Spine

Healthy Spine

The spine has three major components:

  • Spinal column (bones, discs)
  • Neural elements (spinal cord, nerve roots)
  • Supporting structures (muscles, ligaments)

The spinal column is made up of twenty four bones called vertebrae. The spinal column supports the body and gives it form. These vertebrae are connected in the front of the spine by intervertebral discs (durable tissue filled with a gel) that help support the spine and also allow it to move. Ligaments and muscles are attached to the back of the spine and provide power for movement.

The neural elements consist of the spinal cord and nerve roots. The spinal cord is surrounded by spinal fluid and runs from the base of the brain down through the cervical and thoracic spine (about two thirds of the way down your back).

At each vertebral level of the spine there is a pair of nerve roots which supply particular parts of the body with electrical pulses.

The supporting structures of the spine consist of muscles and ligaments. The spinal ligaments and muscles connect the vertebrae and keep the spine stable. They allow the spine to function in an upright position, and the trunk to form various positions.

There are many causes of back pain. Most cases of back pain are caused by wear and tear on the parts of the spine over a period of time. Back pain and damage is commonly caused by arthritis and injuries.

Topics below cover two common areas of spine problems.

  • Arthritis
  • Injuries

Arthritic Spine

Arthritis is a term that is defined as inflammation of the joint and used to describe over 100 different conditions that can affect the human body. Arthritis affects millions of Americans each year with symptoms including pain, stiffness, swelling, and loss of motion in affected joints.

There most common form of arthritis that generally affects the spine is osteoarthritis.

Osteoarthritis, the most common form of arthritis, results in the wearing out of the cartilage that protects the bones in the joints. Once cartilage is damaged or destroyed, cartilage cannot repair or replace itself like many other body tissues. Spine cartilage can be compared to the tread of an automobile tire, very durable but susceptible to wear over time. As we age, the tread surface slowly erodes until the underlying bone is exposed. This exposed bone can be painful when the joint moves and bears weight. In some cases, spinal stenosis can occur which is a narrowing of the space around the spinal cord.

Often the cause of arthritis is unknown, but may develop as a result of injury to the joint, excess body weight, or years of wear and tear on the joint cartilage. There is no known cure. The best that doctors can do for patients is to restore motion and reduce pain.

Common symptoms of osteoarthritis of the spine

  • Severe back pain that limits everyday activity
  • Back pain at night causing sleeplessness
  • Chronic swelling of the back with morning stiffness
  • Decreased activity
  • Impaired lifestyle

Spine Injuries

There are many different types of spine injuries; however, there are a few that are more common than others. Common types of spine injuries include strains and sprains, stenosis, bulging or ruptured disks, sciatica and osteoporosis. These conditions can cause back pain, swelling, and stiffness.

Sprains and Strains are a very common cause of back pain. Sprains are due to ligament injuries. Strains occur because of damage to muscles and tendons. This injury is typically caused by improper or heavy lifting, or after a sudden awkward movement.

Symptoms of a strain or sprain can include, pain that worsens with movement, muscle spasm, decreased motion, difficulty walking, bending forward or sideways, or standing straight.

Spinal Stenosis is a condition where the tissues in the spinal canal are compressed due to the narrowing of the spinal canal. The narrowing of the spinal canal often results in a pinching of the nerve root of the spinal cord. The nerves become increasingly irritated as the diameter of the canal becomes narrower.

Symptoms include pain and numbness in the buttocks and legs along with weakness of the muscles.

A Bulging or ruptured disks is one of the most common causes of back and leg pain. Disks act as cushions between the vertebrae in your spine. A ruptured or bulging disk occurs when the soft material inside a disk bulges or ruptures out of place and presses on a nerve.

Symptoms include pain that radiates to the buttocks, legs, and feet (sciatica), tingling or numbness in the legs or feet, and muscle weakness.

Sciatica occurs when the disks that cushion vertebrae of your lower spine press on the roots of the sciatic nerve.

Symptoms can include weakness, numbness, or a burning or tingling (“pins and needles”) sensation down your leg, possibly even in your toes.

Osteoporosis– Compression fractures of your spine’s vertebrae can occur if your bones become porous and brittle.

  • Medical history
  • Symptoms
  • Health
  • Activity
  • Examine affected joint
  • Range of motion tests
  • Joint-line tenderness
  • Joint deformities
  • Test nerve function
  • Radiological Tests

Radiological Tests

X-rays

X-rays reveal problems with bones, such as infections, tumors, or fractures. They can also give your doctor information about how much degeneration has already occurred in the spine. X-rays are most often the first test ordered before any of the more specialized tests.

Flexion and Extension X-rays

Flexion and extension x-rays may help to determine if there is instability between any of the vertebrae in the spine. These x-rays are taken from the side as you first lean far forward and then far backward. The doctor then compares the two x-rays to see how much motion occurs between each spinal segment.

MRI Scans

The MRI scan uses magnetic waves to make pictures of the lumbar spine in slices. The scan shows the lumbar bones as well as the soft tissue structures like the discs, joints, and nerves. The MRI is the most common test to look at the lumbar spine after x-rays have been taken.

CT Scans

The CT scan is a type of x-ray that allows doctors to see slices of bone tissue created by a computer and x-rays. It is primarily used when there are suspected bone problems.

Myelogram

The myelogram is a type of x-ray test where a dye is injected into the spinal sac. It helps a doctor see if there is a herniated disc, pressure on the spinal cord or spinal nerves, or a spinal tumor. The myelogram is usually used in combination with the CT scan to give more detail; however, it is used less often than the other tests.

Bone Scan

A bone scan is a test in which radioactive tracers are injected into the blood stream. The tracers then show up on an x-rays of your back. These tracers build up in areas where bone is undergoing a repair process, such as a healing fracture or the area surrounding an infection. Most often the bone scan is used to locate the problem.

You should discuss your condition and treatment options with your surgeon.

Most back pain will heal with conservative treatment in 2 to 3 days. Patients often do best when they stay active and perform normal activities as soon as possible, even if there is still some pain. One goal of treatment is to help find ways to control the pain and allow you to continue to complete your normal activities. Please ask your physician before starting any treatment.

  • Bed Rest
  • Back Brace
  • Medications
  • Injections
  • Physical Therapy

Bed Rest

In cases of severe pain, doctors may suggest bed rest that usually lasts no more than 2 to 3 days. This is because lying on your back can take pressure off sore discs and nerves; the lapse in pain will give you some relief and strength to get back to your normal activities faster.
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Back Brace

A back brace is sometimes recommended when back pain first occurs. It provides support to the back muscles and decreases the pressure inside problem discs. Patients are encouraged to gradually discontinue wearing the support belt over a period of 2 to 4 days or else the back muscles begin to rely on the belt and start to atrophy.
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Medications

There is no medication that will completely fix low back pain. Medications are primarily prescribed to help control pain, inflammation, and muscle spasm.
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Injections

There are several different types of spinal injections that your doctor may suggest depending on your condition. Injections usually incorporate a mixture of an anesthetic and cortisone preparation.
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Physical Therapy

For acute back pain, you may be prescribed a few weeks of physical therapy. At first, the physical therapist may apply various forms of treatment to address your symptoms. To help reduce pain and muscle spasm, your therapist may apply heat or ice packs or even electrical stimulation.

Active rehabilitation reduces the possibility that back pain will become a chronic issue. However, you should be cautioned not to try to do too much, too quickly, you should have a guided approach in your return to your usual activities. Your physical therapist should also show you safe body mechanics to help you protect your low back as you complete your daily routine. As you recover, you should slowly advance in a series of strengthening exercises for the abdominal and low back muscles. This is because working these core muscles will help you begin moving easier and reduces the chances of future pain.

When non-surgical treatments fail to provide adequate relief from the symptoms of back pain your surgeon may suggest surgery. The goal of all spine operations is to remove pressure from the nerves of the spine, and to reduce excessive motion between vertebrae. The type of surgery that is best depends on the patient’s conditions, symptoms and history.

  • Laminectomy
  • Discectomy

Laminectomy

A laminectomy is a surgical procedure to relieve pressure on the spinal nerve roots by removing the lamina and any bony growths or ruptured disc material. The lamina is the layer that covers the bony ring of the spinal canal. When the nerves in the canal are squeezed by a herniated disc or from bone spurs, this procedure is used to release the pressure on the spinal nerves. Only your surgeon can determine if you are a candidate for this surgery or if another type would better suit your unique situation.

Minimally Invasive Discectomy

Discectomy is a surgical procedure to remove a portion of a disc to relieve pressure on the nearby nerve roots.

Many surgeons now perform minimally invasive discectomy procedures that require only small incisions in the low back. The advantage of this procedure is that there is less risk of damage to the back muscles and a faster recovery. Only your surgeon can determine if you are a candidate for this surgery or if another type would better suit your unique situation.

Complications

While uncommon, complications can occur during and after surgery. Some complications include infection, blood clots, nerve damage, spinal fluid leak and blood loss. Although surgery is extremely successful in most cases, some patients still experience stiffness and pain. Be sure to discuss these and other risks with your surgeon.

Preparing for Surgery

Patients should begin preoperative strengthening exercises to help them prepare for surgery and their recovery. Patients may be given a comprehensive nutrition plan to help ensure optimum health before surgery.

There are many things that your surgeon may do to minimize the potential for complications. Your surgeon may have you see a medical physician before surgery to obtain tests. You may also need to have your dental work up to date and may be shown how to prepare your home to avoid falls.

After Surgery

After surgery, you probably will be hospitalized for 1 to 2 days. During this time, you will receive pain medication and begin physical therapy. It is important to start moving as soon as possible after surgery to promote blood flow, maintain mobility, decrease the risk of scar tissue, and to facilitate the recovery process. You should be out of bed and walking within 24 hours of your surgery.

Before you leave the hospital, your therapist will show you a variety of exercises designed to help you regain mobility and strength in your spine. You should be able to perform these exercises on your own at home. You will be shown how to safely climb and descend stairs, and how to get into and out of a seated position.

At home, it is important to continue with your exercises as your physician has instructed. It is a good idea to enlist the help of friends or family to help you once you do return home.

Recovery

Every person’s recovery time will vary, but most people should be able to ride a bike or swim after a couple weeks. Most people with jobs that are not physically challenging can return to work in 2 to 4 weeks or less. Those with jobs that require heavy lifting or operating heavy machinery that can cause intense vibration may need to wait at least 6 to 8 weeks after surgery to return to work.

At home, you may have some minor restrictions such as not sitting for long periods of time, not lifting objects more than five pounds, or excessive bending or stretching for the first 4 weeks after surgery. Also, you should not attempt to drive an automobile until you have been instructed to do so by your physician.

Your surgeon will tell you when you can return to these activities and will also tell you which activities to avoid.

Planning ahead and preparing for your knee surgery can help ensure a smooth surgery and an easier recovery.

The following recommendations can help you with this process.

  • Preparing For Spine Surgery
  • Caring For Your Spine After Surgery

Preparing for Spine Surgery

When you and your orthopedic surgeon decide that surgery is the best option to relieve pain and restore motion, you will begin the normal preparation for surgery. You should notify your surgeon about any of the medications you are presently taking because some medications must be stopped before surgery. All surgeries carry certain risks and possible complications. Before surgery, your surgeon will explain the possible complications. Your orthopedic surgeon may ask you to see your primary care physician to make sure that you do not have any health conditions that may complicate your surgery.

You may be asked to donate blood before your surgery. There are several options regarding blood donation and surgery, and all of these options should be explained to you.

Surgery also requires anesthesia. There may be some options regarding anesthesia and they will be explained to you. Your options will be based on your health history, the medications you presently take, and the results of your physical examination.

Your surgeon may also recommend that you start a strengthening program before surgery. The prescribed exercises are designed to help add strength and flexibility. Strengthening your muscles before surgery can assist your postoperative recovery.

After surgery your surgeon will give you a specific recovery plan that you should carefully follow. Do not attempt exercises that are not prescribed by your surgeon, and do not attempt to alter your recovery schedule.

Planning ahead for your return home

  • Launder all of your dirty clothing before your surgery. Have loose, comfortable clothing set aside for your recovery time.
  • Prepare single-serving meals before your surgery. These meals can be heated quickly in a microwave and there is less to clean up.
  • Be sure to remove loose rugs and other trip hazards such as electrical cords and magazine racks from walking paths to avoid accidents or falls. If necessary, widen furniture paths to accommodate a walker or cane.
  • Place regularly used items such as remote controls, medications, and reading materials in easy-to-reach locations.
  • Un-tuck bedding to allow for easier access in and out of your bed. If your bedroom is on a second floor, it may be helpful to temporarily relocate your sleeping arrangements to the first floor. This will avoid having to climb stairs when you are not feeling your best.
  • Having some assistance after total joint replacement can also be very beneficial. Contact family members or friends ahead of time so they may make the necessary arrangements to assist in your recovery.

Caring For Your Spine After Surgery

It is important that you move properly during the first 4-8 weeks after your surgery. You may not participate in any contact sports or lift anything heavier than five pounds. Avoid sitting for long periods of time, excessive bending or stretching for the first 4 weeks after surgery.

Continue the prescribed exercises during your entire recovery period, and talk to your doctor about developing an exercise program after you fully recover. Swimming, walking, and bicycling are excellent sources of low-impact exercise if your surgeon feels that these activities are appropriate for your individual condition.

Follow your surgeon’s check-up plan. It is common to visit with your surgeon at three, six, and nine months after surgery and annually thereafter.

Physical Therapy and Exercises for the Spine

You may be prescribed a number of physical therapy exercises. Physical therapy is simply an exercise program that gently stretches and strengthens specific muscles and joints. The exercises you may perform are gentle, range of motion (stretching) exercises designed to restore movement and strength to your joint and to promote blood flow for healing.

It is important to stay proactive in your physical therapy since it can have a direct impact on the total outcome of your surgery. Remember to stay diligent and don’t give up. Ask for help if you need it. Friends, family members, and even neighbors can be helpful during your recovery, especially if you ask for their assistance before your surgery.

Physical therapy is a very important role in the recovery process. A physical therapist may demonstrate a variety of low-impact exercises designed to increase the strength and mobility of your shoulder joint. However, you should only perform the exercises that are ordered by your surgeon.

What is arthritis?

Arthritis is a term that is defined as inflammation of a joint and used to describe over 100 different conditions that can affect the human body. Arthritis affects millions of Americans each year with symptoms including pain, stiffness, swelling, and loss of motion in affected joints.

What are the symptoms of a herniated disc?

When the spinal cord or spinal nerves become compressed by a herniated disc, they don’t work properly. This means that abnormal signals may get passed from the compressed nerves which cause many problems. Common symptoms of a herniated disc include:

  • Tingling & Numbness
  • Muscle Weakness
  • Bowel or Bladder Problems

What are my non-surgical options before considering spine surgery?

  • Bed Rest
  • Assistive devices such as a support brace
  • Exercise or physical therapy can strengthen the muscles around the affected joint(s), possibly providing relief from pain while improving mobility and function.
  • Medical management including nonsteroidal anti-inflammatory medications or steroid injections may assist in reducing painful joint inflammation and restoring function.

When should I have Laminectomy or Discectomy surgery?

Your surgeon will evaluate your health history, perform a physical examination, and take x-rays to decide if you are a candidate for this surgery. You must then decide if your discomfort, pain or stiffness, and overall loss of quality of life justify undergoing surgery. Generally, there is no harm in waiting to have surgery if conservative, non-surgical treatments are effective.

What are the benefits of the minimally invasive discectomy?

The minimally invasive discectomy is a procedure that accomplishes the same goal as the traditional discectomy, but uses a smaller incision. Instead of actually looking at the herniated disc fragment and removing it, your surgeon uses a small camera to find the fragment and special instruments to remove it. The procedure may not require general anesthesia, and is done through a smaller incision with less tissue dissection.

Is age a consideration for spine surgery?

Age is not a problem if you are in reasonably good health and have the desire to continue living a productive, active life. You may ask to see your personal physician for an opinion about your general health and readiness for surgery.

What can I expect from the surgical procedure?

  • One-inch incision in the skin over the affected area of the spine
  • Rehabilitation and walking begin the day after surgery.
  • Hospital stay is normally 1 to 2 days.

What type of recovery can one expect following surgery?

Pain around the incision is common, but usually well controlled with oral pain medications. Some patients may notice that their leg pain is gone immediately; others may notice that leg pain slowly dissipates. Patients usually spend one night in the hospital. A lumbar brace may help with some symptoms of pain, but is not necessary in all cases. Activities such as sitting upright and walking are encouraged after surgery. Patients must avoid lifting heavy objects, and should try not to bend or twist the back excessively.

Are there risks from surgery?

While uncommon, complications can occur during and after surgery. Some complications include infection, blood clots, nerve damage, spinal fluid leak and blood loss. Although surgery is extremely successful in most cases, some patients still experience stiffness and pain. Be sure to discuss these and other risks with your surgeon.

Are there any restrictions on exercise or movement after surgery?

It is important that you move properly during the first 4-8 weeks after your surgery. You may not participate in any contact sports or lift anything heavier than five pounds. Avoid sitting for long periods of time, excessive bending or stretching for the first 4 weeks after surgery.

Are regular visits with your surgeon required after surgery?

The surgeon will set a follow-up schedule for the first year after surgery to evaluate your progress. Usually these follow-ups occur three, six and nine months after the surgery. Annual visits may be required thereafter. Complications can occur with implants, so seeing the surgeon when you notice a change in symptoms can assist in evaluating any changes that may occur with your new joint.

All patient education materials are provided by OrthoPatientEd.com and have been reviewed by our Advisory Board of leading Orthopedic Surgeons to ensure accuracy. All materials are provided for informational purposes only and are not intended to be a substitute for medical advice from your orthopedic surgeon. Any medical decisions should be made after consulting a qualified physician.
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