News Category: Lumbar Spine

In this study, eight healthy male adults ages 20 to 35 lifted a heavy crate from the floor to waist height. Each man lifted the box three times using a different lifting method.

Freestyle, stoop, and squat methods were used in differing orders by each man. The crate was lifted holding it in five different distances away from the body. Each man lifted the crate a total of 150 times.

A special motion analysis system was used to record spine motion. Special markers were placed on the spine, pelvis, hip, and knee. Two cameras took photos of the spine position throughout each lift. Computer software used the data to calculate angles of the spine during the various types of lifts.

The researchers were looking for the effect of lift style and lift distance on the spine. Two areas of the spine involved were the thoracic and lumbar regions. The authors report the following findings:

The results of this study suggest that even when we stoop to lift a heavy item, the spine still flexes the same amount. The ligaments and joint capsules are probably under the same amount of stress and strain no matter which method is used. Likewise, compression and shear forces in the lower lumbar spine are the same when lifting with each style and distance from the body.

The authors conclude that the risk of low back injury is the same no matter what lift style is used. These findings support similar results from other studies on this same topic.

Physical therapists (PTs) around the world have joined the search for a treatment method that can help patients with chronic low back pain (LBP). In this study, therapists from England compare the use of patient education with group therapy using an approach called cognitive behavioral therapy (CBT).

CBT is a way to help patients change how they think about their back pain. It helps them start doing activities they had given up out of fear that it would bring on pain or make their pain worse.

Patients ages 18 to 65 were divided into two groups. Everyone received a booklet of information and a tape to listen to. Both of these tools had advice on stress, posture, and pacing. Setting goals and improving sleep were also included.

One group also received exercise in a group. The sessions were two hours long, once a week, for six weeks. Two PTs lead the group through a series of physical activities and exercises. They taught patients how to identify harmful thoughts. The patients were helped to resume activites or hobbies previously avoided.

Results after treatment were measured based on the basis of the patient’s pain and disability. The cost of each treatment was also calculated. The exercise group had only a small improvement over the education group. The patients who had the best results were the ones who specifically asked for this type of group.

The authors offer some ideas why the results were so limited. They suggested that the training the PTs received in CBT wasn’t enough to make a difference. Or perhaps because many of the patients only had mild LBP, the effect was minimal. The cost was low so this approach may be worth pursuing.

Future studies must find out if it’s the treatment method or the way it’s delivered that is the problem. A second area of study should be the influence of belief systems on results. Patients who wanted to be in the exercise group got the best results. Patients who didn’t want to be in the exercise group had the worst results.

Many people who have surgery to relieve pain from bulging (herniated) discs in the lower back end up having to have repeat surgery. One study estimated that as many as 14 percent of all patients who had a first time (primary) discectomy need more surgery.

Some repeat surgeries are done with hardware or devices that are meant to stabilize the spine in the hopes of keeping the discs from bulging or herniating again. The authors of this study investigated if one such device, the Wallis device, would reduce the need for repeat surgeries.

Researchers followed 37 patients (26 males) who underwent disc surgery with the Wallis implant. The patients ranged in age from 15 to 58 years, average age 36. The patients were followed up at weeks 3 and 6, and then again at 6 and 12 months. The Oswestry Disability Index (ODI) questionnaire, the Short Health Form survey (SF-36), and the Visual Analog Scale (VAS) for pain were used, among other tests, to evaluate the surgery’s outcome.

The findings showed that all patients experienced a significant drop in leg pain (average of 8.2 down to 1.5 on the VAS). The average ODI scale dropped from 43 to 12.7 and back pain dropped from a VAS of 6.6 to 1.4. There were no major complications. Four patients did have a repeat disc herniation after the primary surgery and 1 patient after a revision surgery.

The authors discussed the other types of implants available and how they differed from the Wallis implant. The Wallis implant is considered to be conservative because it doesn’t need any changes in the vertebrae to be inserted, unlike other implants. This makes it easier to remove the Wallis implant if needed.

In conclusion, the authors said that the Wallis implant was successful in relieving both leg and back pain.

For the last 10 years, spinal fusions have been done with titanium cages inserted into the disc space. The cages are filled with bone graft material. Bone fills in and around the cages during the healing process. This forms a solid spinal fusion.

In this study, researchers try using threaded bone dowels instead of cages. The dowels are made from freeze-dried cadaver bone. Cadaver bone comes from a body preserved after death for scientific use. The bone is taken from the femur (thigh bone) or tibia (lower leg bone).

Bone dowels have several theoretic advantages over metal cages. First, bone is more elastic than metal. It can transmit forces better. The bone will become a natural part of the fusion. Without the metal cages in the way, imaging studies can give a clearer view of the fusion site. And bone can be used when there is infection present.

All patients had an anterior interbody lumbar fusion (ALIF) procedure. This means the operation was done from the front of the body. The same surgeon did everyone’s surgery. Everyone was followed for at least two years.

The results showed that the fusion rates are better with titanium cages. Bone dowels can be used successfully but clinical success is not as good. Titanium cages bear higher loads than bone dowels.

Bone dowels should not be used alone. The results are better if they are combined with metal screws or plates along the back of the spine. This instrumentation will help hold the spine stable until fusion takes place.

The authors also suggest that if the dowel cracks or breaks, then it should be replaced right away. A fusion cage should be used in its place.

Many people around the world suffer from chronic low back pain (LBP). Researchers are looking for ways to improve this situation. In this study, physical therapists from England compare three types of physical therapy for the management of chronic LBP.

Patients were assigned to either the usual treatment group, the spinal stabilization group, or the pain management group. By comparing the results, the researchers hoped to find out which type of physical therapy worked the best.

The number of physical therapy sessions and length of time with the therapist varied. The usual treatment group received individual treatment, exercises, and instructions in up to 12 sessions lasting 30 minutes each.

The spinal stabilization group was seen for a maximum of eight sessions. Each session was 90 minutes long. And the pain management group received a combination of advice and education along with a general strengthening and fitness program. The therapist also saw this group for eight sessions of 90 minutes length.

Patients were evaluated at six, 12, and 18 months. Measures of outcomes included pain, disability, time off work, and quality of life. In all three groups, the patients were very satisfied with the results of treatment. And the results were similar among the three groups.

There were some differences in costs of treatment. Pain management was less costly than the other two treatments. Individual therapy was the most expensive but had slightly better overall results.

The results of this study suggest that a pain management approach to chronic LBP by physical therapists is both effective and cost-effective. Patients have improved function and use health services less.

The authors suggest that therapists should offer pain management as a first-line method of treatment. Many times, this type of program is tried as a last resort.

Chronic back pain is a common complaint and from 15 to 52 percent is caused by facet joint syndrome. The nerve endings inside and outside the joints in the back can become irritated and stressed over time from movement or from injury. Researchers have found using radiofrequency, in a procedure called percutaneous conventional radiofrequency (CRF) can help relieve facet joint pain. More recently, other researchers have tried a procedure called pulsed RF (PRF). This procedure uses pulsed time cycles and high temperatures to relieve pain. The authors of this study wanted to compare the effects of both procedures in the treatment of facet joint pain.

Researchers randomly assigned 20 patients each to one of three groups: CRF, PRF, and the control group. The patients in the control group thought they were having a procedure but they were not. The patients ranged in age from 48 years to 69 years. There were more women (56.6 percent) than men. The patients’ pain levels were assessed at 6 hours after the procedure and again at 6 months and 1 year. The patients were asked to rate their pain using the Visual Analog Scale (VAS) and their function with the Oswestry Disability Index (ODI), both before and after the procedure. Patients who scored above 4 on the VAS were allowed to take pain relievers called nonsteroidal anti-inflammatory drugs or NSAIDs.

The researchers found that there were no complications among any of the patients. all the patients has scored lower VAS and ODI scores after the procedures, and those in the PRF and CRF groups were lower than those in the control group. The patients in the CRF group kept the lower ODI scores through to 6 months, but not those in the PRF group. After 1 year, the CRF group continued to score lower than either the PRF and the control groups, which both had similar scores.

The patients were permitted to take pain relievers if needed and more patients in the PRF and control groups did than those in the CRF group. The control patients took the most. In rating satisfaction, the CRF group scored the highest satisfaction with 65 percent reporting excellent results, 30 percent good, and 5 percent moderate. Among the PRF patients, 35 percent reported excellent results, 50 percent good, and 15 percent moderate. Among the control group, 20 percent reported excellent results, 50 percent good, 25 percent moderate, and 5 percent bad.

In conclusion, the authors point out that there have not been enough controlled trials to verify the effectiveness of this treatment in managing chronic facet joint pain. HOwever, they say that both CRF and PRF are safe and effective treatments, although CRF has a longer-lasting effect than does PRF.

The surgical treatment of spondylolisthesis is the topic of this article. Spondylolisthesis occurs when one vertebral body slips forward over the vertebra below. It’s caused by a crack in the supporting column of the vertebral body. This fracture can get disrupted, allowing the bone to move forward.

Surgery (fusion) is needed for this condition in order to stabilize the spine. The operation can be done from the front of the spine (anterior). It can also be done from the back (posterior). Without spinal fusion, when the vertebra moves forward, a traction pull is placed on the soft tissues and spinal nerves. The result can be a painful back condition with numbness, tingling, and weakness of the legs.

In this study, surgeons compared these two types of spinal fusion operations used for spondylolisthesis. There were 48 adults treated with either a posterior lumbar interbody fusion (PLIF) or an anterior lumbar interbody fusion (ALIF).

PLIF was used for patients with severe neurologic symptoms. The ALIF was the choice for patients with back pain but minimal signs of nerve involvement. The goal was to find out if adjacent-segment degeneration (ASD) was better or worse with either of these two operations.

ASD affects the vertebra below the level that was fused. It is defined as a loss of more than 10 per cent of the disc height. Other criteria used to define ASD included: a forward slip of the vertebra, symptoms of disc herniation or spinal stenosis, and compression fracture of the vertebrae.

ASD occurred much more often in the PLIF group (82.6 per cent) compared to the ALIF group (44 per cent). Both operations are good treatments for spondylolisthesis. PLIF may be a better choice when the ASD factor is considered.

However, the short-term results were similar between the two groups. Even when ASD occurred, the patients with PLIF didn’t need any further surgery. ALIF may be a good way to prevent ASD. If PLIF is used and ASD develops, it’s not linked with a poor outcome.

There are nerve endings in all types of tissues. In the spine, they are present in the joints, discs, ligaments, and muscles. Because of this, finding the true source of back pain can be difficult.

In this study, researchers in Sweden measured the amount of nitric oxide (NO) in and around the facet (spinal) joints. This area is called the perifacetal region. They compared the results of patients with chronic low back pain to healthy adults with no back pain.

NO is a gas that acts as a signaling molecule in the body. It has many different functions but appears to have a role in inflammation of the joints. NO is not the same as the nitrous oxide (N2O or laughing gas) that dentists use.

The results of this study showed that chronic back pain patients had three times as much NO in the perifacetal region compared to healthy subjects. When the joint was injected with a numbing agent and steroid, more than half the patients reported a decrease in back pain.

There is no simple test or way to identify the cause of back pain. Scientists hope to find a molecular marker of pain that will tell us the source of pain. Until that happens, tools like the NO sensor used in this study may be helpful. If NO levels are elevated, treatment with injection may be indicated.

In this study, researchers asked the question: what is it that causes disc degeneration the most? Is it what we do (occupational, physical activities)? Or is it how we are put together (size, weight, shape)? For example, is it age, body weight, or lifelong loading from daily activities? Or is it the size of the disc or the person’s lifting strength?

Data for all these variables was collected on 600 men, ages 35 to 70 years old. These men have all been part of a larger study in Finland called the Finnish Twin Cohort. Data on work history and leisure activities was recorded. Basic body measurements were taken. And MRIs of the lumbar spine were obtained.

After analyzing all the data, the authors found that:

Back and leg pain (sciatica) affect many Americans every year. Despite how common the disorder is, the best treatment for the problem still remains unknown. In this study, the results of two different treatments are compared.

Patients with lumbar disc protrusion causing radiculopathy were treated in one group with surgery. The second group had nonoperative or nonsurgical care. Radiculopathy refers to the symptoms that occur when the protruding disc puts pressure on the spinal nerve. Patients report back and leg pain, numbness and tingling (or a pins and needles sensation) down the leg, and weakness.

Surgery consisted of a lumbar microdiscectomy. In this procedure, the surgeon uses a minimally invasive method to remove the disc. For the nonoperative group, care followed guidelines set by the North American Spine Society (NASS). The nonoperative treatment protocol was not described for this study.

There was not a significant difference in the outcomes between the two groups. Both groups got better over time. In general, patients in either group never returned to normal. This means that test measures for function and quality of life were lower for anyone with back and leg pain compared to people their age who did not have pain from radiculopathy.

The authors conclude that the type of treatment received for low back pain with sciatica is not linked with results. And secondly, no matter what kind of treatment is used, some disability persists for most patients.

These results were not consistent with the outcomes of other, similar studies.
The authors suspect the delays in treatment with this government-insured health care may have changed the results. More study is needed to continue sorting out what treatment works and when is the best time to apply that treatment for this problem.

In this article, orthopedic surgeons from the New York University/Hospital for Joint Diseases present a review of osteoporosis. They outline who is most likely affected. They also discuss how to diagnose the problem, and how to treat the condition. In addition, ways to prevent osteoporosis are presented.

Osteoporosis is defined as low bone mass. It leads to a break down of the bone and bone fragility. Compression leads to fractures of the vertebral bones. Vertebral compression fractures are very common for older adults with osteoporosis. The cost and the long-term disability caused by compression fractures require a closer look.

There are many risk factors for osteoporosis. White, postmenopausal women have the highest risk. Aging is another key risk factor for both men and women. Poor diet, smoking, chronic and alcohol use are also risk factors. A lack of the right kind of exercise (weight-bearing) adds to the risk.

Osteoporosis can be prevented by changing lifestyle factors. Quitting smoking, getting more exercise, and good nutrition top the to do list. Once a vertebral compression fracture occurs as a result of osteoporosis, the focus changes from prevention to treatment.

Nonoperative care with medications and physical therapy help up to 80 per cent of the patients. Hospitalization with bed rest and intravenous (IV) pain medication may be needed. In a small number of people, surgery to restore the bone that’s been compressed and fractured is the only choice.

If the bone is strong enough, screws can be put in place to help fuse the spine. Sometimes cement is injected into the vertebral body. This procedure is called a vertebroplasty. A more involved procedure is a kyphoplasty.

In a kyphoplasty, a deflated balloon is inserted inside the vertebral bone and inflated. Then the cement is injected into the newly formed cavity inside the body of the vertebra. There are some potential problems with either of these operations. The cement can seep out of the bone. Or the bone at the next level can break next.

The prevention and treatment of osteoporosis hasn’t been perfected. But osteoporosis is on the rise as our adult population lives longer and longer. The authors say the cost of treating fractures from osteoporosis could be enough to bankrupt the health care industry. More study is needed to prevent osteoporosis and to decrease the cost of caring for people who have osteoporosis.

You may have heard in the news recently results from the federally-funded SPORT study. SPORT stands for Spine Patient Outcomes Research Trial. This seven-year long study of 1244 patients cost 13.5 million dollars.

News reports suggested a startling conclusion about treatment for back pain from lumbar disc herniation as a result of the SPORT study. Many reports summarized the findings by saying that patients got the same results with or without surgery for disc problems.

You may have heard that patients in the surgery group got better faster but the long-term results were the same between the operative and nonoperative groups. You heard right but the interpretation of the results is inaccurate.

In this critical review, Dr. McCormick from the Department of Neurosurgery at Columbia University in New York reports on the SPORT study from top to bottom. He offers explanations for the study results.

The study was set up with a randomized design. This means that patients were put into the operative or nonoperative group randomly (without a specific order or pattern). They weren’t put in one group or another based on their symptoms or personal preference. But they were allowed to crossover.

Crossover means that if they were in one group, they could switch to the other group. In the end what happened was that some patients with severe pain and other distressing symptoms who were in the nonoperative group decided to have surgery. And patients in the surgery group with mild to moderate pain opted to avoid surgery and have conservative care instead.

But the final results for each patient were still reported under the original group they were placed in. So the results for nonoperative cases who actually had surgery were still placed on the nonoperative side and vise versa. Results for patients in the surgical group who didn’t end up having surgery were still linked with surgery.

The study did confirm that patients are able to decide what’s best for them. And patient choice tends to be: surgery for severe, constant pain and conservative care for patients with less pain and less disability.

Over the last 30 years, instruments to allow surgeons to see inside the spine without open incisions have improved remarkably. The tool used is called an endoscope. There is a tiny TV camera on the end that allows the surgeon to look on a video screen and see inside the spinal canal.

A small cut is made in the skin and the endoscope inserted into the spine. Surgical instruments are passed down through the endoscope. The tool can be inserted through the back of the spine. This is called an interlaminar approach. Or it can be passed through the side of the vertebral bone called a transforaminal approach.

The approach used depends on where the disc material is located. If it’s inside the spinal canal, then the translaminar method is used. If the disc is near or around the spinal nerve, then the interlaminar approach is best.

In this study, the results of disc removal using a new endoscope are reported. The new tool was designed to help reduce problems with tissue trauma and access to the disc in such small places.

It has a larger working channel so larger tools can be used. More bone can be shaved away giving the surgeon a bigger working space. The new endoscope also gives the surgeon a wider view of the tissues, bone, and disc material.

The authors describe in detail the operative technique used with both approaches. The advantage of the full endoscopic operation is easier removal of all the disc tissue without causing trauma. It is a minimally invasive operation with less scarring. And with the transforaminal approach, the ligamentum flavum, a supporting ligamentous structure in the spine isn’t cut.

Patient results after full-endoscopic surgery weren’t any better than with conventional operations. The difference was that the surgeon had a better view of the operative field and fewer technical problems to deal with.

The authors conclude full-endoscopic techniques won’t replace current methods used. They will have their own place with certain patients. There is a shorter operating time, less tissue trauma, and less bleeding with this new tool. The result is quicker rehab and lower costs for some patients.

Sometimes chronic low back pain (LBP) doesn’t respond to conservative care. Surgery may be needed for LBP caused by degenerative disc disease. Spinal fusion has been the standard procedure used. Fusion helps decrease the pain but patients are left with decreased motion as a result.

Artificial disc replacement (ADR) may be changing the treatment options for these patients. Clinical trials are underway comparing the results of fusion with disc replacement. In this FDA-regulated study, the results are reported for 286 patients from 17 different clinics around the United States. There were 38 surgeons involved.

Two-thirds of the patients received a ProDisc®-L total disc replacement. One-third had a circumferential fusion. Circumferential fusion means the diseased spinal level was fused from the front, side, and back. Bone graft and screws were used as fusion materials. In both groups, only one lumbar level (between L3 and S1) was treated.

All patients were followed for two years. Results were measured using change in symptoms, function, disability, and satisfaction. Before and after X-rays were taken in both groups. Range of motion was measured for the patients with disc replacements.

The authors report both groups showed improvement in function and disability measures. The ADR group had better overall results. Possible complications after surgery are different for the two different treatment methods. With ADR, there can be sinking or slipping of the device out of place. With fusion, sometimes the fusion doesn’t take, and the patient still has painful movement at the diseased level.

In this study, patients in the ADR group were much happier with the results of their surgery compared to the fusion group. The results of this study suggest Pro-Disc®-L is safe and effective. With the right patients, the results are superior to spinal fusion. Maintaining normal range of motion is a clear benefit of this device.

Lumbar radicular pain, or sciatic pain, is the most common nerve pain experienced by patients with back problems. Unfortunately, not many studies have been done on how best to treat this type of pain, which is caused by injury or trauma to lumbar nerve roots, or by irritation from of deterioration of the disks in the back. It’s so common, in fact, that doctors estimate that adults over the age of 30 have a 4.5 percent chance of developing this type of pain at some point in their life.

In this single-center, four-period, crossover, randomized trial, researchers investigated the effect of nortriptyline with an opioid-based medication. By using this approach, the investigators hoped to attack the pain problem from the different ways or paths that pain is caused. The drugs used were MS Contin, which is a long-acting form of morphine, nortriptyline, a combination of the two, and a placebo. The investigators felt that the result would be that the combination of the two drugs would be more effective than either medication alone, which in turn would be better than placebo.

Of the 61 patients who underwent the initial screening, 28 patients entered and completed the study. They had to have evidence of lumbar radiculopathy, or irritation of the lumbar root nerves. This included pain in one or both buttocks and/or legs for at least three months and for at least five days per week. Other symptoms were included in the list. Their pain must have been rated at 4 out of 10 or higher on the pain scale of 1 to 10, with 10 being the worst pain.

During the study, the patients rated at bedtime their average back and leg pain, and overall pain, as well as worst leg and back pain, and overall pain over the previous 24 hours. These pain diaries were collected at the follow-up visits. The investigators also assessed patient pain through the Global pain relief (GPR) scale, the Oswestry Low Back Pain Disability questionnaire, the Beck Depression Inventory, and the 36-item Short Form of Health Survey (SF-36).

There were four treatment sessions. In treatment session A, there were 55 patients total, 15 who took MS Contin, 13 nortriptyline, 13 combination, and 14 placebo. In treatment session B, there were 37 patients total, 10 who took MS Contin, 9 nortriptyline, 9 combination, and 9 placebo. In treatment session C, there were 28 patients. Seven took MS Contin, 5 nortriptyline, 7 combination, and 9 placebo. Finally, in treatment session D, there were still 28 patients total. Nine patients took MS Contin, 7 nortriptyline, 5 combination, and 7 placebo. With the patients who dropped out between sessions A and B, and then sessions B and C, 28 patients remained to study end.

The researchers found that there were no significant differences between the four groups, including the placebo group, for the relief of average leg pain. There was a 7 percent reduction in average leg pain in the MS Contin group, 14 percent in the nortriptyline group, and 7 percent in the combination group, compared with placebo. The other outcomes were also not significant.

When the investigators looked at the findings of the GPR questionnaires, reporting moderate relief or better, there was a 42% increase among those who took MS Contin, 40% nortriptyline, 67% for the combination, and 37% for the placebo.

The authors concluded that their assumption wasn’t met by their surprising findings. Neither the tricyclic antidepressant (nortriptyline) nor the opioid (MS Contin) were significantly effective in treating the pain, even in combination. The authors point out that there may have been some drawbacks to the study, including that the findings could have been affected by chance effect and the modest sample size. They also suggest that the study should be repeated because of their sample size and high drop-out rate. Their recruitment, through newspaper ads, may also have encouraged participation from patients who were already treatment-resistant.

In this review article, orthopedic spine surgeons discuss minimally invasive (MI) methods of lumbar spinal fusion. MI refers to surgery performed with an endoscope passed through a very small incision to the lumbar spine.

An endoscope has a tiny TV camera on the front end to allow the surgeon to see inside the spine. It also provides a channel down which the surgeon can pass surgical instruments needed to perform the operation. Pros and cons of open surgery versus the closed or MI approach to fusion are presented.

With MI operations, there is less cutting into the soft tissues. Less trauma to the muscles may mean faster recovery. There is also less blood loss. And patients like the smaller scar that’s left behind.

The downside of this method is the steep learning curve for surgeons. They can’t expect to conquer this new technique with just a few patients. And until the surgeon has done enough of these operations, the surgery time is longer.

Two new methods of MI fusion are presented. These include the lateral transpsoas and anterior presacral methods. Illustrations of the surgical technique for both approaches are provided. The surgeon uses a new electromyography-based monitoring system to avoid damaging nerves.

The authors point out that MI lumbar spine surgery is still in its infancy. Studies of results comparing open methods versus MI are in their early stages. Long-term results aren’t ready yet. So far it looks like the final outcome (rate of spinal fusion) is the same with either operation.

The authors suggest that if the fusion rates aren’t better with the MI methods, then the risk of MI and the time and effort needed by the surgeon to learn this method may not be worth it. It looks like newer and better ways of using MI may be needed to get past this bump in the road of improving lumbar spine fusion.

Of the many patients who undergo surgery for chronic back pain, as many as 15 percent may need a second surgery to remove the hardware (screws, rods) that was installed. There are several reasons why a back surgery may not work properly, including pseudoarthritis, infections, and a failure for the spinal fusion to take. However, there are some patients who have pain that is not explained by any of the possibilities. It’s with these patients that there is some controversy as to whether a second surgery to remove any hardware should be done. The authors of this study wanted to evaluate the safety and efficacy of such a second surgery.

The authors looked at files of patients who had undergone a second spinal surgery. They found 10 men and 15 women who fit their criteria. After the surgery, all the patients had continued pain (14 back pain and 11 both back and leg pain) that didn’t respond to pain medication or physiotherapy. All 25 had the second surgery during which all the hardware was removed, as well as any tissue that had surrounded the implants.

After the surgery, the patients used the Visual Analog Scale to score their pain levels, and they answered questionnaires that measured their function, medication use and their satisfaction following the second surgery. After an average of 20 months follow-up, none of the patients showed any signs of infection. On examining the hardware that had been removed, the researchers noted that all of the patients had tissue form around the implants, three had loosening screw-bone interface, as well as a “halo formation” around the screws.

There was an average 50 percent decrease in pain reported by the patients and 46.2 percent reported that their function was “much better,” while 38.5 percent said their function was “somewhat better.” Reporting as “none better,” was 11.5 percent. Only one patient (3.8 percent) said that he/she was “worse” and no patient reported “all better.” Significantly, 85 percent of the patients said that they would have the surgery again and 89 percent said that they would recommend the surgery. Eight-one percent felt that their surgery was a success.

There is still much to be understood about post-implant surgery back pain. The diagnosis can only be made after ruling out all other possibilities, and surgery is the only true way to make a diagnosis. Many doctors say that there are other possibilities that could cause this pain, such as inflammation (swelling) around the foreign bodies in the back.

Total disc replacement (TDR) may replace spinal fusion for patients with disc disease. Studies are being done to track patients’ short-term to long-term results. In this study, the clinical results of two TDR devices are compared.

Clinical results refer to patient recovery and function. This is an important distinction because many studies use radiologic results as the main measure of success. How the patient looks on X-ray and how he or she feels are two different standards of measure to consider.

The first disc device used in this study is the CHARITÉ. It has six spikes on the endplates to hold it in place. The second is the ProDisc model. Instead of spikes, it has a central keel to keep it stable. The ProDisc is easier to insert and to get a good position.

Results were compared between the two TDRs by measuring motion, function, and pain. The authors also looked at the condition of the joints and discs at the adjacent levels (above and below the TDR level).

Recovery rates and levels of back pain weren’t different between the two groups. Success rates measured by improved function and patient satisfaction were the same among all the patients. Lumbar range of motion was less in patients with the ProDisc implant.

While comparing the results of these two disc replacements, the surgeons made an important discovery. No matter what kind of TDR was used, there was a significant amount of joint and disc degeneration. The changes were most obvious at the level above the TDR.

These results suggest further study is needed of the long-term results for TDRs. Implant design may be part of the problem. It’s not clear yet whether changes seen on X-rays and MRIs will become symptomatic later on. These two groups will remain in the study to assess results after 10 years.

Back and neck pain are among the most common complaints in industrialized or developed countries. Statistics show that chances of having back pain within a one-year period is anywhere from 15 percent to 56 percent, depending on the country in which you live. For neck pain, the chances are between 12 percent and 34 percent. However, neck pain and back pain often go hand in hand.

Although there have been studies investigating people with mood disorders who had back pain, there have been no studies that have investigated the association of back and/or neck pain and mood, anxiety, or alcohol disorders in populations from several developed countries.

Researchers in this study examined data from 17 countries from all over the world. They had four goals: to estimate the 12-month prevalence of chronic back pain within the general population, to estimate the same prevalence among people who have mood, anxiety disorders, or alcohol dependence, to investigate which mental disorders were most prevalent among those with back and/or neck pain, to investigate the consistency across the 17 countries in the study. Eighteen populations were ultimately studied because China had two groups: one from Beijing and one in Shanghai.

All participants were interviewed, face-to-face, using the Composite International Diagnostic Interview (CIDI 3.0) that was developed to assess mental disorders, treatment, and possible risk factors. The disorders included major depression, generalized anxiety disorder (GAD), panic disorder, agoraphobia, post-traumatic stress disorder (PTSD), social phobia, alcohol abuse, or alcohol dependence. Participants were also asked questions adapted from the US Health International Survey about back or neck pain.

Results from the studied covered a very wide range. Although chronic back and/or neck pain was found in all 18 groups, the 12-month prevalence rate ranged from a low of 9.7 percent in Colombia to a high of 42.1 percent in the Ukraine. When analyzing the data for mood disorders and neck and back pain, there was an average of 4 percent to 11 percent prevalence, but it went as low as 2.5 percent in Lebanon to as high as 15.7 percent in the United States. Although other disorders were identified, there was a prevalence of mood and anxiety disorders, and alcohol abuse and dependency, not just depression as is commonly thought.

The authors concluded that this was the first cross-national, population-based study investigating chronic back or neck pain with mental disorders found that such chronic pain is not associated with only depression, but also anxiety and alcohol dependence or abuse. With this knowledge, doctors should be aware of these risks as they make their decisions on how to manage their patients.

Spinal stenosis is the cause of low back pain for many older adults. Sometimes there’s leg pain with the back pain. Patients report numbness and tingling down the leg, too. Pressure on the spinal cord or spinal nerves in the low back is the cause of these symptoms. Bending forward often reduces the pain. It’s made worse by standing up straight or extending the spine.

One way to treat this problem is with the new X Stop implant device. It fits in the interspinous space. The spinous process is the bony knob you can feel along the back of the spine. The interspinous space is the space between the spinous processes of two vertebrae.

The X Stop is designed to hold the stenotic level in a flexed position. This is the position that takes pressure off the nerve and gives the most pain relief. It also helps to take the load off the spinal joints at the same level.

In this study of 40 patients, the X Stop reduced pain and increased function. Patients reported being satisfied with the short-term results. Patients got the most benefit in the first three months. Almost three-fourths of the patients were still satisfied 12 months after surgery.

The authors conclude the X Stop device is a safe and effective way to treat lumbar spinal stenosis. It is less invasive than open surgery or decompression and fusion, the more standard treatment used.

The symptoms did come back for one-third of the patients. They had further treatment with epidural injections. In two patients, the device slipped out of place and had to be removed. Spinal fusion was done in those cases.