Posts Tagged ‘Disc’
Sciatic Pain Treatment
As a Wichita Chiropractor for more than twenty years, I have treated many people suffering from sciatic pain, therefore, I’m genuinely aware from experience just how incapacitating sciatic pain can be. Those who suffer from sciatica are unfortunately all too familiar with the deep radiating pain that persists during the day and inhibits almost all of their daily activities.
Here’s how you can ascertain if your low back pain is caused by sciatica. You are probably experiencing sciatica if your pain travels from your low back, through your buttock(s), down the large sciatic nerve in the back of one or both legs, and possibly shoots into one or both knees. Moreover, sitting, as well as movement, can be painful. Frequently lying down will lessen, or perhaps even temporarily eliminate the pain. However, it’s important for you to be aware that sciatica cannot be corrected without proper treatment.
Radiculopathy
One of the clinical diagnoses of sciatica is called a “radiculopathy”, a medical term that means simply that a disc has protruded from its natural position in the vertebral column and is putting pressure on the radicular nerve (nerve root) in the lower back, which forms part of the sciatic nerve. This kind of pressure can produce excruciating pain.
Increased pressure on the intervertebral discs, as well as imbalances in the muscles encasing the spine, can take place during and after extended sitting, specifically with bad posture. A particular event or injury isn’t commonly the cause of sciatica, more often sciatica is likely to progress over time as a result of everyday wear and tear on the vertebrae of the lower spine. After a while the lower spine can lose its normal functioning capabilities during common stresses.
If this occurs, the intervertebral disc develops small fissures or cracks, which then allow the soft nucleus to protrude the disc outward. Pain is produced as the disc pushes on sensitive tissues. This occurrence is commonly referred to as a ruptured, or slipped, disc. If the disc presses on the spinal nerve, a person can develop sciatica. The good news is that most disc conditions, including sciatica, can be completely relieved with chiropractic manipulation and therapy that often includes postural exercises.
Periformis Syndrome
Periformis syndrome is another condition that results in sciatic pain. Periformis syndrome occurs when the periformis muscle, which is superficial to the sciatic nerve, goes into spasm and irritates the nerve. Along with chiropractic manipulation, this kind of sciatica can be significantly relieved by sciatica stretches that your chiropractor will advise you on.
If you are experiencing sciatic pain, it is crucial for you to seek chiropractic attention.
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Spinal Fusion Options
Spinal fusion has become a very common surgical procedure in the United States over the past 10 years. There are many diagnoses that range from fractures of the spine to severe degenerative disc disease that prevent patients from being able to stand or walk are best treated with a surgical remedy. This article is intended to provide a basic review of the many spinal fusion options that are available.It is best to talk to a fellowship-trained spine surgeon who will be able to give you a complete picture of all of the devices available that are recognized for quality and reliability or to help you rule out those that are not advisable.
As the number of spinal fusions has increased, the variety of procedures and hardware alternatives that are available has also increased. It may be easier to understand why there are so many types of fusions if you consider how fractures need to be fixed with fusion. With broken bones, there is usually little question about the wisdom of providing casts or plates and screws to stabilize bones that need to be realigned or stabilized. Spinal fusion provides the same stability for the spine as is used for other fractured bones. What is a spinal fusion? Screws and rods in the spine are used to keep bones from moving as the bone graft that is placed allows the stabilized bones to form a connection across a previously mobile disc space. The growth of bone between 2 previously mobile bones is called fusion.
Standard Fusion Technique
Initially, fusion of the vertebral bones was done by laying bone graft between the bones, to provide a scaffolding across which the native bone cells could grow. As the patient s bone cells move across the bone graft, they are able to incorporate the bone graft into the patient s own bone structure, forming a complete connection called a fusion. Bone graft is of primary importance in allowing the vertebral bones to fuse across a previously mobile segment. Studies of patient s with fusions done with bone graft alone have shown a relatively good rate of incorporation when patients are placed in back braces for 3 months or more. Because of the inconvenience and discomfort of the bracing, pedicle screws and rods have been added to provide an internal support that obviates the need for external supports. Internal screws and rods have increased successful fusion rates, as well as allowed patients to become mobile very quickly after the spinal fusion.
Interbody Fusion Cages
As the skill of the surgeon s has grown when applying screws and rods to the spine, we have looked for better ways to gain improved results.Now, it is possible to put bone graft around the back of the spine, as well as into the disc spaces. With these improved grafting methods, we are able to safely access the lumbar disc from the back of the spine. Adding bone graft to the disc increases the surface area for healing and should improve the overall success rate of the spinal fusion. Interbody grafting can be done from several different approaches, as access to the disc space can be achieved from multiple directions.
XLIF
This acronym stands for extreme lateral interbody fusion. XLIF is a newer device designed to provide a carrier for bone graft and support to the disc space. It is placed through an incision on the patient s flank. By making an incision on the patient s side, the abdominal contents can be moved out of the way for a good view of the spine. Unfortunately, there are some significant nerves in the front of the spine that are very sensitive to being moved. This type of access to the spine can lead to weakness in one leg because of the sensitivity of these nerves.At this time, there are no long-term studies that demonstrate that this procedure is a success.
AxiaLif
This is another fusion device that has received some attention, due to its being touted as the least invasive spine fusion .This device is placed across the lowest disc space by access from the front of the sacrum (a large, triangular bone at the base of the spine, wedged between the two hip bones). By placing instruments through a small incision near the rectum towards the spine, the disc is accessed through a series of cannulas (hollow surgical tubes) and drills. This allows the disc material to be removed from the disc space. After the disc material is removed, bone grafting can be placed into the hole that is created. This disc space is then supported by a tapered screw placed into the bones. So far, this device has had minimal post-surgical study and is most likely best done in conjunction with standard screw and rod fusion techniques.
Flexible Rods
There has been some recent excitement around rod and screw systems that are so-called non-fusion fusion devices. This confusing name infers that, although the intent of the screws and rods is for the bones to not move, these devices are designed to allow some movement. As was discussed earlier in this article, fusion is the solid connection of bones that had previously moved.The idea of these flexible rods is to provide enough stability to allow the bones to fuse together, but not enough to change the spinal forces. This is termed a soft-fusion .At this point, there is no concensus as to how much or how little support is needed to achieve this. It is known that current screw and rod systems provide enough support to allow a fusion to occur while providing complete immobility of the vertebrae. Other than this complete connection, the amount of support less than complete immobility has not been defined and at this point is still under investigation.
Disc Replacement
Disc replacement was developed as an alternative to fusion and is suggested for those discs that have ruptured, but in which the bone structure is still good. If only the disc has gone bad, removal of the disc leaves a space that we normally fill with bone graft to promote fusion in the neck or lower back. With the development of the disc replacement, the space that is left from disc removal can be filled with a device that allows motion, rather than fusion. This is a complete reversal in the approach to disc removal; from complete immobility to complete mobility. Disc replacement is intended to maintain the motion in the spine. This reconstruction of the spine should maintain the forces across the discs in the spine to prevent the other discs from deteriorating any more rapidly than their normal degenerative process. Disc replacement in the lumbar spine has met with some success in well-selected patients. It has not been a panacea for all patients with low back pain or degenerative disc disease.Disc replacement in the cervical spine has had good success, as most neck fusions are done for bad discs with the bones still in good condition.
Improved training, including advanced specialty training in fellowship programs, as well as improved implants, has decreased most surgical procedure times to 2 hours or less. Historically, older techniques have been known to take 4-6 hours for the operation alone. By decreasing operative times, surgeons have seen decreased complications from the anesthesia, as well as decreased risks of infection and blood loss. Most surgeries under 2 hours will not require a blood transfusion.
A well-informed patient, who understands the benefits and the risks of their surgery, can fully participate in the choices that need to be made about their surgery. If you have been told that you need a spine fusion, ask questions and do your research. It is appropriate to ask your surgeon about their experience performing spinal fusions, how many of the fusion procedures they perform, how long the operation will take and the likelihood of needing a blood transfusion. Selecting a well-qualified surgeon can help ensure the best outcome for you and the success of your spinal fusion.
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Older fusion methods and inadequate diagnostic approaches left surgeons with few options for treating these patients, so some patients were given fusions as a last attempt to improve their pain . Most patients with lower back pain and …
However, this treatment option is quite inconvenient for the patient as it has to be worn up to 24 hours a day and is quite uncomfortable. *Surgery: For scoliosis, it is specifically referred to as Spinal Fusion Surgery wherein a spinal …
If the later is the case, a spinal fusion has been mentioned as a option. You have seen people with a spinal fusion before, their necks appear to be sunken down to their shoulders and when they look left or right, up or down, …
Spinal Fusion Surgery To Relieve Low Backache
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Back Pain and Spinal Stenosis
A recent study published by Boston University has found out that lumbar spinal stenosis affects 4.71% of the general population, which seems like a very low number. However, 47.2% of individuals in the 60-69 age group have lumbar spinal stenosis on their MRI scan, which is a significant number. The individuals that actually are diagnosed with severe stenosis will approach 20%. These patients with significant spinal stenosis have a 3 times higher incidence of back pain than the general population. As our population continues to live longer, stenosis of the spine will certainly be a significant health problem.
Spinal stenosis is the progression of arthritis in the spine occurring in the neck, as well as in the lower back. As we age, the cartilage in the discs of our spine will lose their ability to hold water. The water in the discs is what helps the disc move and remain flexible to bending and compression. As the discs lose their water content, they become more fragile.If the brittle cartilage breaks, the condition is called degenerative disc disease.As discs degenerate, they will begin to expand and put pressure on the spinal canal and nerve roots. This disc bulging will decrease the diameter of the spinal canal,a condition referred to as spinal stenosis. This slows the information that flows between the brain and the extremities. The arms will be affected by spinal stenosis in the neck and the legs will be affected by lower back (lumbar) spinal stenosis.
Patients with lumbar spinal stenosis will feel back pain, as well as leg pain or fatigue. Because of the fatigue in the legs, patients will have to sit frequently during walks.Lumbar spinal stenosis will also cause patients to find benches in the mall and grab the cart at the grocery store, in order to make it through their errands due to the fatigue. Some patients may attribute their fatigue to age and as they continue to remain active later in life, this may severely limit their ability to join in their families activities.The leg fatigue can cause significant pain and cramping during activity, but is lessened when the patient sits down. The act of sitting opens the spinal canal by decreasing the curve in the lower back,which also occurs while the patient is leaning on the grocery cart.
Spinal stenosis in the neck may cause more severe symptoms. The cervical spine protects the spinal cord as it descends from the base of the brain.Because spinal stenosis in the neck puts pressure on the spinal cord, the disc pressure will cause symptoms related to the area. These include a decrease in the ability to walk as well as problems with the hands.Patients may find they tend to stumble, as it becomes harder to control the feet and legs as the disease progresses. They may also find their handwriting getting severely worse and that they have difficulty differentiating the size and feel of coins or shirt buttons.
Spinal stenosis is usually treated with physical therapy and anti-inflammatory medications. Physical therapy is intended to help position the spine and open the spinal canal. With better posture and stronger core muscles, patients may find their leg symptoms and fatigue improve. They may find they are able to walk farther or faster. Oral anti-inflammatory medications are a first-line option for improving the inflammation related to the degenerating discs. When physical therapy and oral medications no longer provide relief, injections of steroid around the discs and nerves may decrease the pain and symptoms related to the nerve pressure. Some patients are able to tolerate their symptoms with a few injections per year.
When all of these efforts fail, surgery becomes an option for improving the patient s pain.Surgery is aimed toward relieving the pressure from the arthritis on the spinal canal and nerves.The mechanical pressure can only be alleviated by physically removing the bone spurs or disc protrusions. The surgical procedures involve removal of bone and disc, as well as protecting the nerve roots. Fellowship-trained orthopedic spine specialists have undergone the most intense training available in the treatment of the spine and are uniquely qualified to treat patients with spinal stenosis.
Dr. Jeffrey R. Carlson is a doctor at the Orthopedic and Spine Center, a leading provider of Hampton Roads orthopedics services such as Hampton Roads spine surgery, Hampton Roads custom fit knee replacement, and many other services. The Orthopedic and Spine Center can be found online at: OSC-Ortho.com
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Causes of Spinal Stenosis and How to Cope
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Chiropractic treatment of lumbar spinal stenosis
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Spinal Fusion Treatment
Spinal fusion is a surgical procedure that many back pain sufferers don’t understand. Many people have heard horror stories about people who have had back surgery and never recovered.
Many patients think a spinal fusion will cause their spine to become completely rigid, and they envision a future of pain and stiffness and being unable to bend their backs or touch their toes, afterwards. Over the past decade, spinal fusion has also had a less than bright reputation as a treatment for pain. Given the overall perception that fusion of the spine is a delicate surgery with questionable outcomes, patients are quite concerned about proceeding with a fusion. This article will help to dispel many of the misconceptions that surround this treatment and why it is important to understand the procedure, when it should be performed and who might benefit from a spinal fusion.
What is Spinal Fusion?
Spinal fusion is a surgical procedure designed to provide stability to an area of the spine that has too much movement or movement that causes pain, tingling, numbness or weakness in the arm or leg. The object of a spinal fusion is to connect the bones (vertebrae) that were previously too mobile and form a connection of bone in the spine that is more rigid.
A History Lesson
Orthopaedic surgeons have long applied casts to broken bones to provide support to fractures and allow the bones to heal. This external support keeps the bones from moving. Why is this important? When there is too much movement between broken bones or bone fragments, the repair cells are prevented from being able to connect the bone fragments together, so their process of healing will stop.
As orthopedic surgeons have progressed in the use of technology, plates and screws, called internal fixation devices, are now applied to fractured bones. These rigid internal fixation devices are stronger, and they add more support to the fractured bone. Plates and screws have been able to replace bulky external casting in a large group of fracture types.
The same treatment principles are used by the orthopedic spine surgeon. There was a time when fusions were supported with external bracing. This external support, provided by casting or rigid bracing, has been replaced with internal rods and screws. Using these internal supports provides stronger bone connections that decrease motion even more. As a result, the number of successful fusions has increased. The internal support of the spine is stronger, allowing patients to get up and out of bed and walk the day of surgery and to return to their usual activities in 6 weeks. This is a far cry from the days of original spinal fusions that were supported with a cumbersome hard plastic brace or cast, leaving patients with limited mobility or bed rest for many months.
Spine surgeons are now better able to determine which patients will be helped with a spinal fusion. Advanced imaging studies, including MRI and bone scans, as well as the use of diagnostic injections, help today s spine specialist more accurately diagnose patients who would benefit from spinal fusion. Advances in surgical techniques and components, including the development of better screws and rods, also have greatly improved patient results. Improved diagnostic and surgical training, including advanced training in spine fellowship programs, has helped spine surgeons interpret and use these advances in technology to obtain better outcomes for patients.
Who Needs a Spinal Fusion?
As with all surgeries, there are proper uses that will result in good outcomes for patients with spinal fusion.
In patients where the spinal bones have begun to slip and cause pressure on the spinal nerves (spondylolisthesis), this excessive movement may need to be stopped to prevent worsening of the nerve pressure. During surgery, these patients will have the bone spurs and disc protrusions removed from around the nerve roots and spinal cord, which may destabilize the bones of the spine and cause the bones to slip more. Inserting screws and rods in these bones will prevent the bones from slipping any further after surgery and also may be used for correction of the original slippage.
Use of screws and rods can also provide stability and correction for patients with scoliosis. Scoliosis is the bending of the spine in an abnormal direction. The curve of the spine may increase with time or may be painful as the curvature of the spine increases. If the patient has a large curve or the curve is continuing to get worse, screws and rods are used to correct the position of the spine and prevent the curve from worsening.
In patients with obvious bone destruction from fracture, tumor or infection, stabilizing the bones with screws and rods will provide the support that is needed so the underlying disease can be addressed. The structure of the spine can be improved while the patient receives chemotherapy or radiation. By removing the tumor in the spine, the back pain related to an expanding tumor can be relieved and the patient can remain mobile, which helps to prevent pneumonia and blood clots. Being ambulatory, while receiving chemotherapy and radiation, also improves the patient s mood and outlook while coping with their disease.
Who is Not a Candidate for Spinal Fusion?
Most patients with disc herniations or pinched nerves will not need a spinal fusion. These conditions can be treated with simpler procedures that allow the removal of pieces of discs or bone spurs that do not increase the movement in the bones.
The more difficult indication for spinal fusion is in the patient with severe pain in the back. Degenerative disc disease is the leading cause of back pain in the United States, but back pain can have many underlying causes. One of the reasons that spinal fusion developed a bad reputation is that they were performed as a remedy for back pain that did not respond to other forms of treatment. Older fusion methods and inadequate diagnostic approaches left surgeons with few options for treating these patients, so some patients were given fusions as a last attempt to improve their pain . Most patients with lower back pain and degenerative disc disease will not need a spinal fusion.
What To Expect From Spinal Fusion?
It is expected that most patients will be back to their usual state of health and activity at approximately 6-8 weeks after their fusion surgery. Most patients will be pain-free after their spinal fusion. It is important to choose a well-trained surgeon to make educated decisions about your diagnosis and treatment. With the combination of the proper diagnosis and properly applied spinal fusion most patients will have successful outcomes.
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Treating Failed Back Surgery Syndrome
Failed back surgery syndrome is the term used to describe recurring or persistent pain in the back or legs following a lumbar spine surgery.
Often, surgery is used to fix an anatomical problem, such as a herniated disc pushing on a nerve. Unfortunately, even in the hands of the most skilled surgeon, some patients will continue to have pain after the anatomical problem has been repaired. The exact number of patients who continue to suffer pain is not clear, but more surgeries appear to increase the risk of this condition.
There are many reasons why patients may continue to have pain. Low back pain is often from more than one source. For example, there could be pain from a herniated disc, or pain from arthritis in the small joints, known as facet joints. After repair of one problem, pain may persist from the other. There can be a problem related to the surgery itself, such as a complication of hardware that was inserted or an infection. Continued degeneration of the discs and joints of the spine can also cause pain. Scar tissue formation (known as epidural fibrosis) and inflammation around the nerves (known as arachnoiditis) may also cause pain.
The best treatment for FBSS is prevention. Non-operative therapy should be the first step in treating low back pain, unless there is a clear anatomical problem that requires surgical intervention. Patients should be aware that even with a skilled surgeon, there is no guarantee of complete pain resolution from a low back surgery.
If a person develops FBSS, it is important to have a multidisciplinary approach to treatment of this complex problem. If there are no problems requiring surgical intervention, then multidisciplinary care involving physical therapy, medications and spinal injections should be pursued. Physical therapy should include not only treatments for pain, such as deep heat, but also muscular training exercises and instruction on how to do daily activities to prevent increased pain. FBSS therapy may also include spinal injections, such as injections around the nerves, discs or small joints in the back or neck. Epidural steroid injections are the most common, but there are several other injections that may be helpful for treatment or facilitating diagnosis.
There are some patients that do not respond to less invasive techniques, but they may benefit from more intensive treatments, including spinal cord stimulation or pain pump implantation. Spinal cord stimulation is frequently used for the leg pain associated with FBSS. A small lead is placed in the epidural space around the spinal cord and masks pain by producing a tingling or tapping sensation in the place where pain is felt. Before having the device implanted permanently, a screening trial is performed. A temporary lead is placed where the patient feels pain and they are able to test their response to the device. Once the device is permanently implanted, the patient can turn the device on and off, as well as make some adjustments to the stimulation they receive. Another treatment is pain pump implantation, also known as intrathecal drug delivery system implantation. This pump will place medication directly into the fluid around the spinal cord, which requires a much smaller dose of medication than when taken orally. Because the medication does not circulate throughout the body and a much smaller dose is used, the frequency of side effects is less. Though morphine is the most commonly used medication in these pumps, some other opioid and non-opioid medications can be used successfully.
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Spondylolisthesis Treatment
In adolescents back pain may begin as the bones shift and become irritated because of their abnormal connection in the spine. Children who are active in sports and athletic activities will experience instability related to a lack of connection in the back bones that will start to be painful.
X-rays, taken at this time, may show a break in the bones; however, there are a significant number of these kids with back pain who will have normal looking x-rays. These children may need to have a further evaluation with a CT scan to help visualize the bones of the spine more specifically. Many individuals live their whole lives with a break in their vertebrae and are pain-free until their discs start to degenerate.
The largest group of patients with spondylolisthesis have degeneration in the discs that leads to back pain and doctor visits is the middle age population. As the discs degenerate, they are not able to support the weight of the spine, which allows the bones to shift. Due to the change in the position of the bones, the discs will have to bear the brunt of the patient’s body weight and movement, which in turn, applies more stress to the discs and forces them to degenerate faster.
The back or leg pain associated with a mild slippage of the bones will not be any more severe than the normal pain associated with age. There are no particular restrictions in activities that need to be considered in mild spondylolisthesis. As patients age the discs that are between the slipped bones will continue to degenerate. Disc cartilage degeneration can be painful and can lead to an increase in the slippage of the bones. As the spine continues to degenerate and slip, the nerves that are protected by the bones will begin to receive pressure from the discs and bones. Pinching the nerves in the back will cause pain in the distribution of the nerve roots. This pain is felt in the back of the legs and down to the foot, called sciatica. The nerve pain is usually the most painful and many patients will wonder why the doctor is checking their back when it is the leg that is hurting.
The initial treatment for the pain associated with spondylolisthesis is physical therapy combined with anti-inflammatory medications. Exercise, stretching, traction, as well as manual therapies, can be very helpful in relieving the pain. The goal is to try to relieve the pressure on the nerve and mobilize the bones and discs to allow for a more fluid motion of the back without irritating the muscle, tendon or nerves. Most patients respond favorably to this treatment and can maintain their spines with exercise at home. If this treatment is not successful, injections of steroids around the nerves and joints may be helpful in relieving some of the acute pains. After pain reduction, the exercise program may be more effective. If all of these treatments don t work, surgery should be considered to relieve the back and leg pain. Although, most patients are reluctant to have back surgery, with the improved techniques used by the fellowship-trained orthopedic spine surgeon, spondylolisthesis is one of the conditions of the spine that responds very successfully to surgery.
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