Spinal stenosis is the narrowing of the spinal canal, and it can be present at any level of the spine. While lumbar spinal stenosis is the most common type, stenosis can also occur in the thoracic or cervical areas of the spine. Spinal stenosis causes a variety of symptoms such as severe pain, weakness, numbness and the loss of mobility.
Spinal stenosis is often associated with the aging process, as when ligaments begin to calcify and bone spurs form. These abnormalities can intrude into the spinal canal and cause pressure on the nerve roots by limiting the amount of space in the spinal column. This nerve compression often causes pain, tingling, or numbness in the extremities.
Spinal stenosis can be congenital (i.e. a birth defect). With congenital spinal stenosis, the patient is born with a narrow spinal canal due to abnormally formed parts of the spine. This condition is most common in patients with a short stature, such as achondroplastic dwarves. Spinal stenosis may also result from any of the following non-congenital conditions:
Aging
Osteoarthritis
Osteoarthritis is a form of arthritis typically caused by age-related wear-and-tear, and is the most common form of arthritis. Sometimes osteoarthritis follows an injury to a joint. For example, a young person might hurt his knee badly playing soccer. Then, years after the knee has apparently healed, he might get arthritis in his knee joint.
Rheumatoid arthritis
Rheumatoid arthritis is an inflammatory disease that causes pain, swelling, stiffness, and loss of function in the joints. It occurs in a symmetrical pattern, meaning that if one joint is affected, the corresponding joint is also affected. People with rheumatoid arthritis often experience fatigue, occasional fever, and a general sense of malaise.
Spondylosis
Spondylosis is a degeneration of the vertebral functions leading to the formation of bones spurs. Spondylosis commonly occurs with aging. Often there is an accompanying herniation of an intervertebral disc and compression of nerve roots. This compression can result in sensory and motor disturbances and pain.
Spondylolisthesis
Spondylolisthesis is a condition that occurs when one vertebra slips forward over another vertebra.
Spinal injury
Spinal birth defect
Spinal tumors
Swelling after spinal surgery
Paget's Disease of Bone
Paget's Disease is a disease of the bones usually occurring in middle-aged and elderly patients. Paget’s Disease initially results in the excessive destruction of the bone followed by the replacement of normal bone marrow with vascular and fibrous tissue. This excessive bone destruction sometimes leads to bone pain and fractures. When any disease reaches the point of causing nerve root inflammation or irritation, the results can become intolerable.
For more information: www.bonati.com/glossary/spinal_stenosis.html
Wednesday, July 16, 2008
Thursday, July 10, 2008
What Is Spinal Stenosis?
Spinal stenosis is a narrowing of the space called the spinal canal, a small space in the backbone that contains the spinal cord and the sensory and motor nerve roots that run from the brain and out from the spinal cord to all parts of the body. The spinal canal is like a tunnel which runs up and down the human spine. This canal sits directly behind the bone blocks which make up the spine (vertebrae).
A normal spinal canal tunnel contains some free space between the important neurologic (nerve) structures it houses, such as the spinal cord and the nerve roots and the edges of the spinal canal. The canal is surrounded by bone and ligaments and therefore cannot expand if the spinal cord or nerves require more room. Therefore, if anything begins to narrow the spinal canal, there is risk for irritation or injury of the spinal cord or nerves. The spine may become narrowed in any of three areas: in the space at the center of the spine, in the canals where nerves branch out from the spine, and in the space between the bones of the spine (vertebrae).
When an abnormality causes a narrowing of a canal then the neurologic (nerve) structures within that canal can become irritated or compressed. This can lead to a variety of symptoms ranging from tingling, numbness, and weakness to severe pain and paralysis. The most common conditions which can narrow a spinal canal and cause stenosis include herniated discs (often called slipped discs), a fracture of the spine, tumors, infection and degeneration through the aging process.
Stenosis can occur anywhere along the spine but most commonly occurs in the lower spine (lumbar) region. Lumbar spinal stenosis can cause nerve compression which leads to persistent pain in the buttocks, limping, lack of feeling in the lower extremities, and decreased physical activity. Additional symptoms from lumbar spinal stenosis include sensations of heaviness, weakness and pain with walking or prolonged standing. There are several different forms of lumbar spinal stenosis.
The most common form of lumbar spinal stenosis is degenerative stenosis, which occurs to some degree in virtually the entire adult population as a result of the natural process of aging. This form of stenosis is a degenerative narrowing of the spinal canal, the nerve root canals or the intervertebral foramina caused by an unnatural enlargement (hypertrophy) of intervertebral discs, bones or ligaments. The narrowing results in compression of spinal nerves and nerve roots, causing a range of symptoms, including lower back pain, limping or impaired gait as a result of reduced blood supply to the leg muscles (neurogenic claudication) and lower extremity pain.
Congenital lumbar stenosis is relatively rare and usually appears at an early age, often between 30 and 40. The congenital form of spinal stenosis is seen in individuals who are born with a narrow spinal canal. In these individuals, even minimal changes in the structure of the spine brought on by age can cause severe spinal stenosis. Congenital spinal stenosis is largely a mysterious condition that can neither be predicted nor prevented. The onset does not distinguish by sex, race, or ethnicity, and is not associated with any particular occupation or any particular body type.
Acquired lumbar spinal stenosis is more common and generally develops in persons who are in their 60s or older. This form of stenosis is caused by progressive changes in different spinal elements (such as the discs, joints, ligaments, etc.) As people age, all these different elements sag or bulge and form arthritis that narrows the spinal canal.
Treatment for spinal stenosis ranges from physical therapy to epidural injections and finally surgery in certain cases. Arthroscopic surgery for spinal stenosis has a high success rate in patients carefully selected for this procedure. It remains a useful approach in treatment when other options have been exhausted and after careful review of risks and benefits with the patient.
A normal spinal canal tunnel contains some free space between the important neurologic (nerve) structures it houses, such as the spinal cord and the nerve roots and the edges of the spinal canal. The canal is surrounded by bone and ligaments and therefore cannot expand if the spinal cord or nerves require more room. Therefore, if anything begins to narrow the spinal canal, there is risk for irritation or injury of the spinal cord or nerves. The spine may become narrowed in any of three areas: in the space at the center of the spine, in the canals where nerves branch out from the spine, and in the space between the bones of the spine (vertebrae).
When an abnormality causes a narrowing of a canal then the neurologic (nerve) structures within that canal can become irritated or compressed. This can lead to a variety of symptoms ranging from tingling, numbness, and weakness to severe pain and paralysis. The most common conditions which can narrow a spinal canal and cause stenosis include herniated discs (often called slipped discs), a fracture of the spine, tumors, infection and degeneration through the aging process.
Stenosis can occur anywhere along the spine but most commonly occurs in the lower spine (lumbar) region. Lumbar spinal stenosis can cause nerve compression which leads to persistent pain in the buttocks, limping, lack of feeling in the lower extremities, and decreased physical activity. Additional symptoms from lumbar spinal stenosis include sensations of heaviness, weakness and pain with walking or prolonged standing. There are several different forms of lumbar spinal stenosis.
The most common form of lumbar spinal stenosis is degenerative stenosis, which occurs to some degree in virtually the entire adult population as a result of the natural process of aging. This form of stenosis is a degenerative narrowing of the spinal canal, the nerve root canals or the intervertebral foramina caused by an unnatural enlargement (hypertrophy) of intervertebral discs, bones or ligaments. The narrowing results in compression of spinal nerves and nerve roots, causing a range of symptoms, including lower back pain, limping or impaired gait as a result of reduced blood supply to the leg muscles (neurogenic claudication) and lower extremity pain.
Congenital lumbar stenosis is relatively rare and usually appears at an early age, often between 30 and 40. The congenital form of spinal stenosis is seen in individuals who are born with a narrow spinal canal. In these individuals, even minimal changes in the structure of the spine brought on by age can cause severe spinal stenosis. Congenital spinal stenosis is largely a mysterious condition that can neither be predicted nor prevented. The onset does not distinguish by sex, race, or ethnicity, and is not associated with any particular occupation or any particular body type.
Acquired lumbar spinal stenosis is more common and generally develops in persons who are in their 60s or older. This form of stenosis is caused by progressive changes in different spinal elements (such as the discs, joints, ligaments, etc.) As people age, all these different elements sag or bulge and form arthritis that narrows the spinal canal.
Treatment for spinal stenosis ranges from physical therapy to epidural injections and finally surgery in certain cases. Arthroscopic surgery for spinal stenosis has a high success rate in patients carefully selected for this procedure. It remains a useful approach in treatment when other options have been exhausted and after careful review of risks and benefits with the patient.
Tuesday, July 8, 2008
Fixing $5 Haircuts
There's an old fable about a man that had a very successful barber shop offering $10 haircuts. One day another shop opened across the street advertising "$5 haircuts". The established barber, after watching the results of his competitor, over a few days, erected a sign stating "We fix $5 haircuts".
The cautionary tale here is to analyze carefully any claims by spine surgical centers offering "minimally-invasive" spine surgery. When it comes to spine surgery it is possible to avoid "$5 haircuts" with a little prior analysis.
First, look beyond the claims of the number of surgeries "performed" to the percentage of successful surgeries, with success being defined as complete restoration of function, complete eradication of pain, and return to daily activities without impairment.
Secondly, try to gather as much information as you can on the actual mechanics of the surgery. How large is the incision? Some surgical centers, claiming that they are "minimally-invasive", actually work through incisions of four to six inches, rather than the 1/4 to 1/2 inch incision employed by true "minimally-invasive" surgical centers.
If a "minimally-invasive" surgical center claims that they can perform more than one surgery on your spine in a day or one or more surgeries only one day apart, be suspicious. "Minimally-invasive" not only applies to the size of the incision but also to the incremental nature of the surgical protocol. True minimally-invasive, advanced laser spine surgery separates each procedure by at least a week.
Lastly, look into the length of time each surgery takes. In this case, the longer the better. The full protocol for a minimally-invasive arthroscopic discectomy, for example, should take at least 1 1/2 to 2 hours. Anything less is likely to not be the full and proper protocol of a minimally-invasive arthroscopic spine procedure.
The cautionary tale here is to analyze carefully any claims by spine surgical centers offering "minimally-invasive" spine surgery. When it comes to spine surgery it is possible to avoid "$5 haircuts" with a little prior analysis.
First, look beyond the claims of the number of surgeries "performed" to the percentage of successful surgeries, with success being defined as complete restoration of function, complete eradication of pain, and return to daily activities without impairment.
Secondly, try to gather as much information as you can on the actual mechanics of the surgery. How large is the incision? Some surgical centers, claiming that they are "minimally-invasive", actually work through incisions of four to six inches, rather than the 1/4 to 1/2 inch incision employed by true "minimally-invasive" surgical centers.
If a "minimally-invasive" surgical center claims that they can perform more than one surgery on your spine in a day or one or more surgeries only one day apart, be suspicious. "Minimally-invasive" not only applies to the size of the incision but also to the incremental nature of the surgical protocol. True minimally-invasive, advanced laser spine surgery separates each procedure by at least a week.
Lastly, look into the length of time each surgery takes. In this case, the longer the better. The full protocol for a minimally-invasive arthroscopic discectomy, for example, should take at least 1 1/2 to 2 hours. Anything less is likely to not be the full and proper protocol of a minimally-invasive arthroscopic spine procedure.
Choose Spine Team Wisely When Considering Back Surgery
Over 80% of Americans will experience back pain sometime during their lives. The vast majority experience acute pain and will get better, without treatment or with conservative therapies, within four to six weeks. About 5 percent experience chronic pain lasting longer than three months, according to the Mayo Foundation for Medical Education and Research.
Ordinarily, spine surgery will not be considered unless conservative non-surgical measures have failed, and even then, “open” spine surgery is not often recommended.
While most published statistics claim a success rate of approximately 80% for “open” spine surgery, physician practice reports that the actual success rate for open spine surgery is closer to 50%. “Open” spine surgery utilizes a large incision and often detaches spine muscles to visualize the spine, thus causing considerable trauma to the patient.
“Over 10 years ago, if you had spine surgery, you could expect it to take as much as one year before you would be able to return to normal activities. Minimally invasive techniques, however, are changing the face of spine surgery,” the Cleveland Clinic reports.
“Minimally invasive surgery is a developing new field, which is being performed by a limited number of spine surgeons for a very limited number of procedures. Like “building a ship in a bottle,” there is a steep learning curve for surgeons learning to do these procedures. Although the recovery is often faster, the complication rate during surgery can be greater and the results not as predictable when the surgery is performed by surgeons who have not become totally skilled at these newer techniques,” wrote Thomas Lowe, M.D., former Clinical Professor in the Department of Orthopaedics at the University of Colorado.
Ordinarily, spine surgery will not be considered unless conservative non-surgical measures have failed, and even then, “open” spine surgery is not often recommended.
While most published statistics claim a success rate of approximately 80% for “open” spine surgery, physician practice reports that the actual success rate for open spine surgery is closer to 50%. “Open” spine surgery utilizes a large incision and often detaches spine muscles to visualize the spine, thus causing considerable trauma to the patient.
“Over 10 years ago, if you had spine surgery, you could expect it to take as much as one year before you would be able to return to normal activities. Minimally invasive techniques, however, are changing the face of spine surgery,” the Cleveland Clinic reports.
“Minimally invasive surgery is a developing new field, which is being performed by a limited number of spine surgeons for a very limited number of procedures. Like “building a ship in a bottle,” there is a steep learning curve for surgeons learning to do these procedures. Although the recovery is often faster, the complication rate during surgery can be greater and the results not as predictable when the surgery is performed by surgeons who have not become totally skilled at these newer techniques,” wrote Thomas Lowe, M.D., former Clinical Professor in the Department of Orthopaedics at the University of Colorado.
Causes of Pain from Spine Problems
Back pain is an easily recognizable problem that can bring on a number of sensations. It can present itself in any location along the spine, a stack of 26 bones connected by ligaments, muscles and shock-absorbing discs.
You rely on your spine to be the workhorse of the body — its function is essential for nearly every move you make. Because of this, the spine and its inter-vertebral discs can be particularly vulnerable to injury and chronic pain.
Back pain is the most common complaint brought to doctors in the United States. Over six million cases are seen annually, with the majority being in the lower back. It is expensive, too, ranking 3rd after heart disease and cancer in its contribution to medical expenses. Four out of five adults will have at least one bout of back pain sometime during their lives. In fact, back pain is the most common reason for doctor office visits, worker’s compensation claims and missed work.
On the bright side, you can prevent most back pain. Simple home treatment and proper body mechanics will often heal your back within a few weeks and keep it functional for the long haul. Surgery is only occasionally needed to treat back pain.
Causes
Your lower back bears most of the weight and stress of your body. Back pain most often occurs from strained back muscles and ligaments, from improper or heavy lifting, or after a sudden awkward movement. Sometimes a muscle spasm can cause back pain. Often, there is an accumulation of stress with one particular event resulting in pain. In many cases, there may not be an obvious cause.
The following specific conditions can also cause back pain:
• Failed open spine surgery. Following open spine surgery, whether it is a fusion, discectomy or laminectomy, patients can experience chronic pain in the back and or the arms or legs. These syndromes are often due to identifiable causes but are termed by surgeons and the medical community to be failed back surgery syndrome (FBSS).
• Herniated disc. This is a condition in which part, or all, of the soft, gelatinous central portion of an intervertebral disc is forced through a weakened part of the disc. This results in back pain and leg pain or neck pain and arm pain due to nerve root irritation when the inner portion of the disc (called the nucleus pulposus) presses on a nerve root exiting the spinal cord...
• Sciatica. This occurs when there is an inflammation of the sciatic nerve, causing sharp, shooting pain through the buttocks and down the back of the leg.
• Spinal stenosis. This condition is a narrowing of the spinal canal due to arthritis, bone spurs or herniated discs placing pressure on the spinal cord.
• Spondylosis. This condition, also referred to as Degenerative Disc Disease (DDD), is a gradual deterioration of the disc between the vertebrae. As people age, the moisture content in the intervertebral disc in the spine lessen. This causes a narrowing of the normal disc space between vertebrae, often resulting in compression of the nerves running between the vertebrae.
• Spondylolisthesis. This condition is a forward slippage of one vertebra in the spine over another. This condition in adults is most commonly due to degeneration (wear and tear) of the discs and ligaments that bind and support the spine. This condition often narrows the space between adjoining vertebrae resulting in pressure on nerve roots.
Repeated bouts of back pain or failed previous “open” spine surgeries can lead to chronic back pain. Chronic pain is often difficult to treat with conservative non-surgical methods.
Treatment
Most back or neck pain gets better with a few weeks of home treatment and careful attention. A regular schedule of pain relievers and hot or cold therapy may be all that you need to improve your pain. A short period of bed rest is okay, but more than a few days actually does more harm than good. If home treatments aren't working, your doctor may suggest stronger medications or other therapy.
Therapies
There are many different therapies to treat back or pain, after the cause of the pain is found. Even if the cause is not found, there are therapies that can reduce your pain such as pain medications, exercise, electrical stimulation or physical therapy.
Surgical and other procedures
The minority of people with back or neck pain require surgery. Surgery is usually reserved for pain caused by a herniated discs, spinal stenosis or degenerative disc disease. If you have unrelenting pain or progressive muscle weakness caused by nerve compression, you may benefit from surgery.
You rely on your spine to be the workhorse of the body — its function is essential for nearly every move you make. Because of this, the spine and its inter-vertebral discs can be particularly vulnerable to injury and chronic pain.
Back pain is the most common complaint brought to doctors in the United States. Over six million cases are seen annually, with the majority being in the lower back. It is expensive, too, ranking 3rd after heart disease and cancer in its contribution to medical expenses. Four out of five adults will have at least one bout of back pain sometime during their lives. In fact, back pain is the most common reason for doctor office visits, worker’s compensation claims and missed work.
On the bright side, you can prevent most back pain. Simple home treatment and proper body mechanics will often heal your back within a few weeks and keep it functional for the long haul. Surgery is only occasionally needed to treat back pain.
Causes
Your lower back bears most of the weight and stress of your body. Back pain most often occurs from strained back muscles and ligaments, from improper or heavy lifting, or after a sudden awkward movement. Sometimes a muscle spasm can cause back pain. Often, there is an accumulation of stress with one particular event resulting in pain. In many cases, there may not be an obvious cause.
The following specific conditions can also cause back pain:
• Failed open spine surgery. Following open spine surgery, whether it is a fusion, discectomy or laminectomy, patients can experience chronic pain in the back and or the arms or legs. These syndromes are often due to identifiable causes but are termed by surgeons and the medical community to be failed back surgery syndrome (FBSS).
• Herniated disc. This is a condition in which part, or all, of the soft, gelatinous central portion of an intervertebral disc is forced through a weakened part of the disc. This results in back pain and leg pain or neck pain and arm pain due to nerve root irritation when the inner portion of the disc (called the nucleus pulposus) presses on a nerve root exiting the spinal cord...
• Sciatica. This occurs when there is an inflammation of the sciatic nerve, causing sharp, shooting pain through the buttocks and down the back of the leg.
• Spinal stenosis. This condition is a narrowing of the spinal canal due to arthritis, bone spurs or herniated discs placing pressure on the spinal cord.
• Spondylosis. This condition, also referred to as Degenerative Disc Disease (DDD), is a gradual deterioration of the disc between the vertebrae. As people age, the moisture content in the intervertebral disc in the spine lessen. This causes a narrowing of the normal disc space between vertebrae, often resulting in compression of the nerves running between the vertebrae.
• Spondylolisthesis. This condition is a forward slippage of one vertebra in the spine over another. This condition in adults is most commonly due to degeneration (wear and tear) of the discs and ligaments that bind and support the spine. This condition often narrows the space between adjoining vertebrae resulting in pressure on nerve roots.
Repeated bouts of back pain or failed previous “open” spine surgeries can lead to chronic back pain. Chronic pain is often difficult to treat with conservative non-surgical methods.
Treatment
Most back or neck pain gets better with a few weeks of home treatment and careful attention. A regular schedule of pain relievers and hot or cold therapy may be all that you need to improve your pain. A short period of bed rest is okay, but more than a few days actually does more harm than good. If home treatments aren't working, your doctor may suggest stronger medications or other therapy.
Therapies
There are many different therapies to treat back or pain, after the cause of the pain is found. Even if the cause is not found, there are therapies that can reduce your pain such as pain medications, exercise, electrical stimulation or physical therapy.
Surgical and other procedures
The minority of people with back or neck pain require surgery. Surgery is usually reserved for pain caused by a herniated discs, spinal stenosis or degenerative disc disease. If you have unrelenting pain or progressive muscle weakness caused by nerve compression, you may benefit from surgery.
Back Pain Treatment Options
Pain is both a physical and emotional experience caused by real or potential injury or damage to the body. It is often best described as a complex three-way warning system. First, acute pain warns of injury. Second, pain warns against further injury by causing the body’s movements to withdraw from the source of injury. Finally, pain leads to a period of reduced activity, enabling injuries to heal more efficiently.
Pain is often difficult to measure because the severity of the pain does not always reflect the severity of the injury. Some people feel extreme pain from relatively small injuries, while others show little or no pain even after suffering a severe injury. Pain can also be present even though no injury is apparent, or pain can linger long after an injury appears to have healed.
Communicate with Your Doctor
Since each person perceives pain a little differently, and responds to pain differently, it is essential that you communicate as much about the exact nature of your pain to medical professionals, including the location, quality and intensity of your pain. Include in your communication the mechanics of the pain:
• How did the pain start?
• How long have you had this pain?
• What kinds of activities make the pain better or worse?
• Is it better or worse when you walk, sit, stand, or lie down?
Therapies with Medicine
The complexity of human pain often requires a combination of pain therapies with medicine and without medicine to achieve relief. In addition to the body’s own mechanisms, humans have devised many different ways to manipulate the body’s ability to control pain. Drugs that relieve pain, known as analgesics, usually interfere with pain impulse transmission in the nervous system. Narcotic analgesics, such as codeine, have chemical structures that are similar to the pain-blocking neurotransmitter endorphin.
Other drugs that relieve pain alter the way damaged nerves transmit information. Non-steroidal anti-inflammatory drugs, such as aspirin and ibuprofen, are analgesics that reduce pain by inhibiting the synthesis of prostaglandins, the body chemicals that intensify pain and cause inflammation.
Medications prescribed by a physician may be used alone or in combination with other medications and can be administered in a variety of ways.
When Surgery is Required
When conservative treatments don't help, back surgery may offer relief. But it doesn't help every type of back pain. In fact, back surgery is needed in only a small percentage of cases and is usually reserved for times when a nerve is pinched, the spinal cord is compressed or there is too much movement between the spinal bones.
Traditionally, back surgery was one of the most grueling and damaging surgical procedures a patient could endure. Now, through the utilization of cutting edge technology, patients can undergo many back and spine operations in a whole new way. These updated versions of traditional back surgeries allow for great precision, faster healing, and less damage to healthy tissue.
Open back surgery uses large open incisions and multiple levels of tissue and muscle dissection to view the spine. Modern procedures that are less invasive use a combination of surgical and technological innovations in order to repair spinal conditions without having to disturb surrounding healthy tissue.
Consider all options
Before considering any back surgery, obtain a second opinion from a qualified spine specialist. Back and leg pain can be a complex issue that may possibly require a team of health professionals to diagnose and treat. It is important to choose your spine team wisely.
To prevent recurrent back problems, learn and practice good body mechanics, maintain proper body weight, and keep your back muscles conditioned with regular exercise and stretching.
Pain is often difficult to measure because the severity of the pain does not always reflect the severity of the injury. Some people feel extreme pain from relatively small injuries, while others show little or no pain even after suffering a severe injury. Pain can also be present even though no injury is apparent, or pain can linger long after an injury appears to have healed.
Communicate with Your Doctor
Since each person perceives pain a little differently, and responds to pain differently, it is essential that you communicate as much about the exact nature of your pain to medical professionals, including the location, quality and intensity of your pain. Include in your communication the mechanics of the pain:
• How did the pain start?
• How long have you had this pain?
• What kinds of activities make the pain better or worse?
• Is it better or worse when you walk, sit, stand, or lie down?
Therapies with Medicine
The complexity of human pain often requires a combination of pain therapies with medicine and without medicine to achieve relief. In addition to the body’s own mechanisms, humans have devised many different ways to manipulate the body’s ability to control pain. Drugs that relieve pain, known as analgesics, usually interfere with pain impulse transmission in the nervous system. Narcotic analgesics, such as codeine, have chemical structures that are similar to the pain-blocking neurotransmitter endorphin.
Other drugs that relieve pain alter the way damaged nerves transmit information. Non-steroidal anti-inflammatory drugs, such as aspirin and ibuprofen, are analgesics that reduce pain by inhibiting the synthesis of prostaglandins, the body chemicals that intensify pain and cause inflammation.
Medications prescribed by a physician may be used alone or in combination with other medications and can be administered in a variety of ways.
When Surgery is Required
When conservative treatments don't help, back surgery may offer relief. But it doesn't help every type of back pain. In fact, back surgery is needed in only a small percentage of cases and is usually reserved for times when a nerve is pinched, the spinal cord is compressed or there is too much movement between the spinal bones.
Traditionally, back surgery was one of the most grueling and damaging surgical procedures a patient could endure. Now, through the utilization of cutting edge technology, patients can undergo many back and spine operations in a whole new way. These updated versions of traditional back surgeries allow for great precision, faster healing, and less damage to healthy tissue.
Open back surgery uses large open incisions and multiple levels of tissue and muscle dissection to view the spine. Modern procedures that are less invasive use a combination of surgical and technological innovations in order to repair spinal conditions without having to disturb surrounding healthy tissue.
Consider all options
Before considering any back surgery, obtain a second opinion from a qualified spine specialist. Back and leg pain can be a complex issue that may possibly require a team of health professionals to diagnose and treat. It is important to choose your spine team wisely.
To prevent recurrent back problems, learn and practice good body mechanics, maintain proper body weight, and keep your back muscles conditioned with regular exercise and stretching.
Failed Back Surgery Syndrome
Open spine surgery and spinal fusion surgery are the only categories of surgery that actually have a clinical term for failure - Failed Back Surgery Syndrome (FBSS). FBSS is a term used to describe the condition of patients who do not experience relief of pain from these types of surgeries. It is not really a syndrome at all but a post-surgical state many patients experience that occurs frequently enough to have acquired a name with an acronym.
Foraminal stenosis (a decrease in the overall size of the bony window through which the spinal nerves pass) remains the leading cause of FBSS, but painful discs are also common. However, there now exist measures to reduce and alleviate the pain resulting from symptomatic FBSS.
Generally, treatment focuses on conservative measures first, such as rehabilitation and pain management, before further surgery is considered. Other conservative measures may include exercise, manual therapy, spinal cord stimulators and/or an implanted pump to deliver pain medication. Unfortunately, repeated open and fusion surgeries usually are not successful in relieving FBSS pain.
Recent developments have allowed FBSS patients to once again live their lives pain-free. These advances over traditional open and fusion spines surgeries allow for greater precision, faster healing and less damage to healthy tissue. Advanced spine surgeries today can employ the smallest incision possible to correct problems attributed to FBSS with patented instrumentation and methods.
Foraminal stenosis (a decrease in the overall size of the bony window through which the spinal nerves pass) remains the leading cause of FBSS, but painful discs are also common. However, there now exist measures to reduce and alleviate the pain resulting from symptomatic FBSS.
Generally, treatment focuses on conservative measures first, such as rehabilitation and pain management, before further surgery is considered. Other conservative measures may include exercise, manual therapy, spinal cord stimulators and/or an implanted pump to deliver pain medication. Unfortunately, repeated open and fusion surgeries usually are not successful in relieving FBSS pain.
Recent developments have allowed FBSS patients to once again live their lives pain-free. These advances over traditional open and fusion spines surgeries allow for greater precision, faster healing and less damage to healthy tissue. Advanced spine surgeries today can employ the smallest incision possible to correct problems attributed to FBSS with patented instrumentation and methods.
Treating Your Herniated Disc Pain without Invasive Surgery
Patients suffering from chronic back pain due to a herniated disc usually try a succession of recommended and prescribed remedies to help ease their comfort. Because of major advancements in medical technology, now those suffering from this common problem no longer have to live with that pain.
Patients diagnosed with a herniated disc may have pain in the back, leg, neck or arm, or a weakness of the lower extremity muscles. When a disc herniation occurs, the cushion that sits between the spinal vertebrae is pushed outside its normal position. A herniated disc would not be a problem if it weren't for the spinal nerves that are very close to the edge of these spinal discs.
Causes of Herniated Discs
A herniated disc may occur suddenly in an event such as a fall or an accident, or may occur gradually with repetitive straining of the spine. However, disc material degenerates naturally as you age, and the ligaments that hold it in place begin to weaken. As this degeneration progresses, a relatively minor strain or twisting movement can cause a disc to rupture.
Certain individuals may be more vulnerable to disc problems, and as a result may suffer herniated discs in several places along the spine. Research has shown that a predisposition for herniated discs may exist in families, with several members affected.
Symptoms
Symptoms vary greatly depending on the position of the herniated disc and the size of the herniation. If the herniated disc is not pressing on a nerve, the result may be a low backache or no pain at all. If it is pressing on a nerve, there may be pain, numbness, or weakness in the area of the body to which the nerve travels. Typically, a herniated disc is preceded by an episode of low back pain or a long history of intermittent episodes of low back pain.
Herniated discs are most common in the lumbar spine--the part of your backbone between the bottom of your ribs and your hips. Symptoms include:
• Severe low back pain
• Pain radiating to the buttocks, legs, and feet
• Pain made worse with coughing, straining, or laughing
• Tingling or numbness in legs or feet
• Muscle weakness or atrophy in later stages
• Problems with bowel and bladder
• Muscle spasm
Herniated cervical discs are far less common than lumbar disc herniation because there is substantially less pressure placed across this part of the spine. Symptoms of a herniated cervical disc include:
• Neck pain, especially in the back and sides
• Deep pain near or over the shoulder blades on the affected side
• Pain radiating to the shoulder, upper arm, forearm, and rarely the hand, fingers or chest
• Pain made worse with coughing, straining, or laughing
• Increased pain when bending the neck or turning head to the side
• Spasm of the neck muscles
• Arm muscle weakness
Treatment for Herniated Discs
Fortunately, the majority of herniated discs do not require surgery. However, a very small percentage of people with herniated, degenerated discs may experience symptomatic or severe and incapacitating pain that significantly affects their daily life.
The initial treatment for a herniated disc is usually conservative and nonsurgical. Your doctor may prescribe bed rest, or advise you to maintain a low, painless activity level for a few days to several weeks. This helps the spinal nerve inflammation to decrease.
Traditional conservative treatments include ice, ultrasound, electrical stimulation, cortisone injections, anti-inflammatory medications and physical therapy. While these may deliver some relief, it will usually be only temporary.
But the major concern with these traditional treatments is that they cannot fix or heal a herniated disc as they do not address the actual cause of the problem.
Individuals who undergo a series of open back surgeries or fusion surgeries for herniated disc pain experience a lower level of pain relief. Up to 30% of those who undergo surgery have unsatisfactory results, as stated in a Practice Guideline developed for the Aerospace Medical Association by the American Society of Aerospace Medicine Specialists. Herniated disc open or fusion surgery is an involved procedure whose high failure rate can produce more pain than relief.
New Technology Speeds Return to Active Lifestyle
With advances in science and technology, there are alternatives to open or fusion spine surgeries. A proven alternative for helping to alleviate the pain of a herniated disc is The Bonati Proceduressm.
Patients diagnosed with a herniated disc may have pain in the back, leg, neck or arm, or a weakness of the lower extremity muscles. When a disc herniation occurs, the cushion that sits between the spinal vertebrae is pushed outside its normal position. A herniated disc would not be a problem if it weren't for the spinal nerves that are very close to the edge of these spinal discs.
Causes of Herniated Discs
A herniated disc may occur suddenly in an event such as a fall or an accident, or may occur gradually with repetitive straining of the spine. However, disc material degenerates naturally as you age, and the ligaments that hold it in place begin to weaken. As this degeneration progresses, a relatively minor strain or twisting movement can cause a disc to rupture.
Certain individuals may be more vulnerable to disc problems, and as a result may suffer herniated discs in several places along the spine. Research has shown that a predisposition for herniated discs may exist in families, with several members affected.
Symptoms
Symptoms vary greatly depending on the position of the herniated disc and the size of the herniation. If the herniated disc is not pressing on a nerve, the result may be a low backache or no pain at all. If it is pressing on a nerve, there may be pain, numbness, or weakness in the area of the body to which the nerve travels. Typically, a herniated disc is preceded by an episode of low back pain or a long history of intermittent episodes of low back pain.
Herniated discs are most common in the lumbar spine--the part of your backbone between the bottom of your ribs and your hips. Symptoms include:
• Severe low back pain
• Pain radiating to the buttocks, legs, and feet
• Pain made worse with coughing, straining, or laughing
• Tingling or numbness in legs or feet
• Muscle weakness or atrophy in later stages
• Problems with bowel and bladder
• Muscle spasm
Herniated cervical discs are far less common than lumbar disc herniation because there is substantially less pressure placed across this part of the spine. Symptoms of a herniated cervical disc include:
• Neck pain, especially in the back and sides
• Deep pain near or over the shoulder blades on the affected side
• Pain radiating to the shoulder, upper arm, forearm, and rarely the hand, fingers or chest
• Pain made worse with coughing, straining, or laughing
• Increased pain when bending the neck or turning head to the side
• Spasm of the neck muscles
• Arm muscle weakness
Treatment for Herniated Discs
Fortunately, the majority of herniated discs do not require surgery. However, a very small percentage of people with herniated, degenerated discs may experience symptomatic or severe and incapacitating pain that significantly affects their daily life.
The initial treatment for a herniated disc is usually conservative and nonsurgical. Your doctor may prescribe bed rest, or advise you to maintain a low, painless activity level for a few days to several weeks. This helps the spinal nerve inflammation to decrease.
Traditional conservative treatments include ice, ultrasound, electrical stimulation, cortisone injections, anti-inflammatory medications and physical therapy. While these may deliver some relief, it will usually be only temporary.
But the major concern with these traditional treatments is that they cannot fix or heal a herniated disc as they do not address the actual cause of the problem.
Individuals who undergo a series of open back surgeries or fusion surgeries for herniated disc pain experience a lower level of pain relief. Up to 30% of those who undergo surgery have unsatisfactory results, as stated in a Practice Guideline developed for the Aerospace Medical Association by the American Society of Aerospace Medicine Specialists. Herniated disc open or fusion surgery is an involved procedure whose high failure rate can produce more pain than relief.
New Technology Speeds Return to Active Lifestyle
With advances in science and technology, there are alternatives to open or fusion spine surgeries. A proven alternative for helping to alleviate the pain of a herniated disc is The Bonati Proceduressm.
How to Avoid Failed Back Surgery Syndrome
Failed Back Surgery Syndrome (FBSS) affects close to 80,000 patients a year, as reported on the National Institute of Health’s website. Patients suffering from this syndrome continue to have chronic, disabling pack pain after one or more spinal surgeries. Typically, each subsequent surgery to correct the problem has a lower likelihood of success. It is important to understand that – with just a few simple steps - how this debilitating syndrome can easily be prevented.
There are many reasons that a surgery may or not work. Spine surgery is basically able to accomplish only two things:
1) Decompressing a nerve root that is pinched, or
2) Stabilizing a painful joint
It would be nice if back surgery or spine surgery could totally eliminate a patient’s pain. It is only able to change anatomy. An anatomical lesion (injury) that is a probable cause of back pain must be correctly diagnosed prior to any type of corrective surgery. The number one reason for Failed Back Surgery Syndrome is because the injury that was operated on what not the underlying cause of the patient’s pain.
There are two ways to avoid a spine surgery that leads to an unsuccessful outcome. First and foremost, it is important to choose your spine team wisely. Back pain can be a complex issue that may possible require a team of health professionals to diagnose and treat. Secondly, stick to operations that have a high degree of success and make sure that an anatomic injury that can be surgically corrected is identified preoperatively.
Until recently, repeated surgeries rarely relieved FBSS pain. But medical developments have made great strides, allowing FBSS patients to once again live their lives pain-free. These advances over traditional open and fusion spines surgeries allow for greater precision, faster healing and less damage to healthy tissue. Advanced spine surgeries today can employ the smallest incision possible to correct problems attributed to FBSS with patented instrumentation and methods.
To learn more, visit www.bonati.com or call (866) 298-7513.
There are many reasons that a surgery may or not work. Spine surgery is basically able to accomplish only two things:
1) Decompressing a nerve root that is pinched, or
2) Stabilizing a painful joint
It would be nice if back surgery or spine surgery could totally eliminate a patient’s pain. It is only able to change anatomy. An anatomical lesion (injury) that is a probable cause of back pain must be correctly diagnosed prior to any type of corrective surgery. The number one reason for Failed Back Surgery Syndrome is because the injury that was operated on what not the underlying cause of the patient’s pain.
There are two ways to avoid a spine surgery that leads to an unsuccessful outcome. First and foremost, it is important to choose your spine team wisely. Back pain can be a complex issue that may possible require a team of health professionals to diagnose and treat. Secondly, stick to operations that have a high degree of success and make sure that an anatomic injury that can be surgically corrected is identified preoperatively.
Until recently, repeated surgeries rarely relieved FBSS pain. But medical developments have made great strides, allowing FBSS patients to once again live their lives pain-free. These advances over traditional open and fusion spines surgeries allow for greater precision, faster healing and less damage to healthy tissue. Advanced spine surgeries today can employ the smallest incision possible to correct problems attributed to FBSS with patented instrumentation and methods.
To learn more, visit www.bonati.com or call (866) 298-7513.
There is Life After Failed Spinal Fusion
The traditional, and most prevalant, approach to treating pain or disability from lumbar degenerative disc disease is spinal fusion. This surgery involves a bone graft and hardware placed to fuse two adjacent vetebrae togther. Pain relief occurs by stopping the motion of the painful disc(s). If pain recurs after the fusion, there are now alternatives available so a patient does not have to spend a life filled with pain.
An instrumented fusion can fail if there is not enough support to hold the spine while it is fusing. Spinal hardware (pedicle screws) may be used as an internal splint to hold the spine while it fuses. But like any other metal, it can break. In unstable spines, it is often a question of which will occur first – the spine fusing (and the patient’s bone then providing support for the spine) or the metal failing.
According to The New England Journal of Medicine, fusion is associated with more complications than any other type of spinal surgery. Actual clinical success in term of satisfactory improvement in preoperative pain occurs in only 50-80 % of patients undergoing spinal fusion. When a patient continues to have pain despite fusion surgery, this is generally referred to as failed back surgery syndrome (FBSS).
FBSS can be difficult to treat because it is often difficult to find what is causing the pain. The more levels that are fused and the more surgeries that are done, the less likely any further surgical intervention is going to be successful.
Arthroscopic alternatives to open surgery, such as The Bonati Procedures, offer a least invasive option to traditional open, and fusion, surgeries. These Procedures allow for greater precision, faster healing and less damage to healthy tissue. With patented instrumentation and methods, advanced spine surgeries today can employ the smallest incision possible to correct problems attributed to FBSS.
Even if a patient has had previous back surgery involving a fusion and the placement of hardware that has failed and is now producing pain, these microsurgical techniques may offer a solution.
Previously, removing misdirected hardware was avoided because the dissection required to remove hardware was as disabling as the surgery for the initial placement of the hardware. Yet now, the minimal access techniques that The Bonati Procedures employ to relieve pain from spine conditions can be employed to remove misdirected hardware with less pain, less scarring and no complications.
The patient, under local anesthesia, is alert and able to communicate with the surgeon throughout the procedure. The result can be far less trauma to the muscles and tissues, resulting in minimal blood loss and faster recovery. Patients who have had fusion surgeries that did not relieve their pain now have renewed hope with these gentle, carefully controlled outpatient procedures, which are performed sequentially. The Bonati Procedures were developed by and are performed only at The Bonati Institute® by surgical teams that have performed more than 20,000 of these advanced procedures.
To learn more about how The Bonati Procedures allow patients to regain their mobility and quality of life, visit www.bonati.com or call (866) 298-7513.
An instrumented fusion can fail if there is not enough support to hold the spine while it is fusing. Spinal hardware (pedicle screws) may be used as an internal splint to hold the spine while it fuses. But like any other metal, it can break. In unstable spines, it is often a question of which will occur first – the spine fusing (and the patient’s bone then providing support for the spine) or the metal failing.
According to The New England Journal of Medicine, fusion is associated with more complications than any other type of spinal surgery. Actual clinical success in term of satisfactory improvement in preoperative pain occurs in only 50-80 % of patients undergoing spinal fusion. When a patient continues to have pain despite fusion surgery, this is generally referred to as failed back surgery syndrome (FBSS).
FBSS can be difficult to treat because it is often difficult to find what is causing the pain. The more levels that are fused and the more surgeries that are done, the less likely any further surgical intervention is going to be successful.
Arthroscopic alternatives to open surgery, such as The Bonati Procedures, offer a least invasive option to traditional open, and fusion, surgeries. These Procedures allow for greater precision, faster healing and less damage to healthy tissue. With patented instrumentation and methods, advanced spine surgeries today can employ the smallest incision possible to correct problems attributed to FBSS.
Even if a patient has had previous back surgery involving a fusion and the placement of hardware that has failed and is now producing pain, these microsurgical techniques may offer a solution.
Previously, removing misdirected hardware was avoided because the dissection required to remove hardware was as disabling as the surgery for the initial placement of the hardware. Yet now, the minimal access techniques that The Bonati Procedures employ to relieve pain from spine conditions can be employed to remove misdirected hardware with less pain, less scarring and no complications.
The patient, under local anesthesia, is alert and able to communicate with the surgeon throughout the procedure. The result can be far less trauma to the muscles and tissues, resulting in minimal blood loss and faster recovery. Patients who have had fusion surgeries that did not relieve their pain now have renewed hope with these gentle, carefully controlled outpatient procedures, which are performed sequentially. The Bonati Procedures were developed by and are performed only at The Bonati Institute® by surgical teams that have performed more than 20,000 of these advanced procedures.
To learn more about how The Bonati Procedures allow patients to regain their mobility and quality of life, visit www.bonati.com or call (866) 298-7513.
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