Treatment

Cortisone is a steroid. Steroids have gotten a bad reputation because of some really bad side effects suffered by people, such as body builders, who take steroid pills for a long period of time. One or two injections of cortisone into a sore joint or aching back do not carry the same risks. However, there are risks associated with cortisone injection. These risks include infection, bleeding, and headache.

Healing tissues require a fresh and steady supply of blood. Your supply carries needed oxygen, nutrients, blood cells, and other important healing agents to the area. It also provides a way for chemicals, enzymes, and other debris to be flushed away. Smoking puts nicotine in your blood. Nicotine causes blood vessels to become narrower (vasoconstrict) (vase-oh-con-strict), which limits how much oxygen, nutrients, blood cells, and other important healing agents can get through.

Certain parts of your spine, especially in the lumbar area, have naturally limited blood supply. Smoking after spine surgery can further limit the blood supply. This can slow the healing process, and may even lead to other complications during your recovery.

You can maximize your ability to heal by stopping smoking well before surgery and staying smoke-free at least until well after surgery. You may even want to quit smoking permanently. Your doctor can give you some helpful ways to stop smoking.

To understand the type and nature of your job, your physical or occupational therapist may want to ask you a variety of questions. The information you give can help your therapist design exercises to help you control pain at work. If needed, your therapist may want to go to your worksite and observe how your work tasks are done. This can give him or her important information about risks, and whether any changes need to be made. Even small changes in the way your workstation is designed or how you do your job can make a big difference in your comfort and safety at work. Assessing where and how a person does work is called ergonomics (air-go-nom-icks).

There is not very much movement in the joints of the lumbar spine when you bend forward. The total amount of flexion (fleck-shun) (bending) at each level of the lumbar spine is only about three degrees. Most of the movement of bending forward takes place at your hips, so as long as your hips are okay, you should not have any problems bending forward after lumbar spinal fusion.

Yes. Most metal implants will not set off a metal detector. But if you have a concern, your doctor can provide you with a card confirming that you have metal implants in your body.

Metal implants used in surgery are not always removed. Once your spine fusion has healed, the metal rods and screws are no longer necessary. Still, the implants are usually not removed unless they cause you pain or discomfort, can be felt or seen under your skin, or have broken. If a follow-up x-ray shows that an implant is broken, it may be a sign that your fusion did not heal successfully. Your surgeon may suggest additional tests to see whether your fusion has healed before taking out the broken implants.

MIS is associated with the same risks as any general surgical procedure. During the procedure, however, the surgeon may decide to convert from minimally invasive to traditional surgery if visualization is limited or if other complications arise.

Traditional spine surgery typically requires long incisions in the back. Muscles are cut and separated from the spine to allow access to the spinal anatomy. Minimally invasive spine surgery is performed through small incisions in the back. Surgeons use specialized instruments and navigational tools such as interoperative x-ray, microscopes and tubular retractors. Like traditional spine surgery, the goal of minimally invasive surgery is to relieve your back and/or leg pain. But it adheres to a different philosophy - that as little muscle tissue as possible should be damaged.

Studies show that Glucosamine can help relieve the pain of knee osteoarthritis. However, these were short-term trials spanning a four to eight week period. Since osteoarthritis is a chronic problem, more studies will need to be done to investigate the long-term benefits of Glucosamine. A second question is whether people with osteoarthritis of the spine will get the same benefits as those with knee osteoarthritis. At this time, no one knows for sure. Some doctors feel there are enough benefits to encourage their patients to supplement with Glucosamine. Although you may find some relief, there are no studies yet that show with certainty that your back pain will be relieved by taking Glucosamine.
As with all medications, be sure to discuss the use of Glucosamine with your doctor before beginning to take this supplement.

There are a number of things you can do at home to relieve your back pain. Your doctor may recommend using heat or ice, relaxation, breathing, and positioning exercises to help control your pain and relieve stress. Simply giving your body a rest can help calm low back pain, giving your back time to heal. If you are having pain with an activity or movement, it is a sign of irritation. Try to avoid all movements and activities that increase your pain. You may be given exercises for the joints and muscles above and below the sore area to help relieve your pain and protect your back during the initial healing phase.

Your physical therapist (PT) may suggest short periods of rest followed by brief exercises designed to reduce your pain. Prolonged bed rest is not healthy and can cause your muscles to weaken and your joints to get stiff. Any exercises you do should be done only under the direction of your doctor or PT. Extra pain after these or other exercises usually indicates that you are overdoing it. You may need to change the number of repetitions, the amount of pressure applied, or how often you are doing the exercises. Talk to your doctor or PT if you are having extra pain after exercising.

Spinal decompression and spine fusion surgery are two common surgical procedures that can be performed using minimally invasive surgical approaches.

Your doctor may prescribe a supportive brace to help rest your spine, especially if you are feeling severe pain or have increased pain with movement. Using the brace for a short period of time may help you avoid extra movement and give your spine time to heal. You should remove the brace several times each day in order to do some gentle range of motion exercises. Long-term use of a brace can weaken your spine muscles and make your problem worse instead of better.

Back specialists use the term "conservative treatment" to describe any treatment that does not involve surgery. Sometimes, this can be as simple as reassuring you that it is not a serious problem, and recommending that you do nothing but watch and wait. Conservative treatment can also include medications to relieve your pain, physical therapy, and exercise. People with back and neck pain should also learn how to protect their spine by practicing good posture and doing strengthening exercises.

Your doctor will begin by getting your complete health history, followed by a physical examination. The history and physical examination are needed before your condition can be accurately diagnosed or treated. By getting this information, your doctor can begin to determine the source of your problem.
To help get your physical history, your doctor may ask you some questions about your pain and symptoms. The information you give can help your doctor determine your diagnosis. Examples of the questions that you may be asked include:

• When did your pain first begin?
• Was there an injury that may have caused your pain?
• Are you aware of work postures or other factors that may be causing your pain?
• Do you have a family history of similar problems?
• Where do you feel the pain? What is the intensity?
• Does the pain radiate to other parts of your body?
• What makes the pain feel better or worse?
• Have you had problems with your bladder or bowels?

During your first visit to the doctor, he or she may also order some tests to help with your diagnosis. These tests may include an x-ray, CT scan, MRI, EMG, or blood test.

How quickly you can go back to doing the activities you enjoy after spine surgery depends on the type and location of your surgery. For example, a micro-discectomy requires much less healing and recovery time than a fusion surgery. It also depends on the stress of the activity. You will need to begin any activities gradually, and in a gentle, controlled manner. You do not want to cause yourself pain - or worse, re-injure your spine.

Be sure to follow all recommendations from your doctor and physical therapist. Be patient, and follow your rehabilitation program closely. It has been developed to give you the best chance of returning to full function. No activity is worth causing more injury to your spine.

Ice is generally prescribed in the early stages of healing. This period begins at the time your pain or injury starts and lasts up to three days. The cold temperature makes your blood vessels in the sore area vasoconstrict (vase-oh-con-strict ) (become narrower), which helps with the initial stages of healing. Cold treatments can include cold packs or ice bags, which are usually put on the sore area for 10 to 15 minutes.

Heat is generally used after the early stages of healing are over. Heat makes your blood vessels vasodilate (vase-oh-dye-late) (get larger). This helps flush away chemicals that can cause pain. It also helps to bring in nutrients and oxygen, which help the area heal. True heat in the form of a moist hot pack, a heating pad, or warm shower or bath, is better than creams that give the feeling of heat. Hot packs are usually placed on the sore area for 15 to 20 minutes. When using heat, you must be careful to make sure your skin does not overheat and burn. It is also not a good idea to sleep with an electric heating pad at night. This can cause the "lobster effect" where your skin becomes red and actually burns from the prolonged heat.

For people with back or neck pain, the answer to this question is "It depends." It depends on the stress of the activity you have in mind, and the type of back or neck problem you have. Most people can return to hobbies and activities they enjoy by getting warmed up first. You should begin in a gradual, guided manner to avoid injury and complications. Be aware of your limitations and safety. Avoid activities that strain your spine or increase your pain.

Walking is one of the best activities you can do throughout and beyond your rehabilitation. The natural trunk motion helps flush out any swelling or extra chemicals that can build up and cause pain. Walking provides safe weight bearing for your joints, and helps you manage day-to-day stress. Swimming is also an excellent activity choice. The buoyancy of the water lowers stress on your joints and enables you to move more freely.
As with any system of exercises, consult your doctor or PT first.

Once you have had an episode of back pain, the chance of having pain again is very high - about 90%. The goal of your physical therapy program is to help you learn and use ways to prevent future pain and injury as well as to relieve any future pain you may have. If your back pain strikes again, avoid activities, positions, or movements that make the pain worse. Give your sore back or neck a chance to rest. You may get some relief with short periods of rest in a comfortable position. For the first two or three days, you may get relief by applying a cold pack. Once the early pain symptoms are controlled (two to three days), you may get good pain relief by using a hot pack or heating pad. If using a heating pad, remember to turn it off before going to sleep. Check your skin regularly to make sure you are not getting too much heat.

Some exercises are designed to help take pain away. After you have completed your physical therapy treatments, your physical therapist (PT) can go over the exercises that will give you the best pain relief in case you get sore again. Remember to do your exercises exactly how your PT showed you. Overdoing them could make your pain worse. Remember to use healthy posture, body movement, and safe lifting techniques with all your activities. If you are trying to take care of your back or neck but are still not getting relief, you may need to see your doctor or PT again for additional help.

The human body rarely rejects metals that are used in surgical implants. Most metal implants used in spine fusions are made of either stainless steel or titanium. Alloys are another type of metal that may be used in a fusion surgery. An alloy is a mixture of several metals such as cobalt, chrome, and nickel. A good rule of thumb is if you can wear a watch or jewelry without problems, you are not likely to reject a surgical implant. Sometimes implants and have to be removed because of an infection, but this does not mean that your body has rejected the implant.

No, it's common for many operations, including:
Heart surgery
Bariactirc (weight loss) surgery
Total hip replacement
Appendectomy
Gall bladder removal

Benefits of Minimally Invasive Surgery

• Smaller incisions
• Less postoperative pain
• Less surgical blood loss
• Shorter hospital stay
• Less postoperative pain medicine
• Faster return to work and daily activities

Yes. The laser is being used in spine surgery mainly to treat disc problems. A procedure called thermodiskoplasty (ther-mo-disk-oh-plas-ty) is when your surgeon uses a laser to change the shape of a disc. This procedure may be used in combination with microdiscectomy (mick-row-disk-ek-toe-mee). Although the use of lasers in spine surgery is still pretty new, it shows promise as a minimally invasive way to treat disc problems of the spine. It reduces scarring around the nerve roots and can lead to a faster recovery. Also, the hardening affect that lasers have on the disc itself may help keep your spine from becoming unstable after disc surgery.

Usually, surgeons do not remove the entire disc. Instead, they take out just the material in the middle of the inside of the disc. After a simple discectomy surgery, scar tissue fills the area where disc material has been removed.

When a fusion using a bone graft is needed, the disc is taken completely out and the bone graft is put in place of the disc between the two vertebrae. In an anterior interbody fusion surgery, a metal cage may be used in place of the disc between the vertebrae. Total disk replacement (TDR) may be a solution for some people with degenerative disc disease as an alternative to spinal fusion. TDR can reduce the risk of bone graft donor site pain and pseudarthrosis (sewd- arth-row-sis), which is improper movement of a joint after healing. One of the artificial discs with the longest clinical history is the CHARITɮ Artificial Disc. Approved in August 2006, Prodisc the first FDA approved artificial disc on the market. It has been approved for use in patients that have one diseased disc in the lumbar area of the spine. Click here to learn more about the CHARITɮ Artificial Disc.
www.charitedisc.com

After spine fusion surgery, some people need to use a walking aid such as a walker or cane for a short time. When you start walking, do a little at a time and be careful to avoid injury and complications. Try not to over-do it the first few times you get up and walk. Build up gradually to avoid a flare-up of symptoms.

The surgical procedure for lumbar surgery can last from one to eight hours depending on what needs to be done. For example, spine fusion usually takes much longer than discectomy. Many people report immediate improvements in the way they feel after awakening from the surgery. However, strengthening your weakened muscles and soft tissue surrounding and supporting your trunk will require a long-term program of exercise and physical therapy. Although many people see and feel immediate improvements, they often get added benefits with a comprehensive rehabilitation program.

The first decision that must be made is whether your problem is very serious, or less serious. Some problems need immediate attention - possibly even surgery. For example, if you have significant muscle weakness or have nerve pressure that is affecting your bowels or bladder, you may require immediate surgery. If you have pain that cannot be tolerated or you are unable to gain reasonable function for daily activity, surgery may be suggested.

The good news is that the majority of back problems do not require surgery. Once the most likely cause of your problem has been determined (once your diagnosis is made), you and your doctor can decide on a plan for taking care of your back now and into the future. A variety of treatment options exist for different types of back pain. In most cases, conservative therapies such as mild pain medications and rest are effective in relieving the immediate pain. The overall goal of treatment is to make you comfortable as soon as possible, design a program to reduce further pain and injury, and get you back to normal activity as soon as possible. The more you know about how your back works and what you can do to prevent further injury, the better your program will work.

TENS is short for transcutaneous (trans-kew-tay-nee-us) (across the skin) electrical nerve stimulation. TENS uses a small, pocket-sized electrical stimulation unit. It can be used up to 24 hours a day if needed to help control pain. It is usually issued by a physical therapist (PT), but only if you have not found other ways to control your pain. Also, a prescription from your doctor is required for you to use one of these units on your own.

TENS treatment stimulates your nerves by sending a small electrical current gently through your skin. Some people say it feels sort of like a massage on their skin. Electrical stimulation can ease pain by sending impulses that your brain feels instead of pain. Two respected scientists discovered a theory, called the Gate Theory. It says that when you feel a sensation other than pain, like rubbing, massage, or even a mild electrical impulse, your spinal column will actually "close the gate" and not let pain impulses pass to your brain. In the case of electrical stimulation, the electrical impulses speed their way across your skin and onto your central nervous system much faster than pain. By getting there first, the electrical information "closes the gate" to pain, blocking its passage to the brain. Once the pain eases, muscles that are in spasm can begin to relax, letting you move and exercise with less discomfort. Other settings on the unit can be used to help your body release endorphins (en-dor-fins). Endorphins are natural chemicals produced by your body that can lower the sensation of pain for up to eight hours at a time.

Because back pain is unpredictable, it is not realistic to expect that you will be pain-free when you complete your therapy treatments. Every effort will be made to help take your pain away, but you should measure success by how well you can manage your spine condition - even if you still have pain.

The first goal of treatment is to find ways of controlling your pain and symptoms. This can include the use of treatment interventions like heat, ice, and manual therapy. By helping you understand how your spine works and which positions and movements can be used to protect your back and neck, you may find it easier to manage your pain and symptoms. As your symptoms begin to ease, you will be given specific exercises to improve your mobility and strength. An important part of helping you manage your spine condition is called functional training, which can include posture and alignment, safe body movements at home and at work, and safe lifting techniques.

Once your pain is controlled, your range of motion has improved, and your strength has started to return, you will be progressed to a final home therapy program. Your physical therapist will go over ways to take care of your soreness at home, and you will be given exercises to continue improving the range of motion, strength, and function of your spine.

Back specialists use the term "conservative treatment" to describe any treatment that does not involve surgery. Sometimes, this can be as simple as reassuring you that it is not a serious problem, and recommending that you do nothing but watch and wait. Conservative treatment can also include medications to relieve your pain, physical therapy, and exercise. People with back and neck pain should also learn how to protect their spine by practicing good posture and doing strengthening exercises.

Some of the treatments your physical therapist (PT) uses are designed to give you relief from your symptoms. It is hoped that your treatments will give you a longer and longer period of relief between your scheduled visits. As you show steady signs of improvement in controlling symptoms and doing home exercises, your PT will schedule your visits further apart. The goal is to help you learn to manage your condition, even in the unfortunate event that your symptoms do not go away completely. Eventually, you may only need a visit every so often to refresh your exercises and to go over any new concerns you may have. Otherwise, people do not usually continue physical therapy on an ongoing basis.

Something you can do right away to relieve your pain is to use heat or ice. Cold treatments are usually used right after back pain or injury begins. The cold temperature makes the blood vessels in the sore area vasoconstrict (vase-oh-con-strct) (become narrower). This helps your body in the initial stages of healing. Cold treatments can include cold packs or ice bags, which are generally put on the sore area for 10 to 15 minutes.

Heat can be used after the early stages of healing are over - usually at least two or three days after the injury or pain began. Heat makes blood vessels vasodilate (vase-oh-dye-late) (get larger). This helps your body flush away chemicals that can cause pain. It also helps to bring in nutrients and oxygen, which help the area heal. True heat in the form of a moist hot pack, a heating pad, or warm shower or bath, is better than creams that give the feeling of heat. Hot packs are usually placed on the sore area for 15 to 20 minutes. Be careful that your skin does not overheat and burn. It is also not a good idea to sleep with an electric heating pad at night, which can lead to the "lobster effect" where your skin turns red and actually burns from the prolonged heat.

Mild pain medications can reduce inflammation and pain when taken properly. Medications you may be prescribed include:

Aspirin - over-the-counter pain relievers that can help relieve minor pain and back ache.

NSAIDs - non-steroidal anti-inflammatory drugs (NSAIDs) are very effective in relieving the pain associated with muscle strain and inflammation.

Non-narcotic analgesics - relieve pain at the point of injury.

Narcotic pain medications - help relieve severe pain by numbing the central nervous system.

Muscle relaxants - help a little in relieving pain from muscle spasm.

Antidepressants - help relieve the emotional stress that often compounds the symptoms of back pain.

General Caution: All medications can have side effects. Be sure to discuss these with your doctor before beginning to take any of these medications.

MIS is associated with the same risks as any general surgical procedure. During the procedure, however, the surgeon may decide to convert from minimally invasive to traditional surgery if visualization is limited or if other complications arise.

Your ability to turn your head takes place mainly between the two joints at the top of your cervical spine. When you turn your head, about 50% of the movement happens between the first and second levels (between C1 and C2). The other 50% takes place between all the other neck vertebrae combined. So a fusion of one level in the lower part of your neck will not drastically affect your ability to turn your neck, probably less than 10%.

Learn to move without straining your back. When getting in or out of bed, use the "log roll" technique. Roll to your side and sit up while keeping your back steady and secure. Instead of twisting your upper body when you roll to one side, try to roll your whole body as a unit, like rolling a log. When you sit or stand, try to keep your back straight and bend forward at the hips. Also, keep your back straight or use a grabber to avoid bending over at the waist to put on your socks and shoes, or to pick up items from the floor. If you must bend, try to keep your back straight and secure as you bend forward at the hip joint - not your back.

Do not test your back by trying to see how much you can lift or carry. If you must pick up or carry lighter items, squat down by bending your knees. Do not lean forward by bending at your low back. When you lift, keep the item in close to your body, even if it is light. Holding the weight out in front of you puts extra strain on your low back. Check with your doctor or physical therapist if you have any questions about the safety of lifting or carrying.

The goal of physical therapy is to help you control your pain and regain your best possible function. Once your pain is controlled, your range of motion is improved, and your strength is returning, you will be progressed to a final home program. Your therapist will give you some ways to take care of soreness at home, and to keep working on your range of motion and strength too. Before you are done with physical therapy, your therapist may take more measurements to see how well you are doing now compared to when you first started your therapy.