CALL NOW (646) 583-0995

Back Treatment Options

Spinal fusion

In our previous blog we discussed the tremendous stresses borne by the lumbar, or lower portion of the spine comprising the five lowest vertebrae. In fact, lumbar back pain is a significant health issue, affecting about 70 to 85 percent of Americans at some point in their lives, according the National Institutes of Health (NIH). Among the most common causes of lumbar spinal problems is the degeneration of bones and tissue in the spine that occur as a normal part of aging. But one doesn’t have to be older to have lumbar spinal problems. Back pain is the most frequent cause of activity limitation in people under the age of 45, according to the NIH. Trauma or injury, poor posture and biomechanics, genetics, obesity and poor muscle tone can all result in lumbar spinal problems that cause pain, limit mobility, and have other serious health consequences. These conditions include spinal stenosis, bulging disc, herniated disc, slipped disc, radiculopathy and spondylolisthesis.

A variety of treatment options are available for individuals affected by conditions causing lumbar back pain. Individuals with moderate to severe cases of these conditions who do not respond to conservative treatment options such as medication, physical therapy and lifestyle changes, may opt for a surgical solution. Frequently this involves cutting away portions of a lumbar vertebra that is impinging, or putting pressure on a nerve emanating from the spinal column. Such spinal decompression surgery can have a dramatic impact on relieving pain and restoring mobility. However, removing bony elements also weakens and destabilizes the spine, so historically a procedure known as lumbar fusion, or lumbar spinal fusion has been performed in conjunction with spinal decompression back surgery of the lower spine. In this procedure the vertebra from which tissue was removed is fused to an adjacent vertebra. This stabilizes and strengthens the spine, but lumbar fusion eliminates the natural flexion and independent motion of the fused vertebrae. Today lumbar decompression surgery patients have an alternative to lumbar fusion: the TOPS™ (Total Posterior Spine) System. TOPS preserves the full range of the spine’s natural motion, and has been shown to provide better outcomes than fusion in clinical studies performed around the world. If you are considering surgery for a lumbar spinal problem, ask your physician about all your surgical options.

Recovering from Lumbar Spinal Stenosis

Lumbar Spinal Stenosis

 

Lumbar spinal stenosis, a common medical problem, denotes an unnatural narrowing of the spinal canal, the center of the spinal column housing the spinal nerves that relay sensorial information to the brain and control the movements of our muscles. The term stenosis comes from Latin, and means a narrowing. When a portion of the spinal canal narrows unnaturally, it can put pressure on the spinal nerves, and these pinched nerves in turn can cause pain and limit mobility.

The good news is that a variety of treatment options are available that have been proven effective in helping individuals recover from or ameliorate the symptoms of spinal stenosis. Conservative, non-invasive therapies include simple lifestyle changes, medications, physical therapy, and injections of anti-inflammatory agents. For patients with spinal stenosis, there’s no way of knowing which of these approaches will be most successful, so physicians may simply prescribe one of these treatments as a first step, and monitor the results to see how the patient responds. If the first method selected doesn’t achieve the results of helping the patient recover from spinal stenosis, the next option may be tried, and so on.

For patients with moderate to severe spinal stenosis who do not respond to conservative treatments, surgery may be recommended. In this form of spinal decompression surgery, the surgeon trims away excess bone in the narrowed center of the affected vertebra, relieving pressure on the compressed nerve or nerves. Historically, a spinal fusion back surgery operation has been performed in conjunction with surgery to relieve spinal stenosis, in order to stabilize the region of the spine where the operation was performed. Today there’s an important, and better alternative to spinal fusion. The TOPS (Total Posterior Spine) System procedure provides better clinical outcomes than spinal fusion surgery. The TOPS solution has the added benefit of preserving the spine’s full range of motion, unlike spinal fusion, which permanently fuses adjacent vertebrae. TOPS also offers a much quicker recovery from surgical treatment for spinal stenosis than spinal fusion. If you’re a candidate for spinal stenosis surgery, make sure you understand all the advanced surgical solutions available today, and what impact each will have on your recovery from this condition.

 

Back Pain and Steroid Injections

Back Pain and Steroid Injections

Epidural injections of steroids have often been the treatment of choice for patients with a pinched nerve in the back whose symptoms did not respond to simple exercise, physical therapy, or other more conservative approaches. Steroid injections have also been offered to patients with spinal stenosis whose back pain was unrelieved by less invasive therapy. But the results of a new research study hint that injections of steroids for back pain may be less beneficial than believed. The study is small, but it still bears consideration, as the findings are statistically valid and underscore why healing is as much an art as a science.

The study of the efficacy of steroid injections for back pain examined more than 270 patients, aged 53 to 75 years old, culled from the ranks of a larger study of individuals with spinal health problems. The research subjects were followed for four years. Sixty-nine of these patients had epidural injections and 207 did not, but otherwise the patients’ symptoms were primarily the same in terms of severity, as measured by well-established scales used to measure pain in the leg and lower back. Using these scales, researchers found less improvement among those who had epidural injections than among patients who did not have injections.

Several caveats must be offered when considering the results of this research. First, as the authors readily acknowledge, factors that the researchers didn’t account for and couldn’t control may have affected or skewed the results. Nonetheless, we are seeing fresh thinking and new techniques improving outcomes for many spinal patients. For example, patients who elected to have spinal decompression surgery to relieve symptoms of pinched nerves typically opted for a spinal fusion back surgery in tandem, in order to stabilize the spine. Today, a growing number are opting for TOPSTM – the Total Posterior Solution – System, instead of spinal fusion. The TOPS system, unlike spinal fusion, preserves complete independent motion of the individual vertebrae. This is one more way that fresh thinking, and new technologies and procedures are transforming the care and treatment of back problems.

Preparing for Spinal Fusion Surgery, Part II

Doctors Completing Surgery

In our last blog we began addressing the topic of preparing for spinal fusion back surgery.  We touched upon tests that may be performed, and the need to prepare physically through a conditioning regimen so your body is ready for the rigors of surgery. Here are additional points anyone considering spinal fusion should remember:

One potential complication of spinal fusion surgery is excessive bleeding. Several commonly used medications can increase bleeding, including aspirin, ibuprofen and other NSAIDs, as can anticoagulants such as warfarin. You will need to discontinue use of any such medications. Should your physician or surgeon be concerned about the risk of excessive blood loss during your spinal fusion operation, you may bank your own blood, called an autologous blood donation, before the surgery.

Be sure to discuss all the medications you are taking with your physicians, and they will advise you when (and if) you should stop taking them. Some medications could cause adverse affects in combination with the anesthetics or other medications used during the operation, and anti-inflammatory medication such as cortisone and chemotherapy can compromise the body’s ability to heal.

Failure of the bone graft to heal, called pseudarthrosis, is one of spinal fusion’s most problematic post-surgical complications. Smoking is associated with this complication, and nicotine has been shown to compromise the ability of bone cells to grow. It is imperative that smokers stop smoking prior to the surgery, and not smoke before their recovery is complete.

Before resigning yourself to spinal fusion surgery, remember that spinal problems often respond to more conservative treatments, such as physical therapy and healthy lifestyle changes. Alternative surgical procedures may also be available. For example, many candidates for spinal fusion can choose the TOPSTM(Total Posterior Solution) System instead. The TOPS System not only preserves all the natural flexion of individual vertebrae, unlike spinal fusion, but it has also been shown to have better outcomes in clinical trials around the world. Indeed, investigating alternative options is another productive way to prepare for a spinal fusion operation.

How to Prepare for Spinal Stenosis Surgery, Part III

 

Back Surgery

Spinal stenosis, an unnatural narrowing (or stenosis) of the spinal canal, is an all too common cause of back pain and restricted mobility, which results from pressure the narrowing column places on spinal nerves. For those who don’t respond to more conservative treatments, surgery may be recommended to correct spinal stenosis, and it’s important for such patients to prepare for the procedure properly. The preparations starts by ascertaining that back surgery is indeed called for.

Pain in your leg that is greater than the pain in your back caused by a pinched nerve (as measured by standard pain scales), is one indication that surgery is appropriate for a given case of spinal stenosis. Leg pain that does not decrease and interferes with your quality of life, and radiological scans confirming that the pain is likely due to nerve compression, are also indications that surgery may be beneficial.

Much of the advice on preparing for any back surgery applies to a spinal stenosis operation, as well. As in other back surgeries, you should stop smoking and, if overweight, shed excess pounds. Get your blood pressure down. Walk, or engage in other moderate activity that gets your muscles moving. This is important to speed your recovery process.

Check the medications you’re taking and discuss them with your physicians to ensure the medications will not interfere with your surgery or recovery. For example, blood thinners can interfere with blood clotting. Among women, birth control pills and hormone replacement therapy can also interfere with surgery.

Traditionally, spinal fusion back surgery has been performed in conjunction with spinal stenosis surgery to stabilize the spine at the site of the operation. A drawback of spinal fusion is that the procedure eliminates the independent motion of the fused vertebrae, and is also physically demanding. Now there is an alternative to spinal fusion following spinal stenosis surgery. The TOPSTM (Total Posterior Solution) System can be used instead of spinal fusion, and has better outcomes. Investigating whether this alternative procedure makes sense for you could be one of the best ways to prepare for your surgery for spinal stenosis.

How Soon Can I Get Out of Bed After Spinal Fusion Surgery?

How Soon Can I Get Out of Bed After Spinal Fusion Surgery?

In recent blogs we’ve addressed preparations for back surgery – specifically surgery for spinal stenosis, and spinal fusion operations. Yet the recovery process is just as important as the back surgery itself to your long-term health, so it’s important prepare for postoperative routines and realities well before the surgery is performed.

Among the first questions patients often ask about the spinal fusion back surgery recovery process is how soon they will be able to get out of bed following the operation. Patients typically get out of bed the day after their surgery – with the help of attendants, who will assist you in sitting up, getting your legs over the side of the bed, standing up and walking. You’ll be glad you spent time getting in shape before your operation. The preparation pays off at times like this, as being in good health will help throughout your healing and recovery, as the body responds to the trauma of surgery and works to repair itself.

Movement is indeed critical to proper healing, and since you’ll spend a good deal of time in bed in the first days after the spinal fusion operation, its important to learn how to move correctly in bed. You’ll be shown the best way to turn over, sit up, and move in ways that will promote proper healing, strengthen muscles and minimize pain.

Your caregivers will have plenty of useful tips for helping ensure a smooth, steady recovery from spinal fusion. For example, using slip on shoes, eliminating the need to bend over and tie laces; having pajamas with button tops, so you don’t have to lift arms and pull the PJs over your head; and drinking liquids from a squeeze bottle so there’s no need to bend the neck as when drinking from a cup, are among simple tips that will help you recover more quickly and with less discomfort.

Today many candidates for spinal fusion surgery can opt for the TOPSTM (Total Posterior Solution) System instead. The TOPS implant has been shown to have better clinical outcomes and fewer post-surgical complications than spinal fusion. And unlike spine fusion procedures, the TOPS device preserves the full range of each vertebra’s motion. Patients concerned about how soon they can get out of bed following spine fusion back surgery should make sure they’re familiar with all their surgical options, as the choices they make can also affect their recovery.

What is Failed Back Surgery Syndrome?

Back Pain Caused by Failed Back Surgery

Failed back surgery syndrome (also called FBSS, or failed back syndrome) is a generalized term used to describe ongoing pain after back surgery. After going through a spinal surgical procedure, of course both you and your surgeon desire your complete painlessness.  But, even with the best spinal surgeon and the best indications for your spinal surgery success, there is always a small chance that back pain may continue after surgery and recovery (studies report continued back pain after 5% of all spinal surgeries ).

What causes Failed Back Surgery Syndrome? There are many reasons why a back surgery might not result in a completely pain-free existence, partially owing to the fact that spine surgery is only able to accomplish stabilizing a painful joint and decompressing a pinched nerve. If your back condition involves more than these two pain-causing situations, your spine surgeon will need to continue your care and explore additional solutions to your back pain condition.

Back surgery is reported to be 95% successful at changing anatomy that causes pain and correcting the physical results of a back injury.  But it’s also important to realize that back surgeryisn’t a cure-all for every type of back pain-causing condition. Since the spine is a very complex part of your anatomy, with many vertebrae, nerves, and cushioning between your discs, it can be a complex process to get to the root of what’s truly causing you pain.

Your back surgeon will thoroughly assess your back pain condition, and use top technology to diagnose your back pain causes, but it’s important for you to have realistic expectations of what back surgery can and cannot accomplish for you. If you experience Failed Back Surgery Syndrome, your skilled physician will then conduct additional tests and map out a plan of action to remedy as much of your back pain as possible. All valuable things take time, so don’t set yourself up for possible disappointment by expecting a quick fix to any back pain. It may take an extra procedure or extra treatment after your back surgery to get you feeling much better.

If you do have great success after your back surgery, then you’re in that fortunate 95% of back pain patients whose symptoms lessen and whose lifestyle will very soon be active and more comfortable again.