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?
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?
My doctor said he would be using a bone graft. What does this mean? What is a bone graft?
My spinal specialist said he will take the bone graft from my hip. How big is that incision compared to the spine surgery?
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?
I have heard people talk about hip pain after harvesting lasting up to two years or longer. Is that true?
What is INFUSE® Bone Graft and how does it compare to the natural protein in my body that helps bones to grow?
How does INFUSE® Bone Graft compare to the bone taken from my hip?
Is INFUSE® Bone Graft the same as the natural protein found in my body?
What keeps INFUSE® Bone Graft from growing bone in other places in my body?
Why is my doctor using a sponge with INFUSE® Bone Graft? What will happen to the sponge? Will my body absorb it like a suture?
Will INFUSE® Bone Graft cause any side effects?
If my doctor uses INFUSE® Bone Graft, will I get as strong of a fusion as if he had used a bone graft from my hip?
What are common causes of back pain?
The back is one of many complex structures in the body. It is the only location where you have all the organ systems present. It is composed of skin, muscle, bone, ligaments, tendons, nerves, blood vessels, and the spinal cord. Each of these can contribute to back pain. The most common cause is muscle strain or sprain. Less common causes include disc herniations, infection, fractures, disc degeneration, arthritis, tumors, kidney infections or kidney stones as well as intraabdominal origins. Most back pain is self limited, improving with rest, and anti-inflammatory medications. If your back pain persists for longer than 1-2 weeks, you should seek your doctor’s advice.
How do disc injuries cause back pain?
Disc injury occurs primarily by two functions. The first results from stress on the disc causing the outer band of fibers, called the annulus, to weaken, resulting in the soft center of the disc, the nucleus, to herniate out causing trauma to the nerve. The nerve becomes inflamed which is exhibited as leg pain, numbness, or weakness. The second type of disc injury results from wear and tear on the disc or degeneration. Through this process the disc is no longer able to help function as one of the support structures of the spine.
What is the difference between a herniated disc and a bulging disc?
Between each vertebral body lies a disc which endures the compression forces that the spine is exposed to at any given time. The disc is made up of two components. The center of the disc is composed of a soft substance called the nucleus. The outer band of fibers is called the annulus. A disc bulge is when the outer ring is protruding. A herniation is when the outer band has torn, allowing the soft center to escape.
Is it true that a bulging disc can be normal?
Yes, a bulging disc can be considered a normal part of the spine.
How did I herniate my disc?
The most common reason for a herniated disc is through a traumatic event; however many people can not identify the cause of their herniation. It is often as a result of bending or twisting. Obesity can significantly contribute to an increased risk of disc herniation.
What are the symptoms of a herniated disc?
Herniated discs can sometimes cause no pain at all. If the herniated portion is pushing on a nerve, it can result in pain, numbness, and tingling. If the herniated portion is large enough, it can also cause weakness and incontinence.
What is the treatment for herniated discs?
Often times, surgery is not required for herniated discs. With rest, pain medication, anti-inflammatory medication and physical therapy, pain typically resolves. However if conservative modalities do not result in improvement in symptoms, then surgery is recommended. There are various surgical procedures including microscopic surgery, endoscopic surgery, or plasma disc decompression that may be an option. If your symptoms involve significant weakness and/or incontinence, then surgery is the first option.
What is degenerative disc disease (DDD)?
Degenerative disc disease is the natural occurrence of aging in the spine. Genetics, systemic or general medical health factors, occupational requirements such as strenuous labor, and activity and lifestyle may aggravate the degenerative process and lead to earlier symptoms. Adherence to a regular exercise program and strengthening of core muscles (abdomen and back muscles) can help slow this process leading to
an overall healthier back.
What is spinal stenosis?
Spinal stenosis is the narrowing of the normal spinal canal where the neural structures reside. This is usually a gradual process, and can be the result of slippage of one vertebral body on the adjacent vertebral body, fractures, degenerative changes, infection, tumors, or disc herniations to name a few.
What is the treatment for spinal stenosis?
Treatment of spinal stenosis depends largely on the cause. Options for treatment can include rest, physical therapy to strengthen the core muscles (supporting muscles of the spine), anti-inflammatory medications, and injections by pain management doctors. Failing conservative measures, surgery to remove the pressure off the nerves can be quite effective.
My doctor told me that I have arthritis of my spine and that I should learn to live with the pain. Is this true?
There are many treatment options for arthritis of the spine. There are conservative measures including pain medication, spinal traction, anti-inflammatory medication, physical therapy, aquatic therapy, etc. If your symptoms do not improve with these techniques, surgery may be an option.
When is surgery necessary for patients with spine problems?
Surgery may be necessary depending on the cause. Situations do exist where surgery may be an immediate option due to severe compromise of the neural structures which could result in terminal damage if not relieved.
What is a laminectomy?
A laminectomy is a surgical procedure where the back part of the spine is removed in order to decompress the spinal canal or to access various nearby structures.
My spinal specialist said I need a fusion. Is that true?
Indications for fusion vary from patient to patient. Current efforts attempt to preserve motion if at all possible. Fusion is reserved in situations where instability is either evident of suspected.
If I have a fusion, does that mean I will never be able to bend?
Having a fusion does not imply you will not be able to bend. The extent of the fusion will determine the degree of restriction in bending.
My spinal specialist said he would be using implants in my spine. Is this really necessary?
There are many types of spinal implants. In general they are utilized for stabilizing the spine, promoting bone growth, replacing a disc, or long-term pain control.
Does it matter what screws and rods my surgeon uses?
Screw and rod selection does not matter. The choice is usually surgeon preference or reasons associated with accessibility.
Will fusing my spine cause damage to adjacent areas?
It is commonly believed that spinal fusion will accelerate the degenerative process in adjacent levels.
What are the risks associated with spinal surgery?
Risks with spinal surgery include the same general risks associated with any procedure such as infection and bleeding; however with spinal surgery risks to the adjacent structures could result in weakness, paralysis, incontinence, fracture of any implanted screws or rods, damage to major surrounding vessels and abdominal structures, coma, and even death.
Do I need to wear a brace after surgery?
Application of a postoperative brace is dependent upon the type of surgery, the patient’s initial health condition, as well as a surgeon’s preference.
Does my insurance cover low back surgery?
Most insurances cover low back surgery. It is always wise to contact your insurance company with any questions you may have regarding your coverage.
How quickly can I expect to recover from surgery?
In general, recovery is dependent on the type of surgery. In some cases it may be as early as 2-4 weeks and others may be 4-6 weeks. Recovery may involve physical therapy, aquatic therapy, occupational therapy. Recovery is dependent upon your general medical condition prior to surgery as well as the occupational requirements or physical activities you wish to return to doing. A patient’s motivation and compliance are important factors in promoting and healthy and strong postoperative recovery.
I have heard people talk about less invasive back surgeries. What are these? How do I know if I am a candidate?
Minimally invasive techniques have been developed over the last decade. These surgeries involve smaller incisions and less tissue damage leading to shorter hospital stays and quicker recoveries. Most procedures on the lumbar spine have minimally invasive options. The skill and experience of your surgeon, along with the nature of your problem goes a long way in determining whether you are a candidate. One should discuss with their surgeon which option is best for them.
Will I have to have physical therapy? If so, for how long?
The need for physical therapy depends on the preference of the surgeon, the individual need of each patient, and the activities or occupational requirements the patient must return to doing. In general, physical therapy is a good opportunity to for patients to learn proper back exercises and develop good body mechanics to prevent any further injury.
Will I have to take medication for pain? Are there any medications I should be concerned about?
Recovering from a back injury or operation involves many modalities. Pain medication is not a requirement, but can certainly facilitate the healing process by allowing the patient to participate in physical therapy and rehabilitation. There are many types of medications that you and your doctor may consider utilizing. Narcotics are generally reserved for short-term pain management due to their potentially addictive properties.
I hear that men should not have fusion surgery. Is this true?
No. The risks for fusion surgery are the same for men and women. There is a unique concern for men when discussing an anterior approach for spinal fusion. A very small risk of retrograde ejaculation resulting in semen being released into the bladder instead of out through the urethra can potentially result from this type of approach causing sterility. If the male patient is considering children in the future, storing semen is always an option.
What are some of the complications associated with fusion surgery?
Complications associated with fusion surgery include hemorrhage, infection, injury to the surrounding structures such as neural tissue or vascular tissue, fracture of the instrumentation, failure of the fusion, incomplete symptom relief, further surgery, progression of adjacent level disease, loss of bowel or bladder function, among many others. The risks are small and depend on the skill and experience of your surgeon and should always be thoroughly reviewed prior to any procedure.
How many times will I need to see my surgeon after surgery?
Postoperative visits with your surgeon are usually based on the surgeon’s preference. A general guideline is 7-10 days after surgery to remove any sutures or staples, then approximately 6 weeks from the date of surgery, and then at 3 months. Further visits are based on surgeon preference, the patient’s condition and type of surgery.
Why do some surgeons approach the spine from the back and others through the abdomen?
Several factors are considered when determining surgical approach. Radiographical interpretation of the cause of the patient’s pain or symptoms including the location and ease of accessibility to that location, as well as the risks associated with each approach and the experience of the surgeon among other factors are included in the decision-making process. Ultimately it should be the least complicated route to the perceived origin of the problem.
What are the risks from going in from the front?
The risks of an anterior approach include bleeding, infection and or damage to any surrounding structures including abdominal organs or vasculature, neural tissue, sterility for men.
What are the risks from going in from the back?
The risks of approaching the spine from the posterior aspect include the general surgical risks such as bleeding, infection, damage to surrounding neural and vascular tissue resulting in weakness, paralysis, loss of bowel or bladder function, coma, and even death.
My doctor said he would be using a bone graft. What does this mean? What is a bone graft?
A bone graft is spinal implant utilized for stabilization of the spine. The graft usually replaces the excised vertebral body or disc and facilitates fusion between the vertebral body above and below with the intention of creating a solid fusion. There are two types of bone grafts 1) allograft, which is derived from a donor bone bank, and 2) autograft, which is obtained from the patient. In addition, when performing a spinal decompression, the excised bone is usually crushed into tiny pieces and utilized for additional grafting material promoting a healthy fusion.
My spinal specialist said he will take the bone graft from my hip. How big is that incision compared to the spine surgery?
Depending on the levels of the spinal surgery, the bone graft may be able to be taken from the same incision. However, when this is not the case, a separate small incision is made from which the graft is obtained.
Are there any alternatives to having a bone graft taken from my hip?
There are alternatives to the bone graft from your hip. Allografts, or bone from a donor bank or cadaver bone may be used as well as synthetic bone stimulating substances such bone morphogenetic protein which can be used alone or in combination with donor bone or crushed bone from a spinal decompression. The advantage of the bone morphogenetic protein and the excised bone from the decompression portion of the surgery is the abundance of stimulating growth factors present to promote healthy bone fusion.
What are the differences between bone taken from my hip and donor bone?
The major difference between the bone taken from your hip and donor bone is it is foreign to your body. This can result in incompatibility and thus ultimately a failed fusion. This is generally not the case. The advantage of the donor bone is that it provides the same foundation as your own harvested bone for which growth can take place. The advantages to using your own bone is that it contains healthy growth stimulating factors which facilitate healthy fusion; however this is at a cost of increased pain from the harvested site and potential for infection, bleeding, and further injury to the harvested site.
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?
The pain associated with harvesting bone from the hip varies from person to person. The duration can be anywhere from a few weeks to permanent discomfort.
Are there any potential complications with harvesting bone from my hip?
Harvesting bone from the hip carries risk for further injury to the hip such as a fracture, infection, and bleeding.
I have heard people talk about hip pain after harvesting lasting up to two years or longer. Is that true?
Harvesting bone from the hip can potentially result in permanent discomfort in that area. This is not always the case, but is a risk factor.
What is INFUSE® Bone Graft and how does it compare to the natural protein in my body that helps bones to grow?
Infuse bone graft is an engineered protein that can be implanted in your spine to stimulate bone growth. It is nearly identical to the natural resources in you body that stimulate bone growth thus removing the need to harvest bone from elsewhere in your body.
How does INFUSE® Bone Graft compare to the bone taken from my hip?
Infuse is nearly identical to the natural resources in you body that stimulate bone growth thus removing the need to harvest bone from elsewhere in your body.
Is INFUSE® Bone Graft the same as the natural protein found in my body?
Yes. Infuse bone graft is identical to the bone producing proteins in the human body.
What keeps INFUSE® Bone Graft from growing bone in other places in my body?
Infuse bone graft is applied with what is called a carrier. This carrier is what keeps the Infuse bone graft localized to one area and it helps prevent it from getting to other parts of the body. If the fluid from this carrier is dropped outside of the sponge, it is absorbed by the body and excreted without harm to you.
Why is my doctor using a sponge with INFUSE® Bone Graft? What will happen to the sponge? Will my body absorb it like a suture?
The sponge helps keep the Infuse bone graft seated at the site where it is implanted. Your body completely breaks down this sponge material. None of the sponge will remain.
Will INFUSE® Bone Graft cause any side effects?
To our knowledge, there have been no documented side effects from the use of INFUSE®.
If my doctor uses INFUSE® Bone Graft, will I get as strong of a fusion as if he had used a bone graft from my hip?
Yes, it will be of equal strength.