more stable than others who lifted mainly with their backs.

This information can help doctors and therapists treat older patients with functional limitations. This study showed that patients naturally lift with their backs if the hip or knee extensor muscles are weak. Just by watching a patient lift, clinicians can see which muscles might need strengthening and help develop a safer way of lifting. The goal would be to help older patients lift with as much ease as possible–so lifting won’t become a major pain in the back. 

In this editorial, the author gives a brief overview of current treatment for lumbar disc herniation. He explains that this condition is responsible for many cases of lower back pain and most lumbar surgeries.

But little is known about lumbar disc herniation. The condition can sometimes disappear on its own. This makes many surgeries unnecessary. But in which cases? Some patients only find relief with surgery. And the chances of complete recovery are better if patients don’t suffer symptoms for too long. But then again, lumbar disc surgery has a high rate of failure.

The author says there has been a shift in treatment of disc herniation over the past 20 years. In the past, aggressive surgery was the general approach. Now the author suggests the pendulum has swung to the point there is “an excess of nonoperative management.” He urges surgeons to better identify which patients will do better with surgery, and when.

Prevention is the key to keeping many health problems from getting out of control. Effective prevention strategies for back and neck problems could help many people avoid pain and disability. But which types of prevention really work?

These authors reviewed medical research to find high-quality studies that focused on preventing back and neck pain. This was a tall order. Not many studies deal with preventing pain in healthy individuals. The articles found by the authors focused on lumbar supports, education, and exercise. Only exercise was found to have any effect on preventing neck and back pain. No studies meeting the authors’ standards were found on ergonomics or behavior changes (such as quitting smoking or losing weight).

The authors note huge gaps in the research. They suggest that studies should look at a bigger pool of people and should be done over a longer period of time. This would take into consideration the fact that people tend to develop spine pain as they age, and that back pain flares up from time to time. There is a glaring need for studies on ergonomics and behavior changes. And future research should address the lack of compliance the authors noted in these studies. Often, the subjects had stopped using the preventive strategy even before the study was over.

The authors also suggest that future research should look at the combined effects of several different prevention strategies, rather than just one at a time. They also feel that future studies should focus on prevention strategies tailored better for the individual’s risk factors. Until then, exercise has the best track record for actually preventing neck and back pain.

Adolescent idiopathic scoliosis is a type of curvature of the spine that affects mostly girls. It starts to show up at about age 10. Sometimes, the curves get worse over time. If the curves in the spine begin to bend too far, surgery may be needed. In some cases, doctors will do a fusion surgery to immobilize the spine and keep it from bending. When the surgery is done along the back part of the spine, it is called posterior fusion. Fusing the front part is called anterior fusion.

Surgeons have questioned whether doing a posterior fusion alone leads to a problem called the crankshaft phenomenon. This is where a fused spine keeps growing and starts to get too much tension built up. It is thought that younger, immature spines are prone to developing this problem because younger patients have more growing left to do.

This study followed 18 children with scoliosis who had only posterior fusion surgery. Researchers looked at the children’s medical records over an average of three years after surgery. None of the patients developed crankshaft problems. The results were the same for the patients who were older, and thus closer to the end of their growing years, as for the younger patients.

Only one of the children showed significant worsening of the curves. She was one of the earliest patients. The researchers believe that the older, less-advanced kinds of implants–such as screws, wires, and hooks–used in her surgery may have contributed to her problems. The authors conclude that the newer types of implants that are now available may help avoid problems with the crankshaft phenomenon.

Kids with adolescent idiopathic scoliosis have a type of curvature of the spine. It starts to show up at about age 10. The curves sometimes get worse with time, leading to malaligned positions of the back, rib cage, and hips. If the curves get too bad, they can cause serious health problems. And the kids usually don’t like how the spine curves affect the looks of their bodies.

Doctors often prescribe special braces for kids with scoliosis to wear during their adolescent years. The most commonly used form of brace is called a thoracolumbosacral orthosis (TLSO). However, the research is unclear about how much the TLSO actually helps prevent the problems of scoliosis. To shed some light on this question, these researchers studied the medical records of 24 girls with adolescent idiopathic scoliosis. The girls all had significant curves and wore the TLSO brace 23 hours a day on most days. The researchers set up a system to make sure that the TLSO was put on equally tight every day. The girls were examined before bracing, one month after bracing, and regularly for four years. The girls were also examined at age 20, after they had finished using the TLSO brace. As part of their exams, special X-rays were done to show spine curvature from different angles.

The results showed that the TLSO brace did have a positive effect on the progression of scoliosis. In most cases, it corrected the twist in the spine. Most of the girls showed improvement in the alignment of their spine and ribs when they were wearing the brace. Significantly, only 12.5% of the girls needed surgery during the four years of the study. Bracing did not affect all the variables the researchers measured for, but it did improve or maintain several measurements. Many of the girls’ bodies looked better because they had better alignment when viewed from the front.

The story was somewhat different at age 20. By that time, measures of the spine and rib alignment in almost all of the girls was equal to their measurements before using the brace. This means the brace kept nearly all the girls’ spines from bending over the years. It is likely that their curves would have gotten worse without the use of the brace. The results of this study are better when compared to studies of other types of scoliosis braces.

When scoliosis is identified in girls after they have started their periods, the curves don’t tend to get progressively worse. This is because the curve may be mild to begin with, and these girls are nearly done growing. These researchers also found that girls with curves in their lower back saw better correction soon after starting to use the brace. Girls with curves in the middle back showed steady correction throughout the four years.

Researchers don’t know why these factors are true. But findings such as these can help doctors better understand the how scoliosis progresses and how to treat it.

Causes and effective treatments for back pain are often elusive. Much medical research focuses on back pain because the condition affects so many people. It also has a significant and costly effect in the work world. It is one of the major reasons people are out of work on disability status. But so far, medical research hasn’t uncovered any crystal clear truths about diagnosing or treating back pain.

This study, done in Norway, added a bit of information to the search for efficient ways of treating back pain. Researchers measured pain levels and physical performance in 117 patients who were on long-term sick leave because of back pain. The patients were divided into two groups. The intervention group was made up of 81 patients who took part in a specific rehabilitation program. The program was four weeks long, and patients had six-hour sessions, five days a week. Patients received physical therapy, education, adaptations to their workplaces, and assistance in making lifestyle or behavior changes. Little emphasis was placed on pain.

Meanwhile, the 36 patients in the control group arranged their own health care. About 75% received standard medical care, 32% reported using alternative treatments, and five patients didn’t seek any treatment.

Disability status, scores on the physical tests, and pain levels were compared in both groups from the beginning of the study and again one year later. At the one-year follow-up, half of all the patients in both groups had returned to work. They showed improvements over the year in the physical tests and in pain levels. Patients in the intervention group who had not returned to work tended to have high pain levels and difficulty doing the physical tests. However, the researchers note that performance in the common “fingertip-to-floor” test–bending over to touch your toes–didn’t seem to be related to patients’ ability to return to work.

In the control group, the results were not quite as clear. Those who didn’t return to work tended to have higher pain levels. But on the physical tests, they scored about the same as others in their group who had gone back to work.

Because the control group was so small and so little is known about the care they received, it is hard to draw clear conclusions from this study. However, the results do suggest that an intense, comprehensive rehabilitation program that emphasizes activity instead of pain may help providers more objectively sort out which patients can return to work after debilitating back pain.

Surgeons commonly use X-rays, ultrasound, and other imaging tests before and after spine surgery. These tests help them pinpoint the exact areas for the procedure and assess whether a procedure has been properly completed.

Intraoperative magnetic resonance imaging (IMRI) actually allows the surgical team to get MRI scans during surgery. IMRI technology has been used in neurosurgery for some time. The surgeons in this study used IMRI during 12 spine surgeries. The hope was that IMRI technology could improve the accuracy of surgical techniques by giving the surgeons updated images during the procedures.

All 12 surgeries were completed successfully, with no major complications. The authors report that the IMRI helped with surgical planning and locating. It also helped them verify the relief of pressure from the nerve roots in 10 of the 12 patients.

Using the IMRI has some disadvantages. The surgeries took somewhat longer than usual, which was partly due to the surgical team dealing with a new system and new equipment. In two of the patients, the IMRI was not helpful in confirming if pressure had been relieved around the spinal nerve roots, meaning that surgeons will need to continue to rely on their surgical knowledge and experience. Also, MRI scans don’t show bone as clearly as soft tissues, which may make it less helpful for some types of spine surgery.

One of the biggest limiting factors in using IMRIs may well be the expense. The start-up costs are significant, and it also requires using special operating room instruments that don’t interfere with the magnetic field of the machine. The high expenses means that doctors and hospitals will need to decide just how helpful the IMRI really is for spine surgery. Do most spine surgeries really require more precise imaging during surgery? As another doctor writes in a commentary on this article, “We must all ensure that we do not encourage the triumph of technology over reason.”

It is commonly believed that heavy physical loads on the spine cause the discs between the vertebrae to degenerate. The authors of this article tested that theory. They used screws and coil springs to compress the discs of dogs for up to one year. Then the dogs’ spines were studied for signs of degeneration.

The X-ray results showed no visible signs of degeneration. Researchers noticed no disc bulging, disc space narrowing, or cracks in the spine. However, they did see some microscopic changes in the cells of the discs. According to the authors, these microscopic changes might be early indicators of degeneration, which “supports the commonly held belief that high compressive forces play a causative role in disc degeneration.”

A year is an ample time to see if compression really has an affect on the spinal discs. And even though there were no visible changes, the microscopic changes suggests that care should still be taken when it comes to heavy and repeated loads on the spine. So although these new findings don’t add support for the old theory about disc compression, the old theory shouldn’t be discarded on this evidence alone.

Back pain: common, often recurring, difficult to treat. Medical science continues to search for clues about how to predict who will develop chronic back problems later in life.

These authors tried to find predictors for back pain by looking back twenty years. They followed up on more than 6000 Swedish men who had enlisted for the military at age 18, in 1979 and 1980. At that time the men had gotten physical exams and answered questions about their health habits, type of work, and back condition. By the time they were nearly 40 years old, they filled out a questionnaire with the same types of questions.

The authors found that the men who currently had back, neck, or shoulder problems were much more likely to have done heavy work at age 18. They were also more likely to have had everyday back pain when they were younger. Being overweight also related to back pain. So did smoking. The 18-year-olds who smoked more than 10 cigarettes a day were more likely to have back pain in middle age.

This study may not have provided doctors with a clear blueprint of how to predict chronic back pain. But it does suggest that heavy labor, being overweight, and smoking, even at young ages, can lay the foundations for lifelong back problems. 

Which came first–the chicken or the egg? Thin bones, or adolescent idiopathic scoliosis (AIS)? According to this study, the answer to the last question seems to be thin bones.

AIS is an abnormal side-to-side curving of the spine that occurs in adolescence. “Idiopathic” means that the cause of the problem is not understood. This study looked closely at the bones of youngsters with AIS to try to understand the condition’s cause. The 24 girls and four boys in this study were between the ages of 11 and 20. Researchers used two different methods to study the bones. Bone density was measured with a scan that uses low-radiation X-rays. Bone samples from an earlier back surgery were also studied using a high-powered electronic microscope.

Although bones seem hard and dull, they are actually very much alive. Bones are in a constant state of change. Osteoclasts are cells that break down bone tissue, while osteoblasts rebuild new, healthy bone. In this study, the microscopic look at AIS bone showed an imbalance in the way bone was being broken down and built up, resulting in abnormal bone growth.

The bone density scan confirmed this as a thinning of the bone, a condition called osteopenia. The bones of all 28 children showed both the imbalance and osteopenia. This is pretty typical of girls with AIS, as they show less bone and lower body height for their ages.

The authors believe that bone thinning was likely one of several factors that led to AIS. Heredity, hormones, and nutrition are also known to contribute to the development of AIS. The authors hope this research contributes to answering the puzzling question about the possible causes of AIS.

Spine surgeries can be very complex. They often involve placing hardware–rods, screws, pins, or cages–in the spine. Rates of complications are higher after these difficult procedures. Infections are more likely, and sometimes the wound fails to close or may even burst open after healing. In these cases, the hardware may become exposed.

Doctors try to get the wound to heal by cleaning up the tissue around the wound and by using antibiotics. When these measures don’t work, the wound may have to be closed by sewing a flap of skin, muscle, or soft tissue over the exposed area. But this can cause several possible complications.

The authors of this article looked at a different way to treat this problem. They reported on two cases where vacuum therapy was used to create suction over the open wound. This type of treatment is also called vacuum-assisted closure (VAC) or negative pressure therapy.

Both patients in the report were girls (ages 10 and 17) with exposed hardware after spine surgery. Both had wound infections. In both cases, the wounds were packed with a special type of sponge, sealed with special plastic, and fitted with a vacuum device. One patient used the device for six weeks. At that point, the wound was healed well enough to accept a skin graft. The second patient used the device for 10 weeks. Her wound healed without needing any further surgery and was still fine 10 months later.

Patients generally like this kind of therapy. The wound coverings don’t need to be changed as often, and the vacuum device is lightweight and portable. VAC therapy isn’t the first choice of treatment for all spine surgery patients, but it does seem to have fewer complications in difficult cases.

Doctors aren’t sure why VAC works, although the theory is that it has two helpful effects on wounds. First, the negative pressure removes extra fluid. This reduces the pressure in the wound and increases blood flow to the area. Fluids in chronic wounds may also get in the way of the healing process. Second, the suction stimulates the cells to form healthy tissue, which heals the wound better and faster.

The authors conclude that VAC therapy may prove especially useful in the healing of complex wounds where hardware is exposed. They suggest that more study is needed to determine which kinds of wounds could benefit most from VAC therapy.

We don’t realize it, but our eyes have a great deal to do with how we stand and move. The eyes feed the brain information about where the body is in relationship to the ground and objects all around us. Different eye positions in the eye socket inform sensors in the brain so the body can adjust its posture.

It is not surprising, then, that a link has been found between visual problems and spine problems. Scientists in France wanted to see if there was a relationship between scoliosis and vision problems.

A healthy spine normally curves in a couple different directions from front to back, with little or no curvature side-to-side. Scoliosis involves a side-to-side curvature, usually of the upper half of the spine. Often, an “S” shape develops as the spine compensates for the curve.  Scoliosis can be a progressive problem or, as with most children in this study, it can be fairly stable.

The authors compared 75 children who were blind or severely visually impaired with 728 children with normal vision. Both groups averaged between 10 and 11 years old. Researchers used several methods of scoliosis measurement, including specialized photography and the standard forward bend test. Children with visual problems and scoliosis also had X-rays of their back.

The results showed that children with visual impairment were twice as likely to have scoliosis as those in the control group. An additional finding was that 18 of the children with scoliosis also had a head tilt and turn. The authors thought that the head tilt was a way to compensate for visual problems, and that it led to scoliosis of the neck vertebrae. 

For example, nystagmus, a condition that causes constant circular eye movement, can be stopped by holding the head in a tilted position. Strabismus (crossed eyes) is caused by a weak or paralyzed eye muscle that keeps the eyes from looking in the same direction. Children with strabismus tilted their heads so they could avoid using their weak eye muscles. Over time, the head tilts resulted in scoliosis of the neck vertebrae.

Scoliosis caused by tilting the head didn’t seem to be a progressive problem in these children. That led the authors to conclude that this type of scoliosis should not be treated, unless the curve is severe.

Lumbar spinal stenosis is a term commonly used to describe narrowing of the spinal canal that causes pressure against the spinal cord. The problem is fairly common in people with back pain, especially in older people. There are several different types of conservative (nonsurgical) and surgical treatments for lumbar spinal stenosis. But so far it is unclear whether people get better results with surgery or conservative treatment.

Previously, these authors published the results of a one-year study comparing patients who underwent surgery and those who got conservative treatments for lumbar stenosis. It suggested that patients treated surgically got better faster, had less pain, and were more satisfied with their back condition than patients who got conservative treatments.

But did the results of surgery stand up to the test of time? The authors checked in with the same patients four years later. They found that both groups were doing about the same. However, the group who had surgery was still better off than the nonsurgical group. This held true even when the authors compared patients by their condition when they first saw a doctor for treatment. Significantly, 79% of the patients who had surgery reported that if they could go back in time, they would still have the surgery.

The authors note that poor outcomes are common with lumbar spinal stenosis, no matter how it is treated. Up to 40% of patients who have surgery, and up to 60% who get conservative treatment, are not doing too well after four years. So even though this study sheds some light on its possible benefits, surgery is not necessarily the automatic choice for all patients with lumbar spinal stenosis.