Getting Back to Normal What to do when your back is out of whack
By Cheryl Alexander
Our spine is our support, our source of motion, the information highway for our nervous system, and our tool for walking, bending and sitting. Yet until we have a problem, our spines are often taken for granted. I teach Bikram Yoga part-time, and when I was in teacher training, Bikram would remind us frequently that the quality of our spines reflect the quality of our lives. If you’ve ever had chronic pain in your neck or your back, you know firsthand the truth of this statement. When we lose function in our spines, nothing is more important than getting it back.
Conservatively speaking, many doctors begin treating patients with neck and back pain by prescribing medications, both over-the-counter and prescription-strength: aspirins and NSAIDs, non-narcotic and narcotic pain relievers, muscle relaxants and even anti-depressants. Additionally, some doctors utilize Epidural Steroid Injections (ESI) or nerve blocks, which are a combination of cortisone (a powerful anti-inflammatory medication) and a local anesthetic that are given through the back into the space between the facet joint. Epidural steroid injections are not always successful in relieving symptoms of inflammation, and are used only when other conservative treatments have failed.
Other conservative approaches to neck and back pain treatment include physical therapy and the use of neck or back braces which help strengthen weak areas of the spinal column and provide support to prevent worsening of any condition. Also, doctors agree that exercise is vital to recovery and to maintaining a healthy spine and endorse exercise as the most basic way to combat back and neck problems. However, if you already have an injury or damage to your spine, make sure the exercises you choose are effective and safe for your particular case.
OPTIONS FOR SURGICAL PROCEDURES
Few people need surgery for back and neck pain. For those who do, no single type of surgery works for every pain problem. If your doctor thinks surgery will improve your back or neck pain, he or she will suggest the type of surgery that is the best for you. A number of surgical procedures have been developed to treat each type of back and neck pain and are generally done for one of four reasons:
1. To remove pressure from the nerve roots
2. To remove pressure from the spinal cord
3. To stop the motion between two vertebrae
4. To preserve the motion between two vertebrae
The types of surgical procedures your doctor may recommend include the following:
DISCECTOMY — Discectomy means “remove the disc.” A discectomy relieves the pressure on a nerve root by removing the herniated disc causing the pressure.
SPINAL FUSION — Usually performed after a discectomy, the goal of spinal fusion is to stop the motion caused by segmental instability, which reduces the mechanical pain caused from excess motion in the spinal segment.
TOTAL DISC REPLACEMENT — Total disc replacement (TDR) may be a solution for some people with degenerative disc disease as an alternative to spinal fusion. Early research into artificial disc replacement began in the 1960s. Interest was renewed in the 1990s because of the complications sometimes caused by spinal fusion. Since then, research and design efforts on total disc replacement have increased significantly.
LAMINECTOMY — If spinal stenosis is the main cause of your neck pain, then the spinal canal must be enlarged and any bone spurs pressing on the nerves must be removed. One way to do this is a complete laminectomy (“to remove the lamina”). The lamina is the back side of the spinal canal and forms the roof over the spinal cord. Removing the lamina gives more room for the nerves and lets the surgeon remove any bone spurs from around the nerves. A laminectomy reduces the pressure on the spinal cord and relieves the irritation and inflammation of the spinal nerves.
CORPECTOMY — Another method for relieving pressure on the spinal cord that may be causing spinal stenosis or cervical myelopathy is to remove the front of the spinal canal. This means that the large part of several of the vertebrae must be removed — the vertebral bodies and the discs between. This procedure is called a corpectomy (“corpus” means body and “ectomy” means remove). Once the vertebral bodies have been removed, the space must be filled, usually with a bone graft. Some type of internal fixation is usually required to hold the vertebrae and the bone graft in place. You will probably also need to be placed in a halo jacket to hold your head perfectly still while the healing occurs and the vertebrae fuse.
MINIMALLY INVASIVE SPINE SURGERY — Minimally invasive spine surgery is an approach in which special surgical instruments are used to see inside the body and perform surgery without the need for a large incision. The increase in minimally invasive spine surgery techniques has been made possible by advances in lasers, endoscopy, and image guidance systems. Although there are risks associated with any type of surgery, minimally invasive spine surgery offers several advantages over traditional open surgery approaches. These advantages include:
•Less muscle injury
•Less blood loss
•Less post-operative pain
•Shorter hospital stay
•Faster return to activities of daily living including work
POST-SURGERY CARE AND REHABILITATION
The type of spine surgery you have will determine how long you will need to stay in the hospital and how much help you will need in and out of the hospital after surgery. Many procedures for the spine only require one to three nights in the hospital.
After spine surgery, people often report feeling better soon after they awake from the surgery. Although you may see and feel immediate benefits, you will get the maximum benefits of surgery by participating in a comprehensive rehabilitation program. When you are leaving the hospital, your doctor or physical therapist will recommend some guidelines for you to follow at home which will include the use of ice/heat, positioning, bending, lifting, rest and any follow up treatment.
TIPS FOR MAINTAINING A HEALTHY SPINE
•Pay attention to your body: If something you are doing causes your back to hurt, stop and rest or stop altogether. Whether it is a particular exercise, prolonged sitting, bending, or twisting, listen to your body’s signals. Pain is a warning. Discuss the activity with your doctor or physical therapist before proceeding.
•Sit and sleep comfortably: Be sure that your back and neck are properly supported when you sit or sleep. When you sit, make sure your lower back is supported. Talk to your health care provider about choosing an appropriate mattress and pillow. You can upset the alignment of your spine if a mattress is too soft, or a pillow too high.
•Lose weight: If your weight is causing excessive pressure to your spine, weight loss can reduce your discomfort.
•Lift properly: Do not lift heavy loads by placing the pressure on your lower back. Use your legs to lift, and always bend your knees so your arms are at the same level as the heavy object you plan to lift. This simple technique will save your back unnecessary wear and tear.
•Avoid osteoporosis: Talk with your physician about combating the effects of osteoporosis (bone thinning). Possible treatments include weight bearing exercise, adequate calcium and vitamin D, and hormone replacement therapies.