There are numerous causes for back pain ranging from muscle strain, trauma, arthritis, disc herniation, muscle spasm, facet joint pain, and cumulative effect of poor body mechanics.
When the disc bulges or herniates into the spinal canal, the nerves in that area can become inflamed or agitated, creating both back pain and pain in the area where that nerve carries impulses. The muscles surrounding the injured disc can become fatigued and spasm.
A bulging disc is a slight protrusion of the center of the disc (nucleus pulposus) into the spinal canal. In a bulging disc, the annulus fibrosus (outer ring) has not been ruptured. A disc herniation is a large protrusion of the nucleus pulposus (center of the disc), which has burst through the annulus fiborsus (outer ring of the disc) into the spinal canal, invading the surrounding nerves and causing pain in the back, buttocks, hips, or legs.
Bulging discs are very common, and may not produce any symptoms.
As we age, the disc may lose hydration and develop small tears and bulges. The herniation can occur due to a lifetime of poor body mechanics, a trauma, or by lifting, bending or twisting the wrong way at the wrong time.
The classic symptoms of a herniated disc include back pain, hip pain, and any combination of burning, numbness, tingling, or pins and needles in the legs.
A herniated disc is treated with conservative therapy unless there is a spinal deformity or neurologic deficit. Conservative therapy can include physical therapy, chiropractic care, acupuncture, Pilate’s, ultrasound, pain medication, muscle relaxants, and a short course of steroids. If these do not work, the next steps include a steroid epidural or facet joint block. Surgical intervention is the last resort. If surgical intervention becomes necessary, a microdiscectomy is the most common procedure.
Degenerative Disc Disease refers to the loss of loss of hydration in the disc and weakening of the annulus (outer lining of the disc). Trauma can cause the annulus to tear and disc material leaks out and presses on a nerve. Degenerative disc disease is very common in the human population but is not always symptomatic.
Lumbar instability occurs when there is unnatural movement of the vertebras. This can be a result of degeneration of the discs, a spinal deformity such as spondylolisthesis, or occur after a decompression procedure.
Spinal Stenosis is an abnormal narrowing of the spinal canal which holds the spinal cord or the nerves. The narrowing may be caused by age related changes of the spine such as disc degeneration and arthritis causing a bone buildup in and around the canal and nerve holes producing nerve compression. The compression of the nerves causes arm or leg symptoms such as numbness, weakness, or pain.
Conservative therapy may relieve the symptoms of spinal stenosis. If not, a spinal decompression is necessary. This is the removal of the bony narrowing around nerves. The operative strategy will depend not only on the location of the spinal narrowing, and the relative stability and condition of the spine as a whole.
My doctor told me that I have arthritis of my spine and that I should learn to live with the pain. Is this true?
Generally, the pain associated with arthritis can be managed with conservative therapies, exercise, and medication.
Surgery is only indicated if conservative therapy fails, the patient becomes dysfunctional, or the patient should experience progressive neurological problems.
A laminectomy is the removal of a small portion of the vertebra, (lamina) around the affected area. This is done to relieve pressure on the nerve roots.
A fusion is recommended if there is spinal deformity or instability, or if the spine will become unstable due to the removal of the disc or bone.
No. Very little bending capacity comes from the spine. It is from the hips.
The spinal instrumentation serves two purposes. First, it allows the surgeon to restore the alignment and balance of your spine. Secondly, the instrumentation acts as an internal brace, stabilizing the spine while the bone fusion grows.
There are differences in the instrumentation on the market. Your surgeon will select the instrumentation based on the procedure.
That is an excellent question. In a one level fusion, there is little impact on the spine. In a multi-level fusion, the major concern about a fusion is adjacent segment degeneration. The discs act as shock absorbers between the vertebras. When the spine is fused, the discs above or below the fusion may absorb the sheer force from every day motion, and thus wear out. When the fusion is performed it is essential that the balance of the spine is maintained. If this is done, the adjacent segments are at less risk of degeneration.
There are risks associated with any surgical procedure. The risks for spine surgery include but are not limited to: inter operative complications, infection, bleeding, and hardware failure.
Recovery from surgery is individualized, and depends on the surgical procedure. Regardless of the procedure, patients are walking within 24 hours of surgery.
In most cases insurance will cover spine surgery. Your insurance benefits will be verified and explained prior to surgery.
I have heard people talk about less invasive back surgeries. What are these? How do I know if I am a candidate?
Minimally invasive surgery is an option for certain conditions, when performed by a spine specialist. Your physician will explain the treatment options and the pros and cons of each.
Pain medication is administered in the hospital following surgery. Patients typically require oral medication for a period ranging from 1-4 weeks, depending on the individual and the procedure performed. If a fusion has been performed, it is important to avoid anti-inflammatory medications, including aspirin products, until cleared by the physician. These medications will inhibit the growth of the bony fusion.
No. There is an additional risk for men during any surgery involving the abdomen. When an anterior fusion is performed on male, there is a small chance that the nerve that controls ejaculation can be damaged, resulting in retrograde ejaculation. If this occurs, the patient will still be able to become erect, and orgasm, but will not produce semen.
There are potential risks with any surgical procedure. The complications specific to a fusion surgery, while rare, include failure to fuse, hardware failure, infection, excessive bleeding, and adjacent segment degeneration.
Post-operative visits will depend on the procedure and your surgeon.
The surgical approach is determined by the physician based on the diagnosis and symptoms of the patient.
The anterior (front) approach to the spine is generally accompanied by a skilled vascular surgeon. The major complications associated with this procedure are blood vessel damage and sexual dysfunction in males.
The risks of a posterior (back) surgical approach include: nerve damage, bleeding, infection, cerebral spinal fluid leaks, failed hardware, and a failure to fuse.
A bone graft is a bony substitute for a disc, which grows over time to stabilize two or more vertebra together. There are two categories of bone grafts, allograft (donor bone) or autograft (bone used from your body, generally the iliac crest.) The type of bone graft used is based on the procedure, the amount of bone needed, whether the patient is a smoker, and the patient’s overall health.
My spinal specialist said he will take the bone graft from my hip. How big is that incision compared to the spine surgery?
The incision for your spine surgery is correlated with the number of spinal levels that are fused. The incision for the bone graft can vary, but is generally 1 ½- 2 inches long.
The alternatives to using a bone graft from the patient’s hip are to use local bone, cadaver bone, or a bone graft substitute.
The bone taken from the patient’s hip has a higher fusion rate than donor bone.
I have heard people talk about the pain associated with harvesting bone from the hip. Does this happen to everyone and how long does it last?
There is pain associated with any surgical procedure. In the majority of patients the pain is resolved in a short period of time and they do not require medication. There are a small percentage of people who do suffer chronic pain following this bone harvesting.
There are potential complications with any surgical procedure. The complications most often associated with harvesting bone include: infection, bleeding, or chronic pain.
My spinal specialist said that he will perform the fusion from my back and will harvest bone from my hip without a separate incision. Will I be able to tell the difference between that pain and the main procedure pain?
Most patients can distinguish between the pain generated from the procedure and the bone harvesting.
I have heard people talk about hip pain after harvesting lasting up to two years or longer. Is that true?
The majority of patients do not experience long term pain, but it is possible for patients to experience long term hip pain following harvesting.
MRI or CT scans are performed on patients that have had spinal fusion with titanium instrumentation to rule out re-herniation or to aid the physician in diagnosing a new problem. Always inform the imaging technician performing the MRI or CT scan that you have spinal instrumentation.
According to a joint study by AAOS (American Association of Orthopedic Surgeons) and the American Dental Association. At this time antibiotics are recommended for two years following an implant procedure. Notify your dentist when scheduling an appointment. The dentist will prescribe the recommended antibiotic if necessary.
It is recommended, but not mandatory that you advise the TSA officer of an implanted medical devise. With the current screening system, patients have not reported setting off the alarm. With the advent of full body scanners, this may change.