News Category: Lumbar Spine

Chronic low back pain from disc problems is hard to treat. Many doctors say that treatment without surgery is the rule for most of these patients. Short periods of rest, medications, and physical therapy are generally best. Treatment is sometimes difficult because the cause and source of the pain is often hard to find.

Doctors know that in the normal disc, there are no nerve endings in the center of the disc. Some sensation is present in the outer third of the disc. However, this is thought to change when damage to the disc occurs from aging or injury. Nerves grow inward within the disc. Scientists call this neoneuralization, a process that can cause true disc pain.

A new treatment is being studied for this problem. It is called intradiscal electrothermal therapy (IDET). IDET was first used to shrink and tighten loose tissue around the shoulder. In the year 2000, doctors suggested using IDET for chronic disc pain.

A thin, rigid tube called a catheter is inserted into the disc. A form of imaging called fluoroscopy is used to guide the catheter to the right spot. Heat is delivered to the disc for four to six minutes. This shrinks the fibers in the disc and destroys any nerve tissues that have formed. The patient usually doesn’t get pain relief until six weeks later, but it appears to work for 60 to 80 percent of all patients.

IDET isn’t for everyone. Doctors may suggest it as an option for patients with chronic low back pain caused by wearing away of the disc. The disc space must be large enough for the catheter to fit. IDET isn’t for pregnant women or patients with other back problems. Patients with other serious health issues aren’t good candidates either.

If you’re reading this, you’ve probably searched for information on low back pain over the Internet. Chances are you found plenty of sites with information on low back pain. According to these researchers, chances are that much of the information you got was of poor quality–or even completely wrong.

These British authors looked at 60 web sites with information on low back pain. They found the web sites by doing the same kind of search as a typical Internet user. The authors then rated the sites for their overall quality and for the quality and accuracy of the information on low back pain. The two ratings were added together for the total score.

The results were alarming. All but two of the web sites scored less than half of the total points. Many of the sites left out important information. Worse, some sites spread false information. The web sites were most likely to give out bad information about bed rest and exercise. Research and doctors have found that too much bed rest is a bad thing when treating low back pain, and that appropriate physical activity can help patients get better. However, some web sites recommended complete bed rest–for as long as several weeks!

The authors note that there are several reasons for such poor information. Medical information on the Internet does not have to be reviewed by any medical professionals at all. Anyone can write anything and put it on a web site. It is also possible that web sites aren’t updated often enough. Plus, low back pain is difficult to treat. Medical professionals often don’t agree on the best ways of treating low back pain.

So how can you tell which web sites are good and which are full of baloney? The authors found that newer web sites and sites that give references tended to be of higher quality. Some of the worst sites were trying to sell specific services or products, such as back braces. The authors suggest that health professionals need to help steer people towards web sites with useful and accurate medical information. Low back pain sufferers should surf for medical information with care.

The Swedish Lumbar Spine Study Group is busy measuring back pain. They are measuring pain before and after treatment to find out what treatments work best. They are also checking the test tools to make sure they can be trusted. How accurate are these tools used to measure low back pain?

This group compared four different tests used to measure the results of back treatment. They didn’t find any difference comparing patients who had surgery and those who didn’t. Patients in both groups had the same amount of change (better or worse) no matter what treatment was given.

Members from the study group say that a higher score after treatment doesn’t always mean that the patient is better. How much change is needed before the patient says he or she is “better,” “much better,” or even “worse”?

After finding out a change has occurred, researchers want to know what caused the change. For example, did the score change because the patient could sleep better? A change in score could also happen when the patient lifts more weight or walks farther.

Three of the tests don’t detect changes that are important to patients. Only one test, called the Visual Analogue Scale (VAS), measured small changes that are important to the patient. The VAS is a scale with numbers ranging from zero to 10 or zero to 100. Zero means “no pain” and 10 or 100 stands for “worst pain.”

The VAS is a measure that detects even small changes in back pain and function after treatment. It can reflect changes in sleep, activities of daily living, and even mood. Improving the patient’s ability to sit, stand, or lift is more difficult to measure.

Doctors from around the world are gathering data about back pain patients. They hope to find ways to predict which patients will get better with surgery and which patients will do just as well without surgery. Many physical, psychological, social, and work-related factors have been studied.

The Swedish Lumbar Spine Study has a new report about predictors after spinal fusion surgery. Doctors from 19 medical centers joined this study. The patients all had low back pain for at least two years before having surgery. The researchers found two things that helped predict success after surgery.

Patients with a neurotic personality had a worse result after surgery. A “neurotic” patient was described as someone who is tense, stiff, restless, uneasy, and easily panicked. The authors of this study suggest that patients who aren’t neurotic have the best odds of getting better after surgery for low back pain. Nonneurotic patients seem to cope with pain and discomfort in a positive way.

A short sick leave also pointed to a better result. This was true for both the patients who had surgery and those who were treated without surgery. Being younger was an added bonus for patients who had back surgery. Younger, nonneurotic patients had the best return-to-work record.

This study can help guide doctors when choosing low back pain patients who will get better with surgery. The best patients for surgery are young, without signs of neurosis, and with a recent diagnosis of chronic low back pain. With the right patient, surgery without long delays has the best result.

The bones of the spine are normally stacked like blocks, forming a column. If one of these bones slips forward over the one below it, doctors call the condition spondylolisthesis. This can cause low back pain, deformity, and nerve damage. Surgery for this back condition in adults isn’t always successful.

Fusion surgery to join and hold the problem bone in place is the usual treatment for severe slippage. The bones are joined together with a bone graft. Sometimes a rod is also attached alongside the spine. This helps hold the spine while the bone graft fuses in place.

There are two schools of thought about fusion for severe spondylolisthesis. Some doctors fuse the spine “as is,” just holding the bones in place. This keeps the slippage from getting worse. Others advise trying to move the bones back toward a more normal position. This is called reduction.

Those who prefer reduction surgery say that it keeps the bones from slipping even more after the fusion. It also improves the way the patients look and walk. But there are problems with reduction surgery. Neurological problems are common. Moving the slipped vertebra back can put strain on the spinal nerves. It can also cause men to have trouble ejaculating because the sperm moves up back inside the body. This is called retrograde ejaculation.

A new method of holding the vertebra in place has been tried. Doctors at the Institute for Spinal Disorders in Houston, Texas, used pieces of bone to act as a strut. The dowel-shaped bone is tapped into a hole drilled between the lowest backbone and the sacrum below it. The sacrum is the triangle-shaped bone at the base of the spine, between the pelvis bones. The strut helps the lower backbone resist forward pressure over the sacrum.

Partial reduction with strut grafting can be used in cases of spondylolisthesis of the lowest lumbar vertebra. The strut is protected with a rod alongside the bones. This allows the fusion to heal around the strut and helps prevent further slippage.

Intradiscal electrothermal therapy (IDET) is a fairly new way of treating relatively simple disc problems in the low back. IDET involves inserting a probe into the injured tissue and then superheating it. No one knows exactly how it works. But the scar tissue and healing process seem to relieve symptoms from some disc problems. The benefit is that IDET often helps people avoid more complicated spine surgeries.

There can be serious complications from IDET, as with any type of procedure done to the spine. Because IDET is still so new, there is little evidence about what kind of complications can occur. This is precisely why doctors published this case report of one patient.

The patient was a tall 29-year-old soldier who had more than two years of low back pain that radiated down his left thigh. The problem was identified as a “contained” herniated disc, meaning the disc material was bulging but hadn’t squeezed out of the disc.

The problems were limited to two vertebrae in the lumbar spine. The pain continued despite all sorts of medications, physical therapy, and chiropractic treatments. Eventually his doctors did an IDET procedure. It went well with no complications, and the patient seemed to follow the rehabilitation plan. However, five days later he had worse low back pain and new pain all the way down to his left foot. Eventually the pain turned into leg weakness.

A new MRI scan showed a brand new problem: a large herniated disc that affected the nerve root in the low back. Eventually the patient needed a lumbar fusion surgery. After surgery the patient’s pain went away, he got off pain medications, and he went back to work.

The authors cannot say for sure that the new disc herniation was caused by IDET. It might have been a preexisting condition that finally worsened on its own. However, the timing of the problem suggests that IDET either caused this new problem or aggravated a small problem the doctors didn’t know about. The authors stress the need for studies of many patients to help doctors understand the possible risks of IDET.

Low back pain can be a challenge to treat effectively, especially when it lasts for several weeks. When it does, doctors often order X-rays of the spine to try to find the cause.

But spine X-rays have several drawbacks. They are expensive. They don’t necessarily help doctors find the best treatment. And they expose the patient to radiation. So how cost-effective are spine X-rays in treating low back pain?

This British study followed more than 400 patients who had low back pain for over six weeks. The patients were divided into two groups. One group got standard care for low back pain. The other group automatically got spine X-rays. Researchers then tracked their progress for nine months.

At the end of the nine months, there was no difference in pain or back function between the two groups. Obviously, the X-rays didn’t help doctors give better care. But there was one difference between the groups. Patients who had gotten spine X-rays said they were happier with their medical care.

In both groups, 80 percent of the patients said they would have chosen to get an X-ray at the beginning of treatment. But even after having X-rays, there’s still a tendency for people to worry that their pain is caused by a serious problem.

Researchers recommend that future studies concentrate on finding more cost-effective ways of making patients with low back pain feel satisfied with their medical care.

Low back pain is puzzling. It accounts for many visits to doctors, chiropractors, physical therapists, massage therapists, and alternative care providers. Low back pain seems like a simple problem to patients, yet it can be very difficult to treat effectively. It often doesn’t have a clear cause. And doctors find it almost impossible to predict who will get better and who will continue to have back problems.

Much research is done to piece together the puzzle of low back pain — including this study. Researchers looked at a community of 17,000 people in Sweden over three years. In that time, it found that about five percent of the population saw a health professional for a new episode of low back pain.

The researchers noted a number of facts about the course of low back pain among these patients. Many had back pain in the past. Patients’ pain and disability levels usually improved in the first three months, but after that there was not much improvement. This seemed to be true no matter what kind of health care patients got — traditional medicine, massage, chiropractic, or alternative treatment. Notably, about 70 percent of the patients took no days off from work for their back pain in the entire three years. The researchers didn’t find anything that predicted who recovered and who continued to have problems.

These are all interesting facts. But it will take much more study before medical professionals can put together the entire puzzle of low back pain.

Having low back pain from disc problems? Tried everything and still want to avoid surgery? There may be a new treatment option. Steroid injection into the epidural space is having some good results. The epidural space is just outside the outer covering of the spinal cord. Steroids are powerful antiinflammatory drugs. Used for low back pain, they can help reduce the swelling in and around the spinal nerves.

Most disc problems respond to treatment with short period of rest, oral steroids, and physical therapy. Surgery is only needed for a small number of patients. But for those who would like to avoid surgery, epidural steroids reduce swelling of the nerves 77 percent of the time. The patients in this study got pain relief that lasted a year or longer.

Some studies have not had these kinds of results. There are mixed opinions about this way to avoid surgery. Patients getting more than three injections are more likely to still need surgery at some point.

More studies are needed to decide the best time to give these injections. Doctors also need to know how often to give them and how many to give. Finally, the exact place to inject the steroids still remains unknown.

Over 30 million Americans take part in sports activities of some kind. This includes organized teams and recreational sports. Injuries are common among all sports players. Low back pain occurs in up to 15 percent of all athletic injuries. Most of these injuries are sprains and strains of muscles and ligaments. Some are injuries to the discs between the vertebrae.

There is still no good test to find out what’s causing back pain. Likewise, there isn’t a treatment that works for all back problems. Researchers have just started finding out something new about low back injuries and pain. There may be something wrong with the way nearby muscles respond to sudden loads.

When muscles don’t contract and relax with the right force or timing, it’s called a neuromuscular impairment. Doctors at Yale University are studying athletes with and without back injury. They are looking at how the muscles respond to sudden loading on the spine.

When a sudden movement or load occurs, some muscles switch on and others switch off. There is a certain timing needed for this to work smoothly and to prevent injury. These researchers found that athletes with a back injury used more muscles during loading activities. These muscles also stayed “switched on” longer than in normal athletes without back injury.

It is unclear why different muscle responses show up in athletes who’ve had a low back injury. The authors cite earlier research that suggests three possibilities.

Muscles contract because messages from motor nerves tell them what to do. These nerves come from the spinal cord and pass through openings in the bones of the spine on their way to the muscles. For example, the nerve to the calf muscle travels from the bottom of the spine, called the sacrum, to the lower leg.

Anything that changes the signals from the nerves to the muscles can affect the muscles. Pain and weakness are the usual signs of trouble. Difficulty walking or doing some activities may result. The affected muscles may get smaller and waste away.

In some rare cases, the muscle actually gets larger. This condition is called hypertrophy. Hypertrophy is unusual. It usually suggests a muscle disorder, rather than nerve problem.

A single case study brought this to the attention of a team of doctors. A 59-year-old man developed right leg weakness and calf hypertrophy over the course of several months. After much testing and study, doctors were able to tell that this was caused by pressure on the spinal nerve that goes to the calf muscle. Removing the pressure resulted in pain relief and return of muscle strength.

Doctors should be aware that muscle hypertrophy in the calf might be a sign of either muscle or nerve problems. Early diagnosis and treatment can prevent permanent nerve damage and muscle weakness.

The link between weather and pain has been reported in many studies. Researchers can’t always explain it, but anyone with arthritis or past joint injury knows when the weather is changing. For example, a drop in atmospheric pressure and increased humidity means more knee joint pain.

Some people with back pain also respond to changes in the weather. These patients have disk problems and a condition known as vacuum phenomenon (VP). VP is a collection of gas in the space between two vertebrae in the spine. This space is called the intervertebral disc space.

As we age, the soft, spongy disc between the vertebrae starts to wear out and degenerate. This process releases a gas that forms a bubble inside the disc space. It’s benign in the sense that it doesn’t cause cancer or death. If it gets large enough, it can press on the spinal nerve and cause painful symptoms.

VP is rare in children but common in adults over 65. It occurs in other parts of the body such as the joints and spinal canal. Pockets of gas also form inside a bone after a fracture. Scientists have found VP in animals, such as dogs and horses.

Patients with disc degeneration and VP are often good predictors of a change in the weather. When VP is present in the disc, there is a problem adjusting to changes in the outside air. The pressure inside the disc becomes high compared to the atmospheric pressure. As a result, changes in the barometric pressure might increase low back pain in patients with VP.

Back pain is a common problem both for men and women. Often the exact cause of the pain is unknown. Trunk muscle function and strength are key factors. Researchers are gathering information about the muscles of normal adults. They hope to compare this data against the same information in patients with low back pain. This will help in treating back pain patients. It may even be useful in preventing back disorders.

Engineers at the University of Vermont studied the strength of trunk muscles in the standing and sitting positions. They used a special machine called a dynamometer. The dynamometer measures the strength of a muscle contraction. This machine was hooked up to a computer to gather and analyze the data.

Speed and muscle forces were measured through a range of motion while sitting and standing. Healthy men and women without back pain were measured and compared to each other. The men were stronger in all motions except back extension. The reasons for this were greater height, larger upper bodies, broader shoulders, and longer trunk length in men than in women.

The researchers went back and recalculated their findings. This time, they adjusted for differences in height and body mass. When all things are equal, no differences are found in back strength comparing men and women. This means that if men and women of the same height, breadth, and length were measured and compared, their strength would be the same. The only difference was in trunk extension. Women have stronger trunk extensor muscles than flexor muscles compared to men.

Scientists think this strength difference in trunk extensor muscles for women occurs naturally. Women need stronger extensor muscles because of the greater load some carry. In general, women need stronger back muscles to offset the weight of their breasts. Pregnancy requires a stronger back just to stay in an upright position.

This information about trunk strength for men and women can be used in several ways. Strength training can be done over the full range of motion and in different positions using normal values. Physical differences between men and women should be considered. This is important for training and measuring trunk muscle function.

Some people develop a defect in one of the lower back bones. The defect is a crack that forms in the bony ring on the back of the spinal column. The area affected is called the pars interarticularis, so doctors sometimes refer to this condition as a “pars defect.”
When a pars defect is present in only one side of the spine bone, the condition is called spondylolysis. When the break occurs on both sides of the bony ring, the vertebra above can start to slip forward on the one below it. This is called spondylolisthesis.

Doctors are trying to find a way to predict when patients with a crack in one side of the bony ring are at risk for spondylolisthesis. By using X-rays, researchers have been able to photograph and measure different angles in the bones of the back. One of these angles is called the pelvic incidence. The pelvic incidence is a measure of the sacrum in relation to the hips. The sacrum is the triangular-shaped bone at the base of the spine, between the two pelvis bones. This angle is important in deciding how the spine, the sacrum, and the hips line up with each other when viewed from the side.

The researchers found that the worst cases of spondylolisthesis had the most pelvic incidence. In the normal adult, the hip is positioned directly below the last lumbar vertebra. In spondylolisthesis, the hip joint is forward of its normal position.

The presence of pelvic incidence may be a predictor of who will progress from a crack to a slip of the vertebra. Doctors still can’t say for sure, because it isn’t clear whether pelvic incidence is a cause or an effect. More studies are needed to answer this question.

Exercise therapy has been shown to help patients with chronic low back pain (LBP). Researchers are raising questions about the connection between aerobic fitness and pain intensity. Will back pain ease as aerobic fitness improves? If so, are the improvements in pain a result of being more aerobically fit? Finally, does being aerobically fit lessen the intensity of pain in people with chronic LBP?

These and other questions have been studied by a group of doctors and physical therapists. Earlier studies showed that using a treadmill is best for testing aerobic fitness. The amount of oxygen used at each level of exercise is measured. This is called VO2max and is a measure of aerobic fitness. Aerobic fitness tells how well the heart and blood vessels are working.

The researchers measured several items besides pain. They also looked at age, sex, job status, and level of disability. None of these had an effect on pain. Only educational level made a difference. Patients with less education had more pain. The amount of pain medication used before and after the exercise program didn’t change. The patients were able to walk for a longer time at the end of testing.

According to this research, there doesn’t seem to be a link between aerobic fitness (as measured by VO2max) and low back pain. In other words, being out of shape doesn’t appear to increase back pain. The reverse is also true: being aerobically fit doesn’t protect anyone from feeling more back pain during exercise.

Since it’s known that exercise can have a positive effect on low back pain, these new findings are important. The results of this study indicate that aerobic exercise to condition the heart and body doesn’t necessarily change the level of pain. Clearly, more research is needed to find out what kind of exercise is best.

How and when parts of the body age are the focus of many scientists. The spine and its nearby muscles are part of these studies. The steps in the aging of the spine are called the degenerative cascade. This refers to the fact that once a single event occurs, many other changes follow as a result.

For example, when the disc between the bones of the vertebrae starts to age, small tears in the outer rings (annulus) of the disc can develop. This in turn may allow the center of the disc (nucleus) to push out of its normal space. Next, the disc may begin to collapse, causing the nearby joints to bear increased weight and pressure. Changes in the joints, including production of joint pain, can result in this downward spiral.

The back muscles may have an important role in this cascade, too. These muscles, called the paraspinals, help control and move the spine. The loss of nerve impulses to the muscles is called denervation. Denervation of the paraspinal muscles can occur as the result of many spinal disorders.

When these impulses are knocked out, the paraspinal muscles can’t do their job. One theory is that these muscles lose their ability to stiffen the spine during activity, leading to excess movement in the problem area of the spine. This sets up a snowball effect in which the aging process speeds up in the nearby parts of the spine.

Scientists who have studied the degenerative cascade think there are ways to protect the paraspinals. Specific exercises may help prevent damage that otherwise leads to denervation. As a general rule, doctors also believe that taking special care when doing back surgery is important. The paraspinal muscles do best when they are preserved and unharmed. During recovery after surgery, activities that stress the denervated paraspinals, such as overworking these muscles, should be avoided. In the future, there may be prevention and drug treatment to avoid paraspinal muscle injury.

Spondylolysis is a back condition that occurs most often in children and teenagers. Spondylolysis is a defect in one of the vertebra in the low back. The defect is present within the ring of bone that protects the spinal nerves.

In spondylolysis, the ring has a crack in it. It can get worse or progress. When this happens, the vertebra above may begin to slip forward on the one below. This spine slippage is called spondylolisthesis. This can put a big stress on the structures of the spine.

Until now, it was thought that the increased slipping happened up to age 16 years, but not later. Now, doctors have reported more cases of slipping in adults. This is an important finding. Any adult who has spondylolysis and starts having back, buttock, and leg pain should see a doctor. New X-rays will be taken to look for slippage.

Early diagnosis and treatment of this condition can prevent pain and loss of function. An exercise and posture program from a physical therapist is sometimes enough to hold the spine steady. Surgery to fuse the area is needed in some cases.

Back muscles do two things. They hold the spine steady, and they move the spine in all directions. Some back muscles work alone, while others contract together to carry out these two tasks.

Exercises to help regain motion in the spine have been around for years. Exercises to hold the spine steady against force are much newer. These are called stabilization exercises or dynamic stability exercises. They’ve been taught by physical therapists for over 10 years.

Whenever something new comes along, it’s a good idea to keep checking to make sure it stands the test of time. After using these exercises for the last decade, it’s time to retest how well they work. A group in Canada studied a small number of men who had chronic low back pain. They measured the effect of doing three stability exercises for the low back. Muscles of the abdomen, trunk, and back were studied.

None of the exercises were intense enough to strengthen the muscles. The authors feel that these particular exercises could be used early in treatment to improve muscle coordination. It is also possible that as patients improve and begin doing more repetitions of each exercise, strengthening of key muscles might occur.

Step by step, researchers are finding which muscles work during each back stabilization exercise. They are also seeing that patients with back pain use the muscles differently than healthy people do. This will help therapists decide which exercises are best and the amount of exercise needed for each problem.

Medical doctors and chiropractors alike see many people for back pain. Back pain is one of the most common reasons patients are sent to physical therapy. Treatment costs and expenses linked to lost work are high. Billions of dollars are spent each year in the United States on back care alone.

Even though back pain is common, a sure cure or reliable treatment isn’t known yet. There simply isn’t agreement about how to treat and manage acute or chronic back pain. Studies comparing medical treatment of back pain to chiropractic care and physical therapy programs have come up with the same answer over and over.

There is generally very little difference in the final outcome for all three. Even combinations of these treatment methods don’t show any better results. In this study, patients who received medical care alone improved the least. Patients getting just physical therapy had slightly better results at six months than the other groups.

Any differences found in patient wellness after medical, chiropractic, or physical therapy were small. Researchers are back to the drawing board to find a quick and easy cure for back pain.

If you think it’s likely that you’ll hurt yourself while lifting, does it increase the chances of it happening? Researchers say yes. A study of 217 male workers lifting in various jobs answered this question.

The most common source of pain was the low back, followed by shoulder, upper back and hips, upper legs, and neck. Finger pain was rare. The actual number of workers with body aches and pains on any given day is quite high. This is called prevalence.

One of every two workers reported low back pain sometime during a 12-month period of time. One in three reported pain in the other regions listed. The prevalence of work-related low back pain is higher among manual workers than in the general adult population.

Low back and other body pain occurs in response to workers’ worries about injury. Their knowledge of their own jobs, health, and sense of well-being all tie into their view of risks in lifting. Improving workers’ job satisfaction and reducing stress can be a factor in reducing the risk of injury. Less emotional and psychologic strain may reduce the sense of worry about injury and the actual amount of back and body pain.