Relief For Back Pain

Posts Tagged ‘Spondylolisthesis’

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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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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