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Lumbar FAQ |
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| What are common causes of back
pain? |
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| How do disc injuries cause back pain?
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| What is the difference between
a herniated disc and a bulging disc? |
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| Is it true that a bulging disc can be normal?
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| How did I herniate my disc? |
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| What are the symptoms of a herniated disc?
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| What is the treatment for herniated discs?
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| What is degenerative disc disease (DDD)? |
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| What is lumbar instability? |
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| 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, Pilates, 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 microdisectomy is the most common procedure. |
|
| 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? | |
| Unless a patient is at a high risk for not fusing,
then I generally do not prescribe a brace. |
|
| 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. 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? | |
| 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 perfomed 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 perfoming the MRI or CT scan that you have spinal instrumentation. | |
| Will my surgery be photographed or video taped? | |
| Occassionally 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. |
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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 © 1999-2008 eSpine, Inc. Last modified: March 4th, 2008 |
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