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Lumbar FAQ |
|
| What are
common causes of back pain? |
|
| How do disc injuries
cause back pain? |
|
| What
is the difference between a herniated disc and a bulging disc? |
|
| Is it true that a
bulging disc can be normal? |
|
| How did I herniate my
disc? |
|
| What are the symptoms
of a herniated disc? |
|
| What is the treatment for herniated
discs? |
|
| Does "non-surgical" spinal decompression
work? |
|
| What is degenerative
disc disease (DDD)? |
|
| What is lumbar
instability? |
|
| What is spinal stenosis? |
|
| What is the
treatment for spinal stenosis? |
|
| My doctor told
me that I have arthritis of my spine and that I should learn to live
with the pain. Is this true? |
|
| When is surgery
necessary for patients with spine problems? |
|
| What is a laminectomy? |
|
| My spinal specialist
said I need a fusion. Is that true? |
|
| If I have a fusion does
that mean I will never be able to bend? |
|
| My spinal
specialist said he would be using implants in my spine. Is this really
necessary? |
|
| Does it matter what
screws and rods my surgeon uses? |
|
| Will fusing my spine
cause damage to adjacent areas? |
|
| What are the risks
associated with spinal surgery? |
|
| Do I need
to wear a brace after surgery? |
|
| Does my insurance
cover low back surgery? |
|
| How quickly can
I expect to recover from surgery? |
|
| I have heard people
talk about less invasive back surgeries. What are these? How do I know
if I am a candidate? |
|
| Will I have to have physical
therapy? If so, for how long? |
|
| Will I have to
take medication for pain? Are there any medications I should be concerned
about? |
|
| I hear that men should
not have fusion surgery. Is this true? |
|
| What are some
of the complications associated with fusion surgery? |
|
| How many times will
I need to see my surgeon after surgery? |
|
| Why do some surgeons
approach the spine from the back and others through the abdomen? |
|
| What are
the risks from going in from the front? |
|
| What are the risks from
going in from the back? |
|
| Are there any
alternatives to having a bone graft taken from my hip? |
|
| What are the
differences between bone taken from my hip and donor bone? |
|
| I have heard people
talk about the pain associated with harvesting bone from the hip. Does
this happen to everyone and how long does it last? |
|
| Are there any potential
complications with harvesting bone from my hip? |
|
| My spinal specialist
said that he will perform the fusion from my back and will harvest
bone from my hip without a separate incision. Will I be able to tell
the difference between that pain and the main procedure pain? |
|
| I have heard people talk
about hip pain after harvesting lasting up to two years or longer.
Is that true? |
|
| Can I have
an MRI or CT scan after fusion surgery? |
|
| Will my surgery be
photographed or video taped? |
|
| What are common causes of back pain? | |
| There are numerous
causes for back pain ranging from muscle strain, trauma, arthritis, disc
herniation, muscle spasm, facet joint pain, and cumulative effect of
poor body mechanics. |
|
| How do disc injuries cause back pain? | |
| When the disc bulges
or herniates into the spinal canal, the nerves in that area can become
inflamed or agitated, creating both back pain and pain in the area where
that nerve carries impulses. The muscles surrounding the injured disc
can become fatigued and spasm. |
|
| What is the difference between a herniated disc and a bulging disc? | |
| A bulging disc is
a slight protrusion of the center of the disc (nucleus pulposus) into
the spinal canal. In a bulging disc, the annulus fibrosus (outer ring)
has not been ruptured. A disc herniation is a large protrusion of the
nucleus pulposus (center of the disc), which has burst through the annulus
fiborsus (outer ring of the disc) into the spinal canal, invading the
surrounding nerves and causing pain in the back, buttocks, hips, or legs. |
|
| Is it true that a bulging disc can be normal? | |
| Bulging discs are
very common, and may not produce any symptoms. |
|
| How did I herniate my disc? | |
| As we age, the disc
may lose hydration and develop small tears and bulges. The herniation
can occur due to a lifetime of poor body mechanics, a trauma, or by lifting,
bending or twisting the wrong way at the wrong time. |
|
| What are the symptoms of a herniated disc? | |
| The classic symptoms
of a herniated disc include back pain, hip pain, and any combination
of burning, numbness, tingling, or pins and needles in the legs. |
|
| What is the treatment for herniated discs? | |
| A herniated disc is treated with
conservative therapy unless there is a spinal deformity or neurologic
deficit. Conservative therapy can include physical therapy, chiropractic
care, acupuncture, Pilate's, ultrasound, pain medication, muscle relaxants,
and a short course of steroids. If these do not work, the next steps
include a steroid epidural or facet joint block. Surgical intervention
is the last resort. If surgical intervention becomes necessary, a microdiscectomy
is the most common procedure. |
|
| Does non-surgical spinal decompression work? | |
There are many services
advertised that offer "non-surgical" spinal decompression. These treatments
may not be covered by insurance companies. And there is no published
information to suggest that a disk can be unherniated. In my opinion,
the results are equal to inversion therapy. |
|
| What is degenerative disc disease (DDD)? | |
| Degenerative Disc
Disease refers to the loss of loss of hydration in the disc and weakening
of the annulus (outer lining of the disc). Trauma can cause the annulus
to tear and disc material leaks out and presses on a nerve. Degenerative
disc disease is very common in the human population but is not always
symptomatic. |
|
| What is lumbar instability? | |
| Lumbar instability
occurs when there is unnatural movement of the vertebras. This can be
a result of degeneration of the discs, a spinal deformity such as spondylolisthesis,
or occur after a decompression procedure. |
|
| What is spinal stenosis? | |
| Spinal Stenosis is
an abnormal narrowing of the spinal canal which holds the spinal cord
or the nerves. The narrowing may be caused by age related changes of
the spine such as disc degeneration and arthritis causing a bone buildup
in and around the canal and nerve holes producing nerve compression.
The compression of the nerves causes arm or leg symptoms such as numbness,
weakness, or pain. |
|
| What is the treatment for spinal stenosis? | |
| Conservative therapy
may relieve the symptoms of spinal stenosis. If not, a spinal decompression
is necessary. This is the removal of the bony narrowing around nerves.
The operative strategy will depend not only on the location of the spinal
narrowing, and the relative stability and condition of the spine as a
whole. |
|
| My doctor told me that I have arthritis of my spine and that I should learn to live with the pain. Is this true? | |
| Generally, the pain
associated with arthritis can be managed with conservative therapies,
exercise, and medication. |
|
| When is surgery necessary for patients with spine problems? | |
| Surgery is only indicated
if conservative therapy fails, the patient becomes dysfunctional, or
the patient should experience progressive neurological problems. |
|
| What is a laminectomy? | |
| A laminectomy is the
removal of a small portion of the vertebra, (lamina) around the affected
area. This is done to relieve pressure on the nerve roots. |
|
| My spinal specialist said I need a fusion. Is that true? | |
| A fusion is recommended
if there is spinal deformity or instability, or if the spine will become
unstable due to the removal of the disc or bone. |
|
| If I have a fusion does that mean I will never be able to bend? | |
| No. Very
little bending capacity comes from the spine. It is from the hips. |
|
| My spinal specialist said he would be using implants in my spine. Is this really necessary? | |
| The spinal
instrumentation serves two purposes. First, it allows the surgeon to
restore the alignment and balance of your spine. Secondly, the instrumentation
acts as an internal brace, stabilizing the spine while the bone fusion
grows. |
|
| Does it matter what screws and rods my surgeon uses? | |
| There
are differences in the instrumentation on the market. Your surgeon will
select the instrumentation based on the procedure. |
|
| Will fusing my spine cause damage to adjacent areas? | |
| That is
an excellent question. In a one level fusion, there is little impact
on the spine. In a multi-level fusion, the major concern about a fusion
is adjacent segment degeneration. The discs act as shock absorbers between
the vertebras. When the spine is fused, the discs above or below the
fusion may absorb the sheer force from every day motion, and thus wear
out. When the fusion is performed it is essential that the balance of
the spine is maintained. If this is done, the adjacent segments are at
less risk of degeneration. |
|
| What are the risks associated with spinal surgery? | |
| There
are risks associated with any surgical procedure. The risks for spine
surgery include but are not limited to: inter operative complications,
infection, bleeding, and hardware failure. |
|
| Do I need to wear a brace after surgery? | |
| I always
prescribe a brace if a patient is at a high risk for not fusing.
|
|
| Does my insurance cover low back surgery? | |
| In most
cases insurance will cover spine surgery. Your insurance benefits will
be verified and explained prior to surgery. |
|
| How quickly can I expect to recover from surgery? | |
| Recovery
from surgery is individualized, and depends on the surgical procedure.
Regardless of the procedure, patients are walking within 24 hours of
surgery. |
|
| I have heard people talk about less invasive back surgeries. What are these? How do I know if I am a candidate? | |
| Minimally
invasive surgery is an option for certain conditions, when performed
by a spine specialist. It is not an option for Idiopathic Scoliosis.
Your physician will explain the treatment options and the pros and cons
of each. |
|
| Will I have to have physical therapy? If so, for how long? | |
| Your physician
will determine if you need physical therapy. In general, I prescribe
physical therapy for my patients between 4 and 12 weeks post-surgery.
Core stabilization, stretching, and muscle conditioning are very important
to a patient's long term health. |
|
| Will I have to take medication for pain? Are there any medications I should be concerned about? | |
| Pain medication
is administered in the hospital following surgery. Patients typically
require oral medication for a period ranging from 1-4 weeks, depending
on the individual and the procedure performed. If a fusion has been performed,
it is important to avoid anti-inflammatory medications, including aspirin
products, until cleared by the physician. These medications will inhibit
the growth of the boney fusion. |
|
| I hear that men should not have fusion surgery. Is this true? | |
| No. There
is an additional risk for men during any surgery involving the abdomen.
When an anterior fusion is performed on male, there is a small chance
that the nerve that controls ejaculation can be damaged, resulting in
retrograde ejaculation. If this occurs, the patient will still be able
to become erect, and orgasm, but will not produce semen. |
|
| What are some of the complications associated with fusion surgery? | |
| There
are potential risks with any surgical procedure. The complications specific
to a fusion surgery, while rare, include failure to fuse, hardware failure,
infection, excessive bleeding, and adjacent segment degeneration. |
|
| How many times will I need to see my surgeon after surgery? | |
| Post-operative
visits will depend on the procedure and your surgeon. In my clinic, I
see patients that have had a fusion one week post-operatively, and then
at intervals of one month, three months, six months, 9 months, and 12
months post-op. |
|
| Why do some surgeons approach the spine from the back and others through the abdomen? | |
| The surgical
approach is determined by the physician based on the diagnosis and symptoms
of the patient. The anterior (front) and posterior (back) combination
increase the surgical success rate dramatically. |
|
| What are the risks from going in from the front? | |
| The anterior
(front) approach to the spine is generally accompanied by a skilled vascular
surgeon. The major complications associated with this procedure are blood
vessel damage and sexual dysfunction in males. |
|
| What are the risks from going in from the back? | |
| The risks
of a posterior (back) surgical approach include: nerve damage, bleeding,
infection, cerebral spinal fluid leaks, failed hardware, and a failure
to fuse. |
|
| My doctor said he would be using a bone graft. What does this mean? What is a bone graft? | |
| A bone
graft is a boney substitute for a disc, which grows over time to stabilize
two or more vertebra together. There are two categories of bone grafts,
allograft (donor bone) or autograft (bone used from your body, generally
the iliac crest.) The type of bone graft used is based on the procedure,
the amount of bone needed, whether the patient is a smoker, and the patient's
overall health. |
|
| My spinal specialist said he will take the bone graft from my hip. How big is that incision compared to the spine surgery? | |
| The incision
for your spine surgery is correlated with the number of spinal levels
that are fused. The incision for the bone graft can vary, but is generally
1 ½- 2 inches long. |
|
| Are there any alternatives to having a bone graft taken from my hip? | |
| The alternatives
to using a bone graft from the patient's hip are to use local bone, cadaver
bone, or a bone graft substitute. |
|
| What are the differences between bone taken from my hip and donor bone? | |
| The bone
taken from the patient's hip has a higher fusion rate than donor bone. |
|
| I have heard people talk about the pain associated with harvesting bone from the hip. Does this happen to everyone and how long does it last? | |
| I
rarely harvest bone from a patient's hip. There
is pain associated with any surgical procedure. In the majority of patients
the pain is resolved in a short period of time and they do not require
medication. There are a small percentage of people who do suffer chronic
pain following this bone harvesting. |
|
| Are there any potential complications with harvesting bone from my hip? | |
| There
are potential complications with any surgical procedure. The complications
most often associated with harvesting bone include: infection, bleeding,
or chronic pain. |
|
| My spinal specialist said that he will perform the fusion from my back and will harvest bone from my hip without a separate incision. Will I be able to tell the difference between that pain and the main procedure pain? | |
| Most
patients can distinguish between the pain generated from the procedure
and the bone harvesting. |
|
| I have heard people talk about hip pain after harvesting lasting up to two years or longer. Is that true? | |
| The majority of patients do not experience long term pain, but it is possible for patients to experience long term hip pain following harvesting. | |
| Can I have an MRI or CT scan after fusion surgery? | |
| MRI or CT scans are performed on patients that have had spinal fusion with titanium instrumentation to rule out re-herniation or to aid the physician in diagnosing a new problem. Always inform the imaging technician performing the MRI or CT scan that you have spinal instrumentation. | |
| Will my surgery be photographed or video taped? | |
| Occasionally Dr. Pashman will take interoperative
pictures for educational purposes. The photos or video do not show any
identifying features (such as name or your face). This is covered in
your surgical consent form. If you have a preference about being photographed,
please let Dr. Pashman know when you sign the consent form. |
|
The information in eSpine.com is not intended as a substitute for medical advice but is to be used as an aid in understanding back pain and neck pain. Always consult your physician about your medical condition. All content and images © 1999-2010 eSpine, Inc. Last modified: December 1st, 2009 |
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