Having Back or Neck Problems?
Read this informational packet and learn about the problems you are having. Also learn what options you have to deal with these problems.
CONSULT YOUR DOCTOR to figure out your best option.
The Spine
The spine contains many bones, which are known as vertebrae. These bones are stacked on top of one another forming the spine. The bones or vertebrae are connected by ligaments, tendons and muscles. Between the vertebrae are round, spongy pads of cartilage called disks. The disks are filled with a jellylike substance.
Neck and Back Pain
Neck and back pain are very common complaints (especially lower back pain). Neck and back pain can be caused by a variety of factors. Such as when a person lifts something too heavy or gets into an accident. This can cause a sprain, pull, strain or spasm in one of the ligaments or muscles in the back.
A sprain or strain will usually heal on its own. It just needs some time. Your doctor may prescribe over-the-counter or prescription medications. Or they may just tell you to use heat or ice packs on the problem area. Symptoms may only last a few days.
Sometimes though, pain is more severe. You may have a bulging or a herniated disk. Depending on your diagnosis your doctor may give you other options. Physical therapy may be an option and if the pain is very bad and continuous surgery may become an option.
Many times, a doctor will prescribe an MRI to be done to diagnose your condition. An MRI is a magnetic resonance imaging scan. It uses a large, powerful magnet to create a picture of a part of the body. It is non-invasive and will produce a two-dimensional view of your spinal cord. This will allow your doctor to carefully examine your problem area.
Your doctor may suggest chiropractic treatment, acupuncture, a massage or physical therapy. Many people respond to non-surgical treatments.
Should I have an MRI?
Reasons to have an MRI
You are looking for the cause of pain, numbness, tingling, weakness, or loss of reflexes in your neck, back arms or legs.
An MRI is perhaps the most effective tool to diagnose and treat your spine.
Herniated Disk
The bones (vertebrae) that form your spine are cushioned by small, spongy disks. When these disks are healthy, they act as shock absorbers for the spine and keep the spine flexible. But when a disk is damaged, it may bulge or break open. This is called a herniated disk. It may also be called a slipped or ruptured disk. You can have a herniated disk in any part of your spine. Herniated disks affect the lower back (lumbar spine). Some happen in the neck (cervical spine) and, more rarely, in the upper back (thoracic spine).
Symptoms
When a herniated disk presses on nerve roots, it can cause pain, numbness, and weakness in the area of the body where the nerve travels. A herniated disk in the lower back can cause pain and numbness in the buttock and down the leg. This is called sciatica. Sciatica is the most common symptom of a herniated disk in the lower back.
Treatment Options
Non Surgical
If your doctor tells you that you have a bulging or herniated disk or a neck or back strain, the first thing they will usually recommend is to rest and to limit your lifting. That may include a combination of heat and ice therapy, chiropractic treatment, acupuncture and/or physical therapy.
A physical therapist works with your body mechanics using different techniques and exercises to improve your spine alignment, flexibility and strength. He or she can assist with exercises and teach them to be done at home. Your therapist may also use methods such as ultrasound, application of tens units, massage or heat and cold to reduce pain.
Injections
When physical therapy or other non-invasive treatment does not provide relief, many clients decide to try other treatment options.
Epidural Injections
An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of pain is healing.
The patient is placed lying on their side on the x-ray table and positioned in such a way that the physician can best visualize the low back using x-ray guidance. The skin on the back is scrubbed using two types of sterile scrub (soap). Next, the physician numbs a small area of skin with numbing medicine. This medicine stings for several seconds. After the numbing medicine has been given time to be effective, the physician directs a small needle, using x-rays guidance into the epidural space. A small amount of contrast (dye) is injected to insure the needle is properly positioned in the epidural space. A mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) is injected. After the procedure a follow-up appointment will be made for a repeat nerve block if indicated. These injections are usually done in a series of three, about two weeks apart.
One doctor was quoted saying
“Epidural Injections can be a very helpful adjunct in rehabilitation of the patient’s spine pain that radiates into an arm or leg or in the thoracic spine around the chest or trunk. They work by placing cortisone (a potent anti-inflammatory medicine) close to an inflamed nerve. This allows the patient to be fully able to regain full motion and increase the muscular support of the spine critical in the recovery and prevention of future episodes. They are generally not indicated in spine pain that does not radiate from an irritated spinal nerve. Most patients actually respond to injections. Certainly, if there is little or no pain relief after trying two injections, it is unlikely that the third injection will be of benefit. In addition, most patients can be treated with a local anesthetic without the need for sedation which requires an IV and a longer recovery immediately after the process.”
Another doctor stated
“Epidural injections can be done at any level of the spine: cervical (neck), thoracic (mid-back), lumbar (lower back), and sacral (tailbone area).”
The Epidural Steroid Injection is a procedure where numbing medicine (anesthetic) and anti-inflammatory medicine (steroid) is injected into the epidural space to treat pain caused by irritation of the spinal nerves. A protective covering called the dural sac surrounds the spinal cord. This sac contains spinal fluid that bathes and nourishes the spinal cord. The space between the outer surface of the dural sac and the bones of the spinal column is the epidural space. Nerves that go from the spinal cord, through the spinal column and to the body pass through the epidural space. Depending on the location of your pain, the epidural steroid injection can be given in the neck (cervical), middle back (thoracic) or lower back (lumber).
Procedure Details
It is not necessary for you to go to sleep for this procedure; however, medication can be given to keep you comfortable. Normally, an epidural steroid injection takes no more than ten or fifteen minutes.
Before the procedure check with your doctor about:
If you should eat before the procedure?
If you have diabetes, what impact that procedure will have?
All medications you are taking.
If you have asthma or allergic reactions.
If you need medication before the procedure.
If you have the flu, a fever or cold.
Athletes sometimes need injections.
Below is from a newspaper article about Randy Johnson.
Randy Johnson Receives Help with His Back Pain
“Randy Johnson has a herniated disk in his lower back and the Yankees have a potential problem.
Johnson, who has had stiffness in his back in recent weeks, had a magnetic resonance imaging exam Wednesday, which revealed the herniated disk.
Johnson received an epidural yesterday at Beth Israel Hospital in hopes that the treatment would relieve the discomfort in his back to the point where he would be able to pitch next Friday. An epidural is an injection in the back that is usually a combination of a cortisone-type medication and a local anesthetic that reduces inflammation…
Johnson was scratched from his final regular-season start to rest his back for the postseason. But the Yankees had no indication that the back problem was the result of a herniated disk until Johnson had the M.R.I. performed. It was not known exactly when the injury occurred…
Torre said Johnson had the M.R.I. performed because Johnson wanted to make certain he would be healthy for the postseason…
Cashman said it was not clear whether Johnson’s back problem would eventually require surgery.”
Cortisone Injections
Cortisone shots are generally accompanied by an anesthetic such as Carbocaine or Lidocaine. This deadens the area and indicates where the shot should be placed. In general, cortisone injections serve to decrease pain and inflammation temporarily so that the patient can resume the rehabilitation more effectively. It is the combination of rehabilitation and cortisone injections that result in long-term improvement, not just cortisone alone.
Trigger Point Injection
Trigger point injection (TPI) may be an option in treating pain for some patients. TPI is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Many times, such knots can be felt under the skin. Trigger points may irritate the nerves around them and cause referred pain, or pain that is felt in another part of the body.
What Happens During the Procedure?
In the TPI procedure, a health care professional inserts a small needle into the patient’s trigger point. The injection contains a local anesthetic that sometimes includes a corticosteroid. With the injection, the trigger point is made inactive and the pain is alleviated. Usually, a brief course of treatment will result in sustained relief. Injections are given in a doctor’s office and usually take just a few minutes. Several sites may be injected in one visit.
When Is Trigger Point Injection Used?
TPI is used to treat many muscle groups, especially those in the arms, legs, lower back, and neck. In addition, TPI can be used to treat fibromyalgia and tension headaches. TPI also is used to alleviate Myofascial Pain Syndrome(chronic pain involving tissue that surrounds muscle) that does not respond to other treatments.
Frequently, trigger point injections are used to treat Myofascial Pain Syndrome. Trigger points are “taut bands” of muscle tissue that are formed after an overstretch injury. A trigger point is actually the formation of fibrous brands of collagen as a result of tearing of muscle fibers. The fibers are scar tissue that are not as extensible as regular muscle tissue. A trigger point is actually a “knot that is felt deep in the muscle tissue. They are very common in the neck, back and shoulders but may be found anywhere in the body. The trigger point results in a local pain in the muscle tissue with a typical pattern of referred pain. Many times the muscle becomes spastic and numbness in the limb, hand or foot may occur as a result. It is important to distinguish these from pinched nerves.
Spinal Surgery
For those who do not get relief from conservative treatment or pain management injections, the next step is sometimes surgery.
The goal of spinal surgery is to relieve your symptoms. Whatever is irritating or compressing your spinal nerves is removed. Your doctor will discuss with you which of the three basic types of surgery –or combination of surgeries- is the best for your back problem. Your surgeon may remove a part of the bony vertebra (laminotomy/laminectomy), part of a damaged disk (discectomy), or both. In some cases, the surgeon will fuse vertebrae to make the spine more stable. The type of surgery you need is usually decided before surgery begins. Sometimes modifications may be necessary.
Laminotomy/Laminectomy
Spinal surgery usually involves either a laminotomy or laminectomy. Bone is removed to relieve pressure on the nerve and to allow the surgeon access to parts of the spine where surgery is needed, such as an injured disk.
A laminotomy removes just a portion of the lamina. It is performed when the surgeon needs to have access to only a small part of a slightly damaged disk.
A laminectomy removes the entire lamina. Removal of the lamina helps release the pressure when the disk bulges. It is also used when the disk is badly damaged and the surgeon needs greater access to perform a discectomy. If stenosis is present, the surgeon may enlarge the foramen (opening between the vertebrae) to allow space for the nerve to exit.
Diskectomy
For people with disk problems, the surgeon forms a “window” in the torn portion of the outer rings of the disk. He or she then removes a portion of the disk nucleus, releasing the pressure on the nerve. Some surgeons perform a micro-diskectomy. This may require removal of only a small portion of the lamina. A disk nucleus may also be removed either through a needle (percutaneous diskectomy) or endoscope (a thin telescope-like instrument).
Spinal Fusion
For people with instability, the surgeon fuses (joins) adjacent vertebrae. Usually only two lumbar vertebrae are fused. Matchstick-sized pieces of bone may be used as bone grafts on the facets. Or, hockey-puck-shaped plugs of bone may be placed between the vertebrae. Bones and bone grafts grow into one unit. This stabilizes the vertebrae at that point of the spine. Sometimes wires, rods, screws, or plates are also used.
During spinal fusion, your surgeon locks together or fuses, some of the bones in your spine. This limits the movement of these bones, which may help relieve your pain. Your back or neck will not be quite as flexible. Even so, you may feel more flexible after a fusion because you can move with less pain.
Types of Spinal Fusion Surgery
Which section of the spine is fused depends on where your pain is. Sections of the spine that may be fused include: the neck (cervical fusion) and the lower back (lumbar fusion). Fusion can be done from the front (anterior) side of the body or the back (posterior) side of the body. Your surgeon will decide which is best for you.
Bone Graft
To fuse the spine, very small pieces of extra bones are needed. Called bone graft, this bone acts as the “cement” that fuses the vertebrae together. Bone grafts come from a bone bank or from your own body. Your surgeon will choose the type of graft that is best for you. Bone banks collect, evaluate, and store bone. The bone comes from human donors who are recently deceased. Donors are checked for their cause of death and medical history. Tests are done to check for viruses such as HIV and hepatitis. The bone is also treated before it is used as a graft. If bone from your own body is used, a small amount of bone is taken from the surface of the front or back of your pelvic bone. The bone is removed during the fusion surgery- a separate surgery is not needed. Bone may be taken through the incision made for your fusion, or through a separate incision. The area the bone is taken from can hurt quite a bit until it heals. Bone from your own body may work better than bone from a bone bank. Your surgeon will decide whether it is a better choice for your fusion.
Cervical Fusion
Fusing vertebrae in the cervical curve may help ease neck and arm pain. Two or more vertebrae in your neck are fused. Cervical fusion is usually done through an incision in the front of the neck. It may sometimes be done through the back of the neck, or through both the front and back. The surgery generally takes from one to four hours. The procedure begins when the disk is removed from between the vertebrae. Bone graft is packed into the now-empty space between the vertebrae. In time, the graft and the bone around it will grow into a solid unit. To help keep your spine steady and promote fusion, extra support may be used. The incision is then closed with sutures or staples. If extra support is needed metal supports called instrumentation may be used to help steady your spine while it fuses. These supports are not removed. Your surgeon may use one or more types of support. The most common type of support used with cervical fusion is a plate.
Anterior Lumbar Fusion
Fusing vertebrae in the lumbar curve may help ease lower back and leg pain. Anterior lumbar fusion is done through an incision in your stomach area. Depending on how many vertebrae are fused, the surgery may take from three to eight hours. The procedure begins when the disk is removed from between the vertebrae to be fused. Bone graft is packed into the now-empty space between the vertebrae. In time, the graft and the bone around it grow into one solid unit. To help keep your spine steady and promote fusion, extra support may be used. The incision is then closed with sutures or staples. If extra support is needed metal supports called instrumentation may be used to help steady your spine while it fuses. These supports are not removed. Your surgeon may use one or more types of support. The most common type of support used with anterior lumbar fusion is a cage.
Posterior Lumbar Fusion
Fusing vertebrae in the lumbar curve may help ease lower back and leg pain. Posterior lumbar fusion is done through an incision in the back. The graft is put between the vertebrae in one of the two places: in the disk space or between the transverse processes. Depending on how many vertebrae are fused, the surgery may take from three to eight hours.
Fusing the transverse processes is done when bone graft is packed between the transverse processes on the sides of the vertebrae. Occasionally, other nearby parts of the vertebrae are fused as well. To help keep your spine steady and promote fusion extra support may be used. The incision is then closed with sutures or staples.
Fusing the disk space is done when the disk between the vertebrae is removed. Bone graft is packed in the now-empty space between the vertebrae. In time, the graft and the bone around it grow into a solid unit. To help keep your spine steady and promote fusion, extra support may be used. The incision is then closed with sutures or staples.
If extra support is needed metal supports called instrumentation may be used to help steady your spine while it fuses. Your surgeon may use one or more types of support. A cage may be used then fusing the disk space. A cage is a metal “basket” that is packed with bone graft, and then placed between the vertebrae. Screws and rods may be used when fusing the transverse processes. Screws are inserted into the vertebrae. They hold the metal rods that keep the spine straight. In rare cases, these supports may be removed after fusion is complete.
Do not be afraid to ask questions.
Confronting a new diagnosis can be frightening — and because research changes so often, confusing. Here are some questions you may not think to ask your doctor, along with notes on why they’re important.
What is the likelihood of a cure for my condition?
Many cases of back pain resolve after several weeks, but recurrences are common and low-grade discomfort may persist for years. Studies show that for many patients, two or three hourly exercise sessions a week provide modest benefits until normal activities can resume.
What kind of pain management should I be thinking about?
Pain relievers, anti-inflammatory drugs and muscle relaxants are widely prescribed for back pain, but in controlled trials, evidence for their long-term effectiveness is not compelling, and side effects can be severe. Antidepressants, massage, chiropractic manipulation and psychological counseling are also options.
Do I need an injection of steroids or other medications?
Spinal injections of steroids may not be needed unless pain radiates or is severe. A condition called sciatica is often caused by a herniated disk. Spinal injections also involve the use of drugs that can have serious side effects.
Do I need surgery?
Professional organizations typically recommend surgery only if there is structural defects in the spine and noninvasive measures like exercises do not bring relief after several months. A study found that surgery may speed recovery in those who have sciatica caused by herniated disks, though even without surgery, the condition sometimes improve.
How many surgeries and interventions do you perform?
Treatment approaches vary from doctor to doctor. Surgeries and interventions are more expensive, and they are usually reimbursed by insurance. Exercise and pain relief can also be effective.
If I have spinal fusion, how will my mobility be affected?
Spinal fusion always results in immobilization of the area operated on.
What kind of pain relievers do you normally prescribe and what are their side effects?
Some prescription pain relievers are addictive and thus inappropriate for patients with prior substance-abuse problems. Others increase the risk of depression and should be avoided by patients with a history of mood disorders.
Do you collaborate with physical therapists, psychologists and other specialists?
Many top researchers now favor a multidisciplinary approach to spine pain, but specialists must be willing to talk to one another about your case to maximize your chances of recovery.
Is acupuncture worth a try?
A growing body of evidence suggests that alternative therapies such as acupuncture may be helpful for pain relief in some patients.
