Spine Surgery

What is Radiculopathy?

Have you heard of radiculopathy? This condition results from nerve irritation and, if it progresses, can induce debilitating symptoms. If you’ve already been diagnosed with radiculopathy, you know that it can alter your ability to complete day-to-day motions and activities. 

Understanding radiculopathy, what causes it, and what symptoms it triggers can help you more effectively cope with this neurological condition. 

What is Radiculopathy?

Radiculopathy is a term that refers to chronic injuries resulting from the bones of the spinal column (vertebrae), or the cushioning discs between them, impinging on a nerve root in the spinal column. With this condition, the affected nerve root is irritated or inflamed, leading to a variety of neurological symptoms. 

Any part of the spine can be affected by radiculopathy. With lumbar radiculopathy, the condition can trigger lower back pain that spreads down to one or both legs. 

What Are The Symptoms of Radiculopathy?

Common symptoms of radiculopathy include numbness, tingling, weakness, loss of motor function, muscle spasms, and radiating pain. 

The symptoms of radiculopathy may be felt all the way to the tips of fingers or toes, even though the nerve compression occurs at the base of the nerve in the spine. This is because spinal nerves extend from the spinal canal throughout the body, supplying sensation to the extremities. 

Is Radiculopathy Serious?

Radiculopathy can be serious if it’s left untreated. In other words, radiculopathy symptoms become more serious with time when a patient fails to receive professional medical care.

When it’s promptly addressed, radiculopathy often improves within six to 12 weeks. Many radiculopathy cases even resolve with at-home care alone, without the need for medications or hands-on treatments. 

Can I Work With Radiculopathy?

Most patients can work with radiculopathy. Although it can affect your ability to work, in severe cases, radiculopathy most often goes away with rest and at-home treatments. 

When radiculopathy persists longer than a few weeks, it can start to affect your work. This is particularly true for patients in careers that require physical exertion, such as construction, warehouse work, landscaping, agricultural work, firefighting, and professional athletics. 

Surprisingly, radiculopathy can even inhibit your ability to work if you have a sedentary job. This is because lumbar radiculopathy can lead to debilitating pain in the lower back and legs with prolonged periods of sitting. With this in mind, patients who have been diagnosed with radiculopathy and have desk jobs should try to take a break from sitting at least once every hour. 

Is Radiculopathy a Permanent Disability?

Radiculopathy can become a permanent disability over time.

Patients who are suffering from lumbar radiculopathy may be eligible to reap disability benefits. Eligibility requirements can vary depending on your disability insurance plan. 

Radiculopathy may be considered a disability because it can be debilitating, making it difficult to work. Severe radiculopathy can diminish a patient’s ability to walk, stand up, move around, and remain seated for extended periods. 

Can an MRI Show Radiculopathy?

An MRI can show radiculopathy. It’s considered the gold standard of imaging modalities to diagnose radiculopathy. 

Generally, an MRI is used to confirm a radiculopathy diagnosis, even if the doctor is confident of the diagnosis after a physical examination. MRIs can clearly display nerve impingement in the spine and even show any structural lesions that are irritating the affected nerve. This makes MRI scanning an invaluable tool for spinal specialists as they diagnose radiculopathy and other conditions that affect spinal nerves.

What Is the Most Common Cause of Radiculopathy?

The most common cause of radiculopathy is spinal degeneration associated with the normal aging process. Age causes the spinal structures to weaken and lose flexibility. As the spine shifts as a result of these changes, nerve root irritation can occur. 

Whether due to spinal stenosis, spinal disc herniation, or bone spurs, spinal degeneration can narrow the openings where nerve roots exit the spine, known as foramina. This condition may be referred to as foraminal stenosis and can lead to nerve root compression. When a spinal nerve root becomes irritated and inflamed, it can result in symptoms of radiculopathy.  

Besides spinal degeneration, radiculopathy can be caused by a range of other factors, including:

• Repetitive or stressful physical activities, potentially from jobs that involve heavy lifting or repetitive motions
• A lack of proper blood flow to the spine
• Certain chronic conditions that cause nerve damage, like diabetes 

Additionally, genetic predisposition and the presence of other spine disorders can increase one’s risk of developing spinal radiculopathy. 

How is Radiculopathy Treated?

Radiculopathy is treated with rest, physical therapy, and anti-inflammatory medication, in most cases. 

In some mild cases, radiculopathy resolves on its own over time, without the need for treatment. However, patients with persistent symptoms that don’t gradually improve should visit a physician for a treatment plan. Some severe cases of radiculopathy require surgery to restore patients’ mobility and quality of life. 

Does Physical Therapy Help Radiculopathy?

Physical therapy helps radiculopathy by strengthening the muscles in the abdomen and back that support the spine. Greater muscle strength in these areas will alleviate some pressure from the irritated nerve root, leading to reduced symptoms. 

Additionally, physical therapy helps radiculopathy by improving the patient’s body mechanics. This facilitates a balanced distribution of weight with day-to-day motions, which helps alleviate pressure on the affected nerve root. 

Physical therapists may also implement a variety of alternative treatment methods to ease radiculopathy symptoms, including massage and dry needling. 

Massage Therapy

Massage helps reduce muscle tension, which can ease the muscle spasms associated with radiculopathy. Additionally, massage offers anti-inflammatory benefits, helping to reduce the swelling and irritation around the nerve root. 

Dry Needling

Dry needling is a treatment that involves inserting thin filiform needles into myofascial trigger points. This process reduces muscle tension, boosts blood circulation, and eases pain. A 2021 study found that trigger point dry needling can effectively decrease pain in patients with lumbar radiculopathy. 

Your physical therapist may include massage and dry needling in your radiculopathy treatment plan alongside stretching and strengthening exercises. 

Can a Chiropractor Fix Radiculopathy?

A chiropractor can help fix radiculopathy by addressing structural imbalances in the spine. This can alleviate nerve irritation and lessen the patient’s pain. 

A study published in the Journal of Chiropractic Medicine evaluated the clinical outcomes of 162 patients with radiculopathy treated with chiropractic care. Of these patients, 85.5% experienced a resolution of the main subjective radicular complaints after nine treatment sessions. 

What Does Chiropractic Care For Radiculopathy Involve?

Chiropractic adjustments involve a chiropractor manually manipulating the spine to improve its alignment. This process also improves spinal mobility and creates more space around the irritated nerve, allowing blood, oxygen, and healing nutrients to reach the injury.  

Additionally, chiropractors may implement non-surgical spinal decompression to treat radiculopathy. During non-surgical decompression, the chiropractor implements a motorized traction device (a table with a harness and motor) that gently pulls the spine, creating more space between the vertebrae. 

A 2022 study published in BMC Musculoskeletal Disorders evaluated the effects of non-surgical decompression therapy with physical therapy for radiculopathy, compared to physical therapy alone. The study found that the combination of non-surgical spinal decompression therapy and physical therapy was statistically and clinically more effective than physical therapy alone for lumbar radiculopathy patients. It was more effective for improving lumbar range of motion, functional disability, quality of life, and back muscle endurance. 

What Can a Neurologist Do for Radiculopathy?

A neurologist can establish a treatment plan to restore sensation and alleviate pain for radiculopathy patients. 

Neurologists specialize in the diagnosis and treatment of nerve, brain, and spinal cord disorders. They may recommend physical therapy, chiropractic care, medication, or even surgery to resolve radiculopathy symptoms. 

Surgery for Radiculopathy

For patients whose radiculopathy doesn’t improve with several months of conservative treatment, spinal decompression surgery may be recommended. 

During this procedure, the portion of a vertebra impinging on the nerve root is trimmed away. This can provide dramatic relief from radiculopathy symptoms while giving the irritated nerve space to heal.

Traditionally, spinal fusion back surgery has been performed in conjunction with spinal decompression. Spinal fusion is used to stabilize the spine at the point of the operation, preventing future injury and discomfort. Unfortunately, spinal fusion also comes with its own risks and complications. 

Spinal fusion eliminates the natural independent motion of the fused vertebrae, which can compromise patients’ ability to enjoy various physical activities. This procedure may also contribute to the deterioration of adjacent vertebrae, creating the risk of future back pain and neurological symptoms.

Spinal Fusion Alternatives for Lumbar Radiculopathy

Today, there’s an alternative to spinal fusion for lumbar radiculopathy: the TOPS™ (Total Posterior Spine) System implant. This revolutionary device preserves the natural motion of the spine and allows movement in all directions.

Clinical studies have shown that it provides superior clinical outcomes for patients with chronic lumbar spine disorders like radiculopathy, spinal stenosis, and spondylolisthesis. It has been shown in clinical studies around the world to provide better clinical outcomes than spinal fusion. 

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With major medical advances rapidly being released, patients must remain up-to-date on the latest treatment options for chronic back pain. Talk to a spine specialist in your area to learn more about emerging therapies like the TOPS™ System. 

Recognizing and Preventing Post-Surgical Complications

With advanced procedures performed by highly trained and experienced surgeons, spinal surgery today boasts highly successful outcomes. Yet, complications can (and do) occur during the post-surgery recovery process.

The spinal surgery patient can serve as the first line of defense against these complications by taking an active role in managing his or her recovery. To ensure a successful recovery, patients need to prepare for the procedure well in advance. 

In this article, we’ll discuss everything that patients need to know before undergoing spine surgery, including the precautions to take and the complications to be aware of. 

What to Do Before Spine Surgery

Before spine surgery, you should prepare for the recovery process and follow all of your surgeon’s instructions. This will involve preparing your body for the procedure by:

• Stopping medications that could interfere with the surgery and/or recovery process, including blood thinners like Aspirin, Eliquis, Plavix, and Coumadin, as well as monoamine oxidase inhibitors (MAOIs). 
• Completing all of the recommended physical exams and lab tests, such as a complete medical history, EKG, chest x-ray, and/or urine test. 
• Bathing with antimicrobial soap, as recommended by your surgeon, to reduce the risk of postoperative infection.  
• Stop eating and drinking eight hours before surgery, or as advised by your surgeon. 

What Is the Most Important Thing to Do Before Spine Surgery?

The most important thing to do before spine surgery is to stop taking medications that could interfere with the procedure. Continuing to take these medications could alter the effects of the anesthesia, impede the recovery process, and lead to medical complications.

While this is one of the most important things to do before spine surgery, you should follow all of your surgeon’s recommendations to ensure a safe, successful procedure and recovery. Some patients will need to take particular pre-operative steps to account for underlying conditions, such as diabetes. 

What Precautions Should Be Taken Before Spine Surgery?

Before spinal surgery, take the following precautions:

• Quit smoking at least four to six weeks before the procedure. Nicotine suppresses blood flow throughout your body, which can significantly inhibit your healing process. In fact, quitting smoking four to six weeks before surgery and remaining smoke-free for a month afterward can cut your rate of wound complications in half. 
• Stop taking certain medications, as aforementioned. Your surgeon will advise you on which medications to stop taking before the procedure, so make sure to tell them about all of the drugs and supplements you’re currently taking.
• Consider donating your blood to account for possible blood loss during the procedure. Your surgeon can walk you through the pros and cons of giving your own blood, rather than using blood from a different donor. You may need to take an iron supplement before the procedure if you choose to donate your blood. 

What Is Included in a Pre-operation Checklist?

A pre-operation checklist includes the steps and precautions that patients should take before surgery to ensure a successful recovery. These steps generally include:

• Completing a physical exam and lab testing with your PCP, along with any other recommended medical appointments (such as an exam with a cardiologist)
• Completing any other required blood tests that weren’t completed by your PCP
• Determining which medications you need to stop taking before the procedure, and when to stop taking them
• Arranging transportation from the hospital to your home and, if needed, at-home care for the first few days after the surgery
• Preparing your home for the recovery process by:
  • Temporarily relocating your bedroom so that it’s easily accessible (for example, moving your bedroom to the ground floor will spare you from having to use stairs in the early stages of your recovery)
  • Purchasing any tools that will help you complete simple tasks as your spine heals (i.e. a grabber tool)
  • Move all of your essential items, such as paper products, books, snacks, TV remotes, and toiletries, to hip-level. Patients are typically advised to avoid reaching, bending, and twisting after spinal surgery. 
  • Meal prep as much as you can, or purchase ready-made meals, as cooking will be difficult after spinal surgery. You can also ask a loved one to prepare your meals during the early stages of your recovery. 
  • Prepare clean laundry before the surgery, as patients generally can’t do laundry in the first few weeks after surgery. We recommend setting out comfortable clothes to wear around the house after you return home from the hospital. 

What Is the Risk of Complications From Spinal Surgery?

There is a risk of complications from spinal surgery, as there is with any surgical procedure. Since spinal surgery involves operating around the spinal cord and nerves, there is a risk of nerve injury and paralysis. Although serious nerve complications are rare, it’s important to discuss this risk with your physician before planning to undergo spinal surgery.

Other possible complications from spinal surgery to be aware of include:

• Infection

Infection is one significant postoperative risk. The rate of infection varies significantly depending on the type of spinal surgery, ranging from 0% to 18%. The patient’s underlying health also impacts his or her risk of infection.

You’ll be prescribed antibiotics as part of your post-operative recovery regimen. You’ll also be instructed on how to care for your surgical incision as it heals. Proper wound care is crucial to prevent infection – you’ll need to keep the wound clean and dry until it’s fully healed.

It’s important to carefully follow all of your physician’s directives to minimize the risk of infection. Infections inhibit the healing process and, if they spread, can affect other tissues and organs. 

• Shock

Shock is a possible complication of spinal surgery. It occurs when the patient’s blood pressure severely falls, leading to a serious reduction in the body’s blood circulation. 

Infection, blood loss, metabolic issues, and brain injury can trigger shock in spine surgery patients. This complication can be treated by curbing the blood loss, assisting breathing, limiting heat loss, supplementing blood, fluids, or oxygen, and implementing medications that increase blood pressure. 

• Adverse reactions to anesthesia

Allergic reactions to anesthesia are rare but can occur. These reactions can range from mild to severe. The most severe type of reaction to anesthesia is known as malignant hyperthermia, which can be fatal without immediate treatment. 

Most side effects from anesthesia are mild, including vomiting, nausea, sore throat, chills, and temporary confusion. 

• Blood clots

Blood clots in the leg are a potential complication of spinal surgery. Known as deep vein thrombosis, or DVT, this complication causes pain and inflammation in the leg. If the condition escalates, it can lead to a severe condition called pulmonary embolism. 

The risk of DVT after spinal surgery is low, especially with minimally-invasive surgical techniques. 

• Pneumonia

Pneumonia is another post-surgery risk. It’s a lower respiratory tract infection that causes symptoms including cough, chest pain, trouble breathing, and fever. Again, taking an active role in your recovery is the best way to avoid pneumonia and other respiratory problems.

Risk factors for postoperative pneumonia include:

• Older age
• Excessive alcohol consumption
• Smoking
• Limited mobility before or after the procedure
• A suppressed immune system
• Recent viral infection
• Known respiratory disease
• Prolonged ventilator use (longer than 24 hours)

Post-operative respiratory difficulties are exacerbated by inactivity and shallow breathing. The sooner you get up and about, the lower the risk of postoperative pneumonia. Talk to your doctor about how to safely remain active after spinal surgery. 

• Fusion failure

Patients who undergo spinal fusion back surgery are at risk of the bone graft not healing property, known as a “failure of fusion”. 

Spine fusion surgery is typically performed to stabilize the spine after spinal decompression surgery. During spinal decompression, the surgeon removes tissue that’s impinging on the spinal nerves to resolve conditions such as spinal stenosis, spondylolisthesis, and herniated disc. Spinal fusion may be done to stabilize the spine after this procedure. 

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The chances of fusion failure are greatly increased for smokers or patients who use nicotine in any form, including nicotine patches. Some hospitals perform urine tests on patients before spinal fusion to ensure that they have no nicotine byproducts in their systems.

• Adjacent segment disease

Adjacent segment disease is another possible complication of spinal fusion. It occurs when the vertebrae surrounding the fused segment break down more rapidly than usual. This condition develops because the adjacent vertebrae must bear added impact to offset the fusion. 

Avoiding the Complications of Spinal Fusion

Today, the TOPS (Total Posterior Solution) System provides an alternative to spinal fusion for patients undergoing spinal decompression surgery. The TOPS System has been proven in clinical studies conducted globally to produce superior clinical outcomes and fewer complications than spinal fusion. It’s a dynamic implant device that moves with the spine in all directions while preventing instability.

The more you know about the surgical options available to you, the more you can minimize your chances of post-surgical complications. Talk to your spinal surgeon to learn more about preparing for your spinal procedure. 

Causes of Back Pain in Adolescents vs. Adults

Though the majority of spinal problems appear between the ages of 35 and 55, wrought by natural processes associated with aging, you don’t have to be an adult to have back problems. Back pain can also affect adolescents and even children.

As many as half of all young people will experience back pain by age 20. It may appear as a sharp, shooting pain, or as a burning or aching. It may be felt anywhere in the back. These are the same symptoms adults experience, but the causes of adolescent back pain are usually different than those that afflict their elders.

Table of Contents

Is Back Pain Normal for Adults?

What Are the Red Flags for Back Pain?

What Causes Back Pain in Adolescence?

Is Back Pain Normal During Puberty?

When Should I Be Worried About My Child’s Back Pain?

Will My Child’s Back Pain Go Away On Its Own?

How Do You Get Rid of Back Pain for Adults?

Spinal Fusion For Back Pain in Adolescents and Adults

Continue reading to learn more about the differences between the causes of back pain in adolescents and adults. 

Is Back Pain Normal for Adults?

Back pain is normal for adults because it’s an extremely common medical condition. An estimated 80% of adults experience lower back pain at some point in their lives. 

But, why exactly has back pain become normal for adults? There is no singular answer to this question, but medical experts believe that the growing prevalence of back pain is due to factors including:

• A lack of physical fitness
• Occupational risk factors, including sitting in an uncomfortable office chair, sitting for hours without breaks during the work day, and performing jobs that require heavy lifting
• High stress levels
• Poor sleep quality
• Anxiety, depression, and other mental health factors
• Genetic factors, such as a family history of lumbar disc disease

What Are the Red Flags for Back Pain?

The red flags for back pain that indicate the potential for serious complications include:

• Fever
• Weakness, numbness, or pain in the leg muscles
• Lost sensation in the inner thighs and buttocks (saddle anesthesia)
• Weight loss that can’t be attributed to other factors
• Recent surgery, illness, or a history of cancer
• Incontinence 

If you experience back pain with any of the symptoms listed above, seek out urgent medical care. Possible causes of these symptoms, such as cauda equina syndrome, require immediate treatment to prevent permanent complications. 

What Causes Back Pain in Adolescence?

Back pain in adolescence is most often caused by sprains, strains, scoliosis, herniated disc, and spondylolysis (vertebral stress fracture).

Benign musculoskeletal diseases and trauma are responsible for most cases of back pain in adolescents, just as they are for adults. Any strenuous or straining activity – sports or play, carrying a heavy backpack, or falling – can sprain muscles in the back and cause pain. Such strains and trauma account for many of the younger patients seen in hospital emergency rooms suffering from back pain.

Less commonly, back pain in adolescence can be caused by spinal infections, kidney infections, or spinal tumors. 

Is Back Pain Normal During Puberty?

Back pain is normal during puberty, to a degree. Growth spurts during puberty can cause muscular imbalances as the muscles and ligaments struggle to keep up with the growing bone. 

Clinical research published in BMC Musculoskeletal Disorders focused on puberty-related back pain in young girls. This research identified a “highly significant trend” for worsened back pain with increasing levels of puberty until teens reach maturity. Lower back pain, in particular, was linked to puberty, while mid-back and neck pain didn’t seem to correlate with the pubertal stage. 

When Should I Be Worried About My Child’s Back Pain?

You should worry about your child’s back pain if it lasts for longer than several weeks, occurs constantly, keeps them awake at night, or is accompanied by other symptoms, such as fever or neurological symptoms. If your child is exhibiting back pain with these symptoms, seek out prompt medical care for a diagnosis and treatment. 

Will My Child’s Back Pain Go Away On Its Own?

Fortunately, most cases of adolescent back pain resolve on their own. The exact cause of back pain is never identified in at least half the adolescents seeking treatment. However, adolescents can exhibit severe spinal conditions capable of causing long-term problems. 

These include stress fracture of the spine, known as spondylolysis, spondylolisthesis, which is forward slippage of one vertebra on another, and lumbar disc herniations. Infections, inflammatory diseases, and tumors can also cause back pain in children and adolescents, as can other congenital or acquired conditions. However, most cases of back pain in children are caused by muscle strains and generally resolve within a few weeks. 

If your child is experiencing significant, persistent back pain, don’t hesitate to seek out professional medical care. 

How Do You Get Rid of Back Pain for Adults?

To get rid of back pain for adults, start by improving your posture, focusing on your sleep quality, and managing inflammation with ice and heat therapy. Over-the-counter medications, like NSAIDs, can also help reduce back pain and swelling. 

When at-home methods fail to relieve back pain, it’s time to see a medical professional. Your doctor can work to pinpoint the cause of your pain and, if appropriate, refer you to a spinal specialist. 

Your physician and/or spinal specialist may recommend:

• Physical therapy

Physical therapy focuses on strengthening muscles that can lessen the impact on the spine. Physical therapists can also implement other treatments for back pain, including massage, electrical stimulation, and ultrasound.

• Lifestyle adjustments

Physical therapy is often the most effective for back pain when it’s paired with lifestyle adjustments. Your physician can recommend the changes that will be the most effective for your diagnosis, which may include:

• Quitting smoking
• Managing stress levels
• Reaching an optimal weight
• Avoiding high-impact activities, such as running and contact sports
• Engaging in regular, low-impact exercise to retain mobility and strength
• Eating a balanced, nutrient-rich diet
• Altering your sleeping position to reduce strain on the spine
• Practicing proper posture
• Investing in a high-quality desk chair with lumbar support

• Prescription medications 

Certain prescription medications can help with back pain, including muscle relaxants, antidepressants, and prescription-strength NSAIDs.  

• Steroid injections

Steroid medication can be injected directly into the site of your back pain to suppress inflammation and provide fast pain relief. However, physicians advise that patients undergo no more than three to four steroid injections per year to avoid tissue damage. 

• Surgery

When non-surgical methods don’t improve back pain after several months, physicians may recommend surgery. This is typically used as a last resort when back pain starts to disrupt the patient’s normal activities. 

Spinal decompression surgery can alleviate back pain, neurological symptoms, and restricted mobility from conditions like spinal stenosis, spondylolisthesis, and herniated disc. During this procedure, the surgeon removes the tissue that’s impinging on the spinal nerves, providing the space that it needs to heal and recover. 

Spinal Fusion For Back Pain in Adolescents and Adults

To eliminate the possibility of spinal instability after decompression surgery, many surgeons perform spinal fusion. It involves placing bone graft material between the affected vertebrae to spur bone fusion, eliminating all motion at the spinal segment. 

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The fusion process can lead to reduced mobility and adjacent segment degeneration in all patients, regardless of age. In fact, when spinal fusion is performed on younger patients, it’s more likely to lead to complications. This is simply because younger patients have more years to experience the effects of spinal degeneration.

Spinal Fusion Alternatives

Adolescents and adults can both benefit from the TOPS™ System as a spinal fusion alternative. A TOPS™ System implant can be used following decompression spine surgery, rather than the spinal fusion procedure that’s typically performed.

Whereas spine fusion surgery eliminates the independent movement of fused vertebrae, the TOPS™ System preserves each vertebra’s full range of flexion and rotational motion. That’s welcome news for spine decompression patients of all ages.

If you or your child is struggling to manage persistent back pain, schedule an appointment with a spine specialist in your area to learn more about your treatment options. 

Motion Preservation Surgery in The Lumbar Regions of The Spine

The lumbar region of the spine is the most susceptible to pain and injury. This is due to its mobility combined with the amount of weight that it must carry with day-to-day movements. 

Table of Contents

• What is Motion Preservation Surgery?
• Motion Preservation Surgery of The Lumbar Spine
• Motion Preservation Device Example
• What Are The Benefits of Motion Preservation Surgery?

When conditions affecting the lumbar spine (such as spinal stenosis and spondylolisthesis) don’t improve with non-surgical treatment, surgery may be required. Spinal fusion has been widely used over the past several decades to stabilize the spine, namely after spinal decompression surgery. 

The many downsides of spinal fusion, including reduced mobility and the risk of adjacent segment degeneration, have paved the way for better alternatives. Now, motion preservation surgery is being used in place of traditional lumbar spinal fusion for better clinical outcomes.

What is Motion Preservation Surgery?

Motion preservation surgery refers to surgical methods that can be used in place of conventional spinal fusion. As the name suggests, these methods preserve the natural movement of the spine in the affected area.

The goal of motion preservation surgery is to avoid the risks and downsides associated with spinal fusion surgery. 

Motion Preservation Surgery of The Lumbar Spine

Distinct challenges are present for motion preservation surgery of the lumbar spine. As mentioned at the beginning of this article, the lumbar spine is mobile and undergoes a significant amount of weight with normal activities. These characteristics make it difficult to stabilize the lumbar region while preserving its mobility. 

Despite these challenges, patients with spinal conditions affecting the lumbar spine now have multiple options of motion preservation surgery at their disposal, including:

• Interspinous spacer

An interspinous space is placed in between the spinous processes at the back of the spine. It helps alleviate symptoms of spinal stenosis by creating more space in the central spinal canal and foramen. 

• Total element replacement device

A total element replacement device is inserted after spinal decompression surgery to replace all of the elements located in the back of the spine. This provides support and pain relief for patients with spinal stenosis. 

• Facet replacement device

A facet replacement device is also used to treat spinal stenosis, which is often caused by facet joint degeneration. This type of device takes the place of facet joints at the back of the spine for controlled motion and pain relief.  

• Posterior dynamic stabilization device

A posterior dynamic stabilization device acts like a brace for the spine. The goal of this type of device is to allow a controlled, natural range of motion for the spine. 

Posterior dynamic stabilization devices are generally used to treat spinal stenosis, spondylolisthesis, and degenerative disc disease.   

Motion Preservation Device Example

The TOPS System from Premia Spine is a specific example of a posterior dynamic stabilization device that allows for a controlled range of motion in the treated vertebrae. The TOPS System is designed for use at a single level between L2 and L5. As a motion-preserving implant, it allows movement in flexion and extension, rotation, and lateral bending while blocking sheer forces on the lumbar spine. 

The TOPS device replaces structures removed during spinal decompression surgery, like the lamina or facet joint. It includes internal metal stoppers that take the place of the natural bony elements that acted as stoppers in axial rotation. The device’s boot and internal components replace the supraspinous and interspinous ligaments, as well as the ligamentum flavum, which naturally handle flexion. 

Clinical studies carried out since 2005 have shown that the TOPS System relieves chronic lower back and leg pain for patients suffering from moderate to severe spinal stenosis (with or without spondylolisthesis and facet arthrosis). 

Availability of Posterior Dynamic Stabilization Devices in The U.S.

The TOPS System has long been approved and used successfully in Europe and other countries across the globe. In the U.S., clinical trials for the TOPS System are currently underway.

TOPS earned the Breakthrough Device Designation from the U.S. Food and Drug Administration (FDA) in 2021. This designation will accelerate and prioritize the FDA’s review of this device during its regulatory process in the U.S.

What Are The Benefits of Motion Preservation Surgery?

Motion preservation surgery offers several benefits over conventional spinal fusion, including:

Reduced Risk of Adjacent Segment Disease

Adjacent segment disease, or ASD, occurs when the vertebrae surrounding a fused segment degenerate at a faster than normal rate. With all motion eliminated at the fused segment, the adjacent vertebrae must undergo more impact with day-to-day activities. ASD may lead to symptoms including:

• Lower back pain
• Pain that radiates from the lower back to the extremities
• Neurological symptoms
• Pain while walking and/or standing 

By preserving the patient’s range of motion in the spine, motion preservation surgery decreases the risk of ASD. 

Shorter Recovery Period

Since motion preservation surgery omits the extensive bone grafting and fusion process, it involves a shorter, less painful recovery period. It also allows for less blood loss during the procedure when compared to spinal fusion. 

Preserved Spinal Mobility

Though obvious from the procedure name, preserved spinal mobility is a key benefit of motion preservation surgery. Reduced spinal mobility is one of the largest downsides of spinal fusion, as it can have a major, negative impact on patients’ post-op quality of life. Though spinal fusion can alleviate patients’ spinal symptoms, it may also eliminate their ability to partake in their favorite activities. 

One of the prominent goals of lumbar motion preservation surgery is to create a controlled range of motion in the lumbar spine. This provides spinal stability and pain relief without significantly limiting patients’ activities after the procedure. 

Lower Risk of Needing Revision Surgery

Since motion preservation lowers the risk of injury to the adjacent spinal segments, it also lowers the odds that the patient will require revision surgery. An estimated 8% to 45% of spinal fusion patients require revision surgery. 

Motion preservation surgery is an exciting alternative to spinal fusion for patients suffering from lumbar spine conditions and disorders. Contact a spine specialist today to learn more about this treatment option. 

How to Prepare for Spinal Fusion Back Surgery?

Spinal fusion is often performed in conjunction with spinal decompression surgery for various spinal conditions. Decompression surgery alleviates pressure on pinched nerves that extend from the spine. This process reduces pain and restricted mobility stemming from nerve compression.

Unfortunately, spinal decompression also involves removing portions of the vertebrae. This makes the spine weaker and less stable at the affected segment. To prevent further injury, spine specialists commonly use spinal fusion to stabilize the spine after decompression.

Spinal fusion involves fusing two or more adjacent vertebrae into a single bone with a bone graft. As a major surgery, spinal fusion requires extensive preparation and recovery to achieve the best possible results.

What Should You Do Before Spinal Fusion Surgery?

The process of preparing for spinal fusion surgery is similar to preparing for any other spinal operation. However, there are a few specifics to be aware of. 

How To Prepare For Lumbar Spinal Fusion?

Firstly, be prepared to undergo a thorough examination before the surgery. This is essential for your physicians to plan every aspect of the operation. Radiograph assessments for spinal stability, electromyography (EMG) for nerve function, and an MRI, CAT, or other imaging tests to identify nerve compression are often performed.

Your doctors will also assess your overall physical condition to ensure that you’re in sufficient health to undergo the rigors of the surgery. You’ll need to discuss all pre-existing medical conditions with your physicians. These conditions may need to be further evaluated before proceeding with spinal fusion surgery.

With this in mind, one of the most important ways to prepare for spinal fusion is to get into the best possible physical condition. This may involve quitting smoking, improving your diet, and increasing your physical fitness (while following all of your doctor’s instructions). Being in good physical condition translates into fewer complications during surgery and a faster recovery afterward.

How To Equip Your Home For Better Recovery After Spinal Fusion

Most patients are cleared to return home two to four days after spinal fusion. Make sure to plan ahead and have someone drive you home from the hospital. Typically, patients aren’t allowed to drive for a few weeks after lumbar fusion.

There are several ways to equip your home for smooth spinal surgery recovery. Our best tips include:

1. Plan for simple meals after the surgery. Consider subscribing to a grocery delivery service or, better yet, a meal kit service. Many meal kits require little to no preparation and are delivered straight to your doorstep. This will help simplify your meals after the surgery.
   
   For a DIY version of delivery meal kits, consider meal prepping before the procedure and placing the dishes in the freezer. When you’re at home post-fusion, you can defrost the meals to stay nourished without the need to cook.
   
   Keep in mind that the ideal post-spinal surgery diet should be high in protein and fiber. Additionally, try to avoid processed foods and stick with whole grains, nuts, seeds, beans, lean protein, fruits, and vegetables. 

2. Purchase ice packs and heating pads, if you don’t have them already. Both cold and heat therapy are useful after spinal surgery. Cold therapy can help alleviate inflammation, while heat therapy can help ease muscle tension.
   
   Make sure to take your doctor’s advice for heat and cold therapy, and limit your use to 15 to 20 minutes at a time. 

3. Consider a walker or cane. Moving around your home can be difficult in the early days and weeks after fusion. A walker or cane can help provide stability and prevent accidents. 

4. Place everyday items in an easy-to-access location that you won’t need to twist or bend over to reach. You can also consider purchasing a reacher/gripper/grabber device, which will help you retrieve items without straining your spine. 

5. Prep the bathroom with a toilet riser and shower seat or mat. These devices will make it easier to use the toilet and to spend more time in the shower, which can help alleviate pain and tension. 

6. Sleeping can be difficult after spinal fusion. To make it easier, consider purchasing a body pillow, which may help you find more comfortable sleeping positions.  

How Many Years Does a Spinal Fusion Last?

The results of spinal fusion are permanent. This means that the affected vertebrae are permanently fused and can’t be separated. However, there are some instances in which patients require revision surgery, including:

• Fusion failure

Fusion failure occurs when the targeted vertebrae fail to combine into a single bone after the procedure. When this occurs, the patient will continue to experience back pain and neurological symptoms. Patients who have used corticosteroids are at a higher risk of fusion failure, as are patients who underwent fusion without fusion hardware.

• Hardware failure

Hardware is often used during spinal fusion to stabilize the bone graft. Rarely, this hardware may become damaged or malfunction after the procedure. In these cases, the hardware may move around and irritate the neighboring tissue, leading to pain.

• Adjacent segment disease, or ASD

Adjacent segment disease can develop when the vertebrae adjacent the fused segment break down at a faster-than-usual rate. Since the fusion eliminates all motion at the fused segment, the adjacent vertebrae must undergo added strain. Adjacent segment disease can lead to back pain and neurological symptoms, creating the need for revision surgery.

• Scar tissue

The body produces scar tissue during its natural healing process. Generally, scar tissue doesn’t cause any problems. However, after spinal procedures like spinal fusion, scar tissue may irritate or constrict a nerve root, which can cause neurological symptoms.

What Are The Long-Term Effects of Spinal Fusion Surgery?

In a perfect world, spinal fusion surgery would rid all patients of chronic back pain without future complications. But, in reality, spinal fusion creates the risk of various complications later in life.

Can spinal fusion cause problems later in life?

Future complications that may result from spinal fusion surgery include:

• Adjacent segment disease
• Spinal muscle injury, which may lead to instability and further injuries
• Chronic pain at the bone graft site
• Spinal nerve damage
• Poor spinal mobility at the site of the fusion, which can limit patients’ activities

Alongside chronic pain, poor mobility is a major concern among patients facing spinal fusion. Without the ability to bend, flex, or twist at the fused segment, many patients lose the mobility required for their favorite activities. Some patients may always need a reacher device to pick up items off of the floor.

With these possible complications in mind, spinal surgery of any kind, including spinal fusion should only be considered a last resort. Physicians only recommended it if more conservative treatments have proven ineffective.

Are Lumbar Spinal Fusion Alternatives Available?

Considering the prominent downsides of spinal fusion, it’s unsurprising that many patients with spinal conditions seek out alternative treatments. Now, patients undergoing spinal decompression have an alternative procedure to consider.

The TOPS (Total Posterior Solution) System has long been used in Europe and Australia, with better outcomes than spinal fusion. Now, it’s being used across many states in the U.S. and has earned the FDA breakthrough designation.

TOPS is a non-fusion lumbar spine implant that stabilizes the spine without eliminating the independent motion of the individual vertebrae. With TOPS, patients recover with far fewer restrictions and in a much shorter time frame than with spinal fusion.

One of the best ways to prepare for spinal fusion is to discover if an alternative solution like the TOPS System from Premia Spine makes more sense than spinal fusion for you or a loved one. Contact your spinal specialist to learn more about all of the treatment options available today.

Common Questions About Back Pain: Do You Need Back Surgery?

Back pain affects an estimated eight out of 10 people over the course of their lives. So, it’s no surprise that this widespread medical condition sparks many questions among patients. 

One of the most prevalent questions that spine specialists receive from back pain patients is whether or not they’ll need surgery. Understandably, most patients want to avoid back surgery and the risks that it involves. 

In this article, we’ll answer some of the most common questions about back pain and back surgery. With this information, we aim to give you peace of mind in the range of treatments available for back pain today. 

Do I need surgery for persistent back pain?

If you’re experiencing ongoing or severe back pain, you may be wondering if you’ll need back surgery to finally eliminate that constant backache. To answer this question and get on the path to relief from debilitating back pain, you’ll likely need to consult a spinal surgeon.

Your spinal surgeon will need to assess your back symptoms, take a full medical history, and review your general health. But, don’t start worrying about the prospect of surgery. Back surgery is generally only needed in a small percentage of back pain cases. 

How many people require back surgery for back pain?

According to the UT Southwestern Medical Center, only 10% of back pain cases require surgery. Additionally, among back pain patients who require surgery, minimally-invasive procedures are widely successful. 

So, for most patients, back pain can be resolved with a range of non-surgical options. These trusted treatments can keep you off of the operating table and quickly restore your quality of life. 

When conservative treatments don’t help, your physician may recommend back surgery. This is often the case when the doctor is looking to provide relief from severe, disabling back pain that’s limiting your lifestyle, interrupting your sleep, and preventing you from being active.

What non-surgical treatment options are available for back pain?

The most common non-surgical treatment options available for back pain include:

• ice or heat therapy,
• anti-inflammatory medications,
• physical therapy,
• chiropractic care,
• massage therapy.

In some cases, patients may benefit from epidural steroid injections, which can alleviate pain and inflammation in the spine. Unfortunately, steroid injections can also trigger tissue damage if they’re used in excess. Most physicians recommend that patients undergo no more than three to four injections per year. 

Additionally, lifestyle changes are often very helpful in treating back pain without surgery. Specifically, changing your diet to lose weight can help remove pressure from the spinal nerves. This can help the irritated tissue heal and recover, as well as lessen neurological symptoms. 

Your physician may recommend rest for back pain after your initial diagnosis. However, it’s important to stay active with low-impact activities to prevent stiffness and maintain strength. Once back pain and inflammation have decreased, you’ll likely be able to increase your activity level.  

What are the best exercises for back pain?

Exercise is beneficial for back pain because it prevents stiffness in the ligaments and tendons. It can help you maintain mobility in the back while increasing circulation to the injured tissue. 

However, high-impact, strenuous exercise can do more harm than good for back pain patients. So, it’s crucial to choose your activities wisely. 

Some of the best types of exercise for back pain include:

• Walking
• Swimming and water aerobics
• Biking
• Resistance exercises
• Yoga

While exercising with back pain, remember to start slowly with short periods of activity. Make sure to rest in between your workouts. If you feel any pain or other concerning symptoms, such as numbness or tingling in the extremities, stop exercising and consider other activities. 

What causes lower back pain?

The most common lower back pain causes include:

Strains and Sprains

Strains and sprains are the most common causes of lower back pain. Strains involve stretching or tearing of the muscles or tendons, while sprains involve stretching or tearing of the ligaments. 

The causes and treatments of strains and sprains are similar. Overexerting the back while lifting a heavy object, suddenly twisting the back, or falling are possible causes. To treat lower back sprains and strains, physicians typically recommend rest and at-home care, such as heat/cold therapy. 

Patients may benefit from physical therapy for sprains and strains. A physical therapist can recommend stretching and strengthening exercises to alleviate tension while improving support for the back. 

Age-related Spinal Degeneration

The spinal structures, including the vertebrae, facet joints, and intervertebral discs, naturally degenerate with age. This degeneration can contribute to spinal conditions like a herniated disc, spinal stenosis, spondylolisthesis, degenerative disc disease, and osteoarthritis. All of these spinal conditions can lead to chronic lower back pain. 

What does one-sided back pain mean?

Lower left back pain and lower right back pain can be caused by any of the common back pain causes listed above. However, if you have one-sided back pain along with other symptoms, such as fever and/or pain while urinating, the pain could be stemming from an internal organ. So, in this case, make sure to receive a medical evaluation promptly. 

Can sports injuries cause lower back pain?

Especially in young adults, participating in sports is a key risk factor for lower back pain. According to Medscape, 7% to 13% of all sports injuries in college athletes are lower back injuries. Additionally, certain sports are more likely to trigger back pain than others. 

The sports that present the highest risk of lower back pain include gymnastics, soccer, and dance, according to a 2009 study published in Sports Health. 

Which medical conditions require back surgery?

Here are the symptoms and conditions that might make back surgery an optimal solution for you:

• Spinal nerve compression

Back injuries and conditions that compress your spinal nerves can cause debilitating back pain and/or numbness, tingling, and weakness in the legs.

• Intervertebral disc damage

With a bulging, ruptured, or herniated disc, the rubbery discs that cushion and separate the bones in your spine are injured. So, the spinal structures are subject to more impact with day-to-day movements. 

• Vertebral fracture

A fractured vertebra typically causes back pain and spinal instability. Many vertebral fractures heal on their own, while others require surgery. or other damage to your spinal column from a back injury. A fractured disc will cause pain, and also leaves your spine unstable, often causing additional back pain.

You may also be diagnosed with a condition that causes back pain and additional progressive nerve compression:

• Scoliosis, a curvature of the spine that can compress nerves in the back
• Spinal stenosis, a narrowing of the spinal canal typically caused by arthritis
• Spondylolisthesis, the forward slippage of a spinal segment
• Degenerative disc disease, the development of pain in a disc as a result of its normal wear and tear over time
• Radiculopathy, the irritation, and inflammation of a nerve caused by a herniated disc
• Kyphosis, a humpback deformity

What are the main lower back surgery types?

For lower back pain relief in severe cases, spinal surgeons may recommend one of the following types of lower back surgery:

• Spinal decompression

Spinal decompression is the most common lower back pain surgery. It involves alleviating pressure on the spinal nerves by removing certain spinal tissues. 

Several procedures fall under the umbrella of spinal decompression, including:

• Laminectomy: Widely used for spinal stenosis, this procedure involves removing some or all of the lamina, which covers the back of the spinal cord. 
• Discectomy: Commonly used for lower back herniated disc surgery, discectomy involves removing damaged disc tissue. 
• Foraminotomy: This procedure involves creating more space in the intervertebral foramen, where the nerve roots leave the spinal canal. 
• Lower back fusion surgery

During fusion surgery in the lower back, your surgeon will secure bone graft material in between one or more vertebrae. This process permanently fuses the targeted vertebrae to prevent spinal instability. 

Unfortunately, lower back fusion eliminates all independent motion of the vertebrae. This significantly diminishes patients’ back flexibility and may keep them from performing certain activities. Fusion also largely prolongs the recovery time for lower back surgery. 

Recent innovations in spinal surgery, such as the TOPS™ System from Premia Spine, can prevent spinal instability after decompression surgery without compromising the patient’s mobility. The TOPS™ System is a non-fusion spinal implant that moves with the spine, protects neighboring segments from degeneration, and preserves spinal mobility. 

Your spinal surgeon’s primary goal is to eliminate your back pain and restore your quality of life.  When a progressive condition is diagnosed through testing and examination, back surgery may certainly move to the forefront of your surgeon’s mind. It’s their job to consider the best, most individualized treatment options to eradicate back pain before it becomes worse.

Preparing for Spinal Surgery

Whether to treat a slipped disc from age-related spinal degeneration or a traumatic spinal cord injury, spinal surgery is never taken lightly. When lower back surgery is selected as the preferred treatment option, it indicates that the condition being treated is severe.

Spine surgery comes along with the expectation that it will provide a meaningful improvement in the targeted medical condition. This improvement generally includes a reduction in the patient’s pain, as well as restored movement.

With these improvements in mind, there’s actually much to look forward to while you prepare for spine surgery! To ensure that the procedure and recovery go as smoothly as possible, consider these tips:

Get in Shape

So, what’s our top tip for how to prepare for spinal surgery? Get in the best shape you can – mentally and physically.

To improve your physical fitness, exercise thoughtfully and eat a healthy diet. Exercising can be difficult when you’re dealing with a spinal condition. However, maintaining muscle strength and flexibility, as well as reaching a healthy weight, will aid in your spinal surgery recovery. 

Additionally, exercising boosts endorphins, the body’s natural “feel good” chemicals. Endorphins can help you manage stress, pain, and your general mental well-being leading up to spinal surgery.  

Which Exercises Are The Best For Lower Back Pain Surgery?

Certain physical activities are safer and more beneficial for patients with spinal conditions than others. These activities include:

• Walking
• Bicycling and stationary cycling
• Low-impact and water aerobics
• Swimming
• Yoga and tai chi
• Resistance and stretching exercises

We recommend speaking to your physician before starting any new exercise regimen. Your physician can inform you of any exercises to avoid as you prepare for spinal surgery. 

Additionally, as a general rule of thumb, avoid high-impact activities, like running and jogging, while you’re recovering from a spinal condition. High-impact activities can place added stress on the spine and may impede its recovery process. 

How Does Weight Loss Benefit Spinal Surgery Preparation?

Extra weight places stress on the back. In fact, excess weight leads to increased impact on the spine with each step that you take, potentially complicating back surgery recovery.

A 2017 study published in the International Journal of Environmental Research and Public Health found that intervertebral disc disorder and chronic lower back pain are connected to obese and overweight body status. With this in mind, losing weight can support the outcome of your spinal procedure and recovery.

However, lose weight sensibly! Extreme and unhealthy weight loss can compromise your condition leading up to the surgery. 

Here are our top tips for losing weight healthily:

• Eat regular meals, and don’t skip breakfast. 
• Listen to hunger cues. 
• Use smaller plates and bowls for healthier portion sizes. 
• Rather than cutting out foods altogether, treat yourself in moderation. 
• Stay hydrated by sipping on water throughout the day, especially around mealtimes.
• Add high-fiber foods, such as whole grains, legumes, berries, vegetables, nuts, and seeds, to your diet. 

Quit Smoking

If you smoke, it’s in your best interest to quit before spinal surgery. Smoking is detrimental to the success of spinal surgery, as well as the body’s healing process, even for minimally-invasive spine surgery.

Nicotine constricts the blood vessels. This means that when you smoke, the circulation throughout your body decreases. As a result, all of your cells, including those in your spine, will receive less of the oxygen and nutrients that they need to heal.

Decreased blood flow from smoking can also prevent surgical wounds from closing and increase the risk of infection. The infection risk after spinal surgery is further increased in smokers because smoking hampers the immune system. 

Smokers are also at a higher risk of complications from surgery, including stroke, heart attack, shock, and even death.

Several clinical studies illustrate the risk of smoking for patients with spinal conditions:

• A 2015 study found that smoking was linked to increased complications and worse outcomes in three out of four of the largest diagnostic groups. These groups included 136,511 patients admitted for spinal disease treatment.
• A 2017 study found that smoking significantly raises the risk of pseudoarthrosis (spinal fusion failure) in patients undergoing cervical and lumbar fusions. This study also found that smoking increases the risk of other complications including infection, dysphagia, and adjacent-segment pathology. 
• A 2016 study found that smoking significantly influenced the overall perioperative complication rate. 

What If I Can’t Quit Smoking?

If you don’t quit smoking, you’ll be required to stop approximately four to six weeks before the lower back herniated disc surgery and other spinal procedures. You’ll also need to abstain from smoking for two weeks after the procedure. 

Quitting smoking can be difficult, to say the least. Here are a few tips that may help you quit before spine surgery:

• Ask for loved ones to support you in the coming weeks. 
• Consider joining a stop-smoking support group. 
• Avoid scenarios that put you at a high risk of smoking, such as drinking with friends or being around people who smoke.  

Review Medications

Talk to your doctor about all of the medications that you’re taking long before undergoing spinal surgery. Be very thorough, as even herbal supplements can impact your recovery or interact with other medications prescribed for surgery.

There are a few different types of drugs that you generally must stop taking before surgery. These include:

• Anticoagulants

Anticoagulants are also known as blood thinners. This type of medication prevents the formation of blood clots. But, before surgery, blood thinners also raise your risk of bleeding. So, it’s crucial to talk to your prescribing physician and surgeon about the right time to stop taking anticoagulants before surgery. 

Common prescription anticoagulants include warfarin, NSAIDs, enoxaparin, ticlopidine, clopidogrel, and dipyridamole. Additionally, there are several over-the-counter and herbal anticoagulants, including aspirin, NSAIDs (like ibuprofen), vitamin E, ginger, garlic, and ginkgo biloba. 

• Monoamine oxidase inhibitors (MAOIs)

MAOIs remove specific neurotransmitters from the brain. This category of drugs includes certain antidepressants and anti-Parkinson drugs. Unfortunately, MAOIs also interfere with the medications utilized during anesthesia and should be stopped about a week or two before spinal surgery. 

All MAOIs are prescription medications. Examples include tranylcypromine, phenelzine, rasagiline, and isocarboxazid. 

Get Well Informed

Prepare for lower back surgery by learning as much as you can about the facets of your spinal condition, as well as the available treatments. There are numerous lower back surgery types, especially with recent advances in the medical field. Different types of lower back surgery may offer unique benefits and drawbacks.

One essential aspect of education before lumbar spine surgery is to understand the expected recovery period. Spine surgery recovery can last anywhere from a few months to a year if you undergo lower back fusion surgery. 

Learning about the recovery time for lower back surgery well in advance of your procedure will streamline your healing process. With this knowledge, you can better plan how much help you’ll need around the house, how much time to take off of work, and when you can expect to return to your favorite activities. 

Learn About Recent Innovations in Spinal Surgery

The last few years have seen dramatic advances in spinal procedures that can provide significantly improved clinical outcomes and shorter recovery periods. The TOPS™ (Total Posterior Solution) System, often used in the treatment of spinal stenosis, spondylolisthesis, and other back problems involving a pinched nerve, is one such advanced procedure.

TOPS™ is an implant system approved for use as an alternative to lumbar spine fusion surgery after spinal decompression. The TOPS™ System preserves the independent flexion and bending of the individual vertebrae. This is in contrast to fusion surgery of the lower back, which eliminates this independent motion and can contribute to the deterioration of adjacent vertebrae. 

The TOPS™ System has also been shown in clinical studies to provide better short- and long-term outcomes than spinal fusion.

Before undergoing spinal surgery, make sure to learn everything that you can about your condition and surgical options. By thoroughly discussing your treatment plan with your physician and asking any questions that come to mind, you’ll be far better prepared for your back surgery.

What is Spondylolisthesis?

If you’re struggling with persistent back pain along with numbness, tingling, or weakness, you may have a spinal condition. Spondylolisthesis is one possible condition that can trigger these symptoms and ultimately compromise your quality of life. 

In this article, we’ll dive into the topic of spondylolisthesis and explain what patients can expect from a spondylolisthesis diagnosis. While the prospect of managing this condition may seem intimidating, rest assured that there are numerous effective treatment options for spondylolisthesis. 

What is Spondylolisthesis?

With spondylolisthesis, one of the vertebrae in the spine becomes displaced due to instability. As a result, it moves downward in relation to its proper position, settling on the vertebra beneath it.

This malpositioning can put pressure on the spinal cord, as well as the nerves that emanate from the spinal column. This pressure can lead to pain in the lower back and leg.  

Spondylolisthesis of the lumbar region (meaning that it occurs in the lower back) is the most common. Specifically, the L5-S1 level of the spine is most frequently affected by spondylolisthesis, followed by the L4-5 level. 

Is Spondylolisthesis The Same As a Slipped Disc?

You’ve probably heard the common medical term, “a slipped disc”. While this may seem to indicate the slippage involved in spondylolisthesis, it’s an entirely different condition. 

Spondylolisthesis affects the spinal bones, which are known as vertebrae. A slipped disc is an injury involving an intervertebral disc, which is a cushion of shock-absorbing tissue. There’s an intervertebral disc located in between each of the vertebrae in the spine. 

Given that spondylolisthesis and a slipped disc affect different parts of the spine and develop differently, it’s crucial to distinguish them. A spinal specialist can give you an accurate diagnosis of back pain. 

Spondylolisthesis vs. Spondylolysis

As another spinal condition that’s commonly confused with spondylolisthesis, you may have heard of spondylolysis. This condition, unlike a slipped disc, is related to spondylolisthesis. However, they’re still different conditions. 

Spondylolysis is a stress fracture that runs through the pars interarticularis, a small segment of bone that connects two vertebrae. When the pars interarticularis is fractured, patients may experience back pain that worsens with physical activity. However, not all spondylolysis patients have symptoms. 

Approximately one out of 20 people have spondylolysis, making it a relatively common condition. Additionally, spondylolysis can lead to spondylolisthesis. This is because the pars interarticularis fracture can diminish the stability of the spine and potentially lead to slippage. 

What Are The Most Common Causes of Spondylolisthesis?

Spondylolisthesis has several possible causes, the most common of which include:

• Spinal degeneration

The most common cause of spondylolisthesis is degenerative changes in the vertebral joints and cartilage due to aging. When spondylolisthesis is caused by age-related spinal changes, it’s known as degenerative spondylolisthesis.

• Birth defects

Younger individuals may experience spondylolisthesis caused by a birth defect in the facet of the vertebra. The defect, which is present at birth, can cause the vertebra to slip out of position. This is referred to as dysplastic spondylolisthesis. 

• Spinal trauma

Spondylolisthesis can also result from sudden trauma, such as a sports injury or car accident. This is known as traumatic spondylolisthesis and can occur in people of all ages. 

• Sports injury

In athletes that repetitively strain and overstretch the spine, spondylolisthesis is a relatively common injury. This is especially true in younger athletes, given that their spines haven’t fully developed.  

Key Spondylolisthesis Symptoms 

Lower Back Pain

The most frequent symptom of lumbar spondylolisthesis is lower back pain. The pain typically worsens after exercise and abates when you sit or bend forward.

Reduced Mobility

Decreased range of motion and tightness of the hamstring muscles are common spondylolisthesis symptoms.

Neurological Symptoms

The nerve compression may also result in pain, numbness, tingling, or weakness in the legs, and in cases of severe compression, loss of bowel or bladder control.

Spinal Stenosis

Spinal stenosis isn’t exactly a symptom of spondylolisthesis. However, degenerative spondylolisthesis is a prevalent cause of spinal stenosis, which is an abnormal narrowing of the spinal canal. 

How Is Spondylolisthesis Diagnosed?

A physician specializing in spinal disorders can diagnose spondylolisthesis using radiographs and x-ray imaging, as well as a comprehensive physical exam. You’ll likely stand sideways as the x-rays are taken so your physician can see the vertebra’s slippage clearly.

After your physician has examined the imaging test results, the severity of your spondylolisthesis case will be graded. The grading scale is based on the degree of slippage from the vertebra’s normal position.

Upon making a diagnosis, a physician can recommend appropriate treatments for spondylolisthesis.

What Are Spondylolisthesis Grades?

As aforementioned, spinal specialists use a grading system to determine the severity of spondylolisthesis cases. Spondylolisthesis grades include:

• Grade I: 1% to 25% slippage
• Grade II: 26% to 50% slippage
• Grade III: 51% to 75% slippage
• Grade IV: 76% to 100% slippage
• Grade V or Spondyloptosis: Over 100% Slippage

What Makes Spondylolisthesis Worse?

Several factors can worsen spondylolisthesis, including:

• High-intensity physical activities
• Heavy lifting
• Poor posture
• Being involved in an auto accident

If you’ve been diagnosed with spondylolisthesis, your physician likely recommended lifestyle adjustments to help you avoid the factors listed above. 

Spondylolisthesis Exercises To Avoid

Any exercises that involve heavy lifting and excessive twisting or bending should be avoided with spondylolisthesis. If you enjoy a specific sport, you should talk to your physician about whether it’s safe to participate in that sport while you’re struggling with spondylolisthesis symptoms.  

Sports that tend to exacerbate spondylolisthesis symptoms include:

• Weightlifting and powerlifting
• Running
• Football
• Soccer
• Diving
• Competitive swimming
• Gymnastics
• Certain types of dance, including ballet

Spondylolisthesis Treatment

Treatments for spondylolisthesis include physical therapy, exercises for relieving pressure on the affected spinal nerves, medication, and epidural steroid injections. In many patients, these treatments are sufficient to alleviate the symptoms of spondylolisthesis.

What Does Physical Therapy For Spondylolisthesis Involve?

Physical therapists can help patients manage spondylolisthesis in several ways.

For one, your PT can offer valuable insights and education about how your lifestyle is affecting your symptoms. From your exercise regimen to your footwear to your posture, your physical therapist can identify areas for improvement. In making the recommended adjustments, you can likely reduce the pressure on your spine, leading to an improvement in spondylolisthesis symptoms. 

Additionally, your PT can implement various non-invasive methods of pain management. Targeted heat and cold therapy can help alleviate inflammation and pain. Electrical stimulation is another popular method among physical therapists to gently reduce the transmission of pain signals to the brain. 

Physical therapists can also recommend stretching and strengthening exercises for spondylolisthesis. By stretching to reduce muscle tension, you can gain greater back flexibility. By strengthening various muscle groups, you can gain greater stability in the lumbar spine, hips, and pelvis. 

Does Chiropractic Care Help With Spondylolisthesis?

Many spondylolisthesis patients find that chiropractic care is a helpful tool for alleviating their symptoms. Chiropractors specialize in spinal manipulation to treat issues involving the musculoskeletal system.

Key goals of chiropractic care for spondylolisthesis include improving spinal mechanics, restoring spinal function, and improving posture. In achieving these goals, your chiropractor may alleviate compression on the spinal nerves, which often leads to reduced symptoms. 

One of the main benefits of chiropractic care for spondylolisthesis is that it’s non-invasive. Chiropractors focus on methods including manual and instrument-assisted manipulation to adjust the spine, making it a safe back pain treatment option. 

Which Medications Are Used To Treat Spondylolisthesis?

Physicians often recommend over-the-counter medications to help spondylolisthesis patients manage pain and inflammation. In more advanced cases that don’t improve with over-the-counter options, physicians may instead suggest prescription medications. 

There are a few different types of drugs that may help with spondylolisthesis. The main types include:

• Analgesics

In simpler terms, analgesics are painkillers. These over-the-counter medications’ primary function is to relieve pain. The most common analgesic is acetaminophen, or Tylenol. 

• NSAIDs (non-steroidal anti-inflammatory drugs)

NSAIDs alleviate inflammation along with pain. There are numerous over-the-counter NSAIDs, such as aspirin, Aleve, and Advil (ibuprofen), as well as prescription NSAIDs. 

• Neuropathic agents

This type of prescription medication can be helpful for patients suffering from spondylolisthesis nerve pain. Neuropathic agents target nerve pain directly and can help with spondylolisthesis symptoms including tingling, numbness, and weakness.

Gabapentin and pregabalin (Lyrica) are two of the most commonly prescribed neuropathic agents for spondylolisthesis. 

• Muscle relaxants

Some spondylolisthesis patients experience chronic back pain caused by muscle spasms in the back. In these cases, physicians may prescribe a muscle relaxant to stop the spasms. Soma, Flexeril, Baclofen, Tizanidine, and Robaxin are among the most widely prescribed muscle relaxants. 

Will I Need Spondylolisthesis Surgery?

For patients with moderate to severe spondylolisthesis who don’t respond to conservative therapies, physicians may recommend spinal decompression surgery. The idea of undergoing surgery can be daunting, but note that most patients’ symptoms improve with non-surgical treatment.

If you and your physician determine that surgery is the right route of treatment, you’ll likely discuss the spinal decompression procedure. 

What is Spinal Decompression?

Spinal decompression involves removing portions of the vertebrae that impinge on the spinal cord and nerve roots. There are several different approaches to spinal decompression, including laminectomy, foraminotomy, discectomy, and corpectomy. For spondylolisthesis, surgeons often opt for laminectomy. 

Laminectomy involves removing some or all of the lamina. This is the small section of bone that covers the back of the spinal canal. By removing it, your surgeon can create more space for the spinal nerves and alleviate nerve impingement. 

Spinal decompression can have a dramatic effect, relieving pain and other spondylolisthesis symptoms. However, removing portions of the lamina reduces the stability of the spinal column. So, after decompression surgery, spinal stability remains a key concern for spondylolisthesis patients.

This is why surgeons traditionally perform spinal fusion after spinal decompression. 

What is Spinal Fusion?

Spinal fusion involves placing bone graft material in between the affected vertebrae. Then, screws and rods are implanted to secure the graft in place and provide additional stability.

In the period following spinal fusion surgery, the bone graft material will spur the permanent joining of the affected vertebrae. This prevents all movement between the fused vertebrae, which can prevent instability in spondylolisthesis patients. 

Unfortunately, in stabilizing the vertebrae, spinal fusion eliminates the natural independent motion that gives the spine flexibility. This diminishes patients’ ability to carry out certain movements, namely those that require the bending or twisting of the spine. Fusion has also been shown to promote the deterioration of adjacent vertebrae.

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The TOPS™ System For Spondylolisthesis

In a seven-year study for patients with degenerative spondylolisthesis and lumbar spinal stenosis, the TOPS™ System maintained clinical improvement and stability. Additionally, in a five-year study of the TOPS™ System for 10 patients with degenerative spondylolisthesis and lumbar spinal stenosis, the clinical outcome scores “improved significantly across all scoring systems”. In this study, there were no failures at five years and no patients required revision surgery.   

The TOPS™ device is approved for use in Europe and many other countries. In the United States, the FDA granted Premia Spine approval to begin an IDE investigation of the TOPS™ System. 

TOPS™ Testimonials

Patient and surgeon testimonials are highly encouraging for the TOPS™ System as a spondylolisthesis treatment. Many patients note that they’re able to return to their favorite activities after the TOPS™ procedure, as it preserves spinal mobility. 

We encourage anyone with persistent back problems to consult a physician who specializes in spinal disorders and learn about the latest available treatment options.

Advantages of Medical Tourism

Can you really travel to a foreign destination for a vacation and receive high-quality medical care at the same time? That’s the question many people raise when the subject of medical tourism comes up.

Many people are skeptical of medical tourism, and understandably so. When you receive medical care in your home country, you’ll naturally feel more comfortable with the treatment process. However, there are many advantages that medical tourism can offer. 

For some patients, traveling to a different country for medical care is a worthwhile task. Keep reading to learn more. 

What is Medical Tourism?

Medical tourism is a term used to describe the action of traveling internationally for medical care. 

What Are The Benefits of Medical Tourism?

The following benefits are attributed to the popularity of medical tourism for USA patients:

• Affordable care

This is the key benefit of medical tourism. Many people can attain high-quality medical care at a fraction of the cost by traveling overseas. This particularly applies to patients in the U.S., which lacks a public healthcare system. 

• High-quality care

The quality of care should always be the primary consideration in medical tourism. There are first-rate medical facilities and health care professionals in many areas across the globe. Some of these areas, which are widely considered to be the best countries for medical tourism, include Germany, the United Kingdom, Turkey, Israel, India, Thailand, Singapore, Latin America, Eastern Europe, and Cyprus.

• Advanced treatments

Different areas of the world have different medical regulatory bodies. Here in the United States, the FDA (Food and Drug Administration) protects Americans’ health by regulating drugs, biological products, medical devices, food, cosmetics, and even certain electric products. 

In many instances, medical innovations have been developed, proven to be successful, and used for many years in other areas of the world. But, with the FDA’s regulatory processes, it can take a long time for those proven medical solutions to become available in the United States. This can also apply to residents of other countries who don’t have access to many of the advanced medical treatments in the United States. 

Medical tourism can give patients access to the latest medical technology and, as a result, a higher quality of care. 

Why is Medical Tourism Popular?

The United States has the most expensive healthcare in the world. So, while few people would consider medical tourism to the U.S., many Americans contemplate international travel to lower their medical expenses.

Medical Tourism Statistics

When considering traveling internationally for a procedure, it’s wise to consider medical tourism examples and statistics. 

• In 2017, over 1.4 million Americans sought out medical care from various medical tourism countries around the globe. 
• According to the World Health Organization, an estimated 12 to 14 million people travel abroad annually for medical care. 
• Many countries offer certain medical procedures at 30% to 65% of the cost of care in the U.S. 
• The worldwide medical tourism market is expected to grow at a compound annual growth rate of 32.51% between 2022 and 2030. 

Which Choice Factors Are The Most Important To Medical Tourism Consumers?

Consumers who are interested in medical tourism value a variety of factors. The most prominent of these factors include:

• Finances

Finances are arguably the most important factor to medical tourism consumers. In fact, in a study from the Medical Tourism Association, 85% of surveyed patients who traveled overseas to a hospital reported that the cost of medical care was a very important deciding factor.

The healthcare system in the United States leaves an estimated 9.6% of residents without health insurance, as of 2021. Even among individuals who do have health insurance coverage, high co-pays and deductibles can make it difficult to afford medical care. 

With these facts in mind, it’s unsurprising that cost is a crucial factor for medical tourism consumers. Above all, these consumers want to secure an affordable price for medical care by traveling overseas.

• Quality of care

Quality of care is paramount for many medical tourism consumers. By traveling to other countries, patients can attain a higher quality of care (at a lower cost) when compared to the medical treatment available in their home countries.

However, without the assurances that Americans are accustomed to under the FDA, consumers must consider the laws and regulations surrounding medical care in the country that they’re traveling to, as well as the foreign practice’s certifications. 

• Treatment availability

While discussing the benefits of medical tourism, we mentioned that it can grant patients access to advanced treatments that aren’t available in their home country. With this in mind, the treatments available in other countries are a key consideration for medical tourism consumers. 

• Waiting lists

Waiting lists for health care services are another consideration among medical tourism consumers. As of 2022, in the United States, 28% of patients sometimes, rarely, or never receive a response from their primary physician on the same day. This is a high percentage when compared to many other areas of the globe. However, 27% of patients in the U.S. wait one month or more for a specialist appointment, which is a lower percentage than in many other countries, including Norway and Canada.

With that said, long wait lists are primarily a concern for medical tourism consumers in nations with public healthcare systems.

What Are The Risks of Medical Tourism?

Although medical tourism can provide several benefits, it also presents certain risks and safety concerns, including:

• Infectious disease

Some countries have a risk of complications including HIV, hepatitis B, hepatitis C, blood infections, wound infections, and infections from donor tissue or blood. 

• Communication difficulties

If patients travel to a facility using a language that they don’t speak fluently, doctor-patient communication can be difficult. Given that doctors provide crucial pre-op and post-op information, as well as procedure specifics, this may lead to confusion and errors. 

• Quality of care

Certain areas may not have comparable requirements for medical licensing and accreditation. This creates the risk of low quality of care. 

• Flying after a procedure

Doctors typically advise against air travel immediately after surgery. This is because flying raises the risk of developing a blood clot. Depending on the type of surgical procedure, patients should wait between seven and 10 days before flying. 

To avoid these risks, medical tourism consumers should ensure that:

• The medical facility has been accredited by the Joint Commission International
• The medical facility utilizes the World Health Organization Checklist
• The staff at the facility follows stringent sanitation, disinfection, and hygiene measures
• The provider is board-certified and internationally-recognized

What Is The Best Country For Medical Tourism If You Need a Spine Surgery?

As we’ve already mentioned, a significant benefit of medical tourism is that you can gain access to treatments that have not yet or have only recently been, approved for use in your country. Procedures that have been proven effective and are widely used in certain areas of the world can often benefit international patients.

The TOPS™ (Total Posterior Solution) procedure, performed in association with spinal decompression surgery, is an example of a procedure that has been used extensively in Europe but not yet in the United States. TOPS is an alternative to spinal fusion back surgery.

Spinal fusion is widely used with spinal decompression procedures for conditions like spinal stenosis, spondylolisthesis, bone spurs, and more. Unfortunately, fusion can severely limit patients’ range of motion in the back. Additionally, the complete recovery process for spinal fusion may last for six months to a year. 

The TOPS System preserves the full range of motion between the individual vertebral segments, unlike spinal fusion. It involves a minimally-invasive surgical procedure, which greatly shortens the spinal surgery recovery period. In fact, patients may start moving around the day after TOPS surgery with few, if any, restrictions. 

For certain patients with specific medical conditions, medical tourism could be the ticket to high-quality, low-cost healthcare. If you think you may benefit from medical tourism, make sure to conduct thorough research, find an accredited facility, and evaluate all of the risks before scheduling your appointment abroad. 

Caring for Your Spinal Surgery Incision

All patients undergoing back surgery should actively ensure that the healing process goes as smoothly as possible. In doing so, you can attain the best possible results from the procedure while avoiding complications that could compromise your health. 

Proper incision care is a key step in the process of adopting healthy habits and positive lifestyle choices to promote healing. As an aspect of your spinal surgery recovery, incision care will benefit your overall health. 

Here, we’ll discuss how to care for a spinal incision to ensure a successful surgical recovery and back pain relief. Additionally, we’ll explore innovations in the field of spine surgery that allow for smaller incisions and, as a result, a lower risk of complications. 

How Are Incisions Closed After Spinal Surgery?

After spinal surgery, the incision may be closed with Steri-Strips, staples, or sutures, including dissolvable sutures. Most often, spinal surgeons use a combination of these closure methods.

Since spinal surgery is performed beneath the layers of skin and muscle in the back, the incision must be closed at various layers. Your surgeon will suture the muscle layer together before closing the skin. 

• Sutures are also commonly referred to as stitches. This wound closure method involves using sterile surgical threads, which are stronger than the threads most people are familiar with. The surgeon uses these threads with a needle to suture the incision closed, and certain types of sutures will dissolve within a few weeks of the procedure. 
• Staples are metal clips. They allow for fast wound closure but don’t dissolve. So, you’ll need to return to your surgeon to have them removed after the procedure (typically seven to 14 days post-op). 
• Steri-Strips are adhesive bandages that may be used to help close an incision after spinal surgery. They may be applied over dissolvable stitches to help keep the skin closed or to help the wound heal after the sutures are removed. 

Preparing and Recovering From Back Surgery

In preparing for back surgery, patients should begin on a path of improving their diet and physical activity. These practices will improve your overall health to ensure that the spinal surgery goes off without a hitch. 

With that said, implementing healthy habits is not only essential for the surgery itself but also for the recovery process following the operation. While continuing the positive lifestyle changes that you applied before the procedure, make sure to rigorously follow your doctor’s orders, including those about what medications to avoid. Certain medications can interfere with the healing process, namely including NSAIDs. NSAIDs, like aspirin, ibuprofen, and naproxen, are blood thinners and can impair the body’s repair processes.

How Do You Treat an Incision After Back Surgery?

Proper care for the surgical incision is one of the most important aspects of post-operative home recuperation following back surgery. 

Immediately After The Procedure

You won’t be permitted to apply any ointments or lotions to the incision while it’s healing. You also shouldn’t bathe in a tub, swim, or use a hot tub until your incision is healed. Immersing the incision in water before your surgeon clears you to do so may increase your risk of infection and inhibit the healing process. 

Additionally, you’ll need to keep the incision clean after spinal surgery. You can clean the incision site with soap and water, then gently dry it with a clean cloth. This helps prevent infection as the incision heals. 

Two Weeks After The Procedure

In most cases, non-dissolvable sutures and staples are removed 14 days following the spinal surgery. At this point, the incision is usually fully healed. 

Six Weeks After The Procedure

Many spinal surgery patients are eager to reduce scarring by applying scar treatments and vitamin creams to the incision. However, you must wait to get the go-ahead from your surgeon before doing so. Typically, surgeons allow patients to start applying scar creams six weeks after the procedure. 

How Long Does It Take For a Spinal Incision To Heal?

It generally takes about two weeks for a spinal incision, including a spinal stenosis incision, to completely heal. At this point, your surgeon will remove sutures and staples, as well as clear you to take baths and swim. However, this timeline can vary from patient to patient. 

Spinal incision infections typically appear two to four weeks after the procedure. Your surgeon will advise you to be aware of infection symptoms, which include fever, worsening redness at the incision, and changes in the infection drainage. If any of these symptoms occur, make sure to reach out to your surgeon immediately.

Additionally, if the surgeon places any hardware or devices during the procedure and an infection develops, they may need to be removed. This also applies to patients with an implantation spinal cord stimulator incision or spinal fusion incision. 

How Long Does It Take For Spinal Nerves to Heal After Surgery?

Immediately after the spinal nerves are decompressed in surgery, the healing process can begin. But, nerve tissue heals far slower than other types of tissue in the body, namely muscle tissue. So, while some patients will experience an immediate improvement in nerve pain after spinal surgery, other patients may need more time to notice a difference. 

In the weeks and months after spinal surgery, patients should notice a gradual improvement in neurological symptoms such as numbness, tingling, and weakness. By adopting healthy lifestyle habits, such as engaging in low-impact exercise, eating healthily, and refraining from smoking, you can ensure that the spinal nerves heal as quickly as possible. 

Spinal Surgery Advances For Smaller Incisions

Surgeons always aim to create as small an incision as possible while successfully carrying out the procedure. This is because a smaller incision leads to less blood loss, less scarring, and a lower risk of infection. 

Fortunately, the last several years have seen a revolution in back surgery procedures and outcomes. Now, more minimally-invasive procedures are available to patients that require spinal surgery. These procedures allow for much smaller incisions, among other advantages over traditional open back surgery.

Spinal Fusion Alternatives

One procedure that can now be replaced with minimally-invasive alternatives is spinal fusion back surgery. This procedure was traditionally performed in conjunction with spinal decompression surgery for spinal stenosis, spondylolisthesis, and related conditions. 

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Spinal fusion involves positioning an implant containing bone graft material in between the affected vertebrae. Over the course of several weeks after the procedure, the bone graft will trigger the fusing of the vertebrae, turning them into a single bone. As a result, the patient can avoid spinal instability after decompression surgery. 

Unfortunately, spinal fusion requires a long recovery period and eliminates the natural movement of the individual vertebrae. It also creates the risk of adjacent segment disorder, or ASD, which occurs when the vertebrae surrounding the fused segment degenerate more rapidly than they otherwise would. 

The TOPS System From Premia Spine

Thankfully, a spinal fusion alternative has emerged to improve outcomes and preserve patients’ range of motion: the TOPS (Total Posterior Solution) System. The TOPS System is an implant that facilitates a minimally-invasive spinal surgery. It’s been shown in clinical trials around the globe to provide superior outcomes for patients who undergo treatments such as lumbar laminectomy or other spinal decompression procedures for various causes of lower back pain. 

As the example of the TOPS System indicates, these advances in minimally-invasive back surgery allow for not only fewer complications in surgical incision healing, but also improved outcomes overall.

Don’t hesitate to discuss concerns surrounding post-op incision care with your surgeon, and make sure to explore all of your spine surgery options.