Spine General (involves multiple spine areas)


My Dad had back surgery about six months ago. He's about 62-years old. He complained mightily about back pain that went down his leg. The surgeon removed a disk that had gone bad and was pressing on a nerve. His leg pain went away but the back pain is still there. In fact, Dad thinks his pain is worse but we think he's way better. He can do more. He sleeps better. He isn't limping. Is he just looking for sympathy or what? We can't figure it out.

You may be observing something doctors call response shift phenomena. It happens to many, many patients before and after surgery (or other treatment). They have less pain and better function, but they rate their progress as worse than before treatment. They seem to see themselves as more disabled even though tests show they are stronger and more active.

A New Concept in Spine Research: Response Shift Phenomena

When conducting any medical study, before and after results are used to measure the success of the treatment. Many times patients are asked to fill out surveys that measure their responses to treatment as the primary outcome or measure of results. A surprising thing has been noticed about back pain patients from before to after surgery. They have less pain and better function, but they rate their progress as worse than before treatment.

I heard a talk at our hospital about why we are moving more toward using bone graft substitutes. I'm just a nurses aid on the orthopedic floor, so I really didn't understand it all. They said these new substitutes are inductive and conductive. After that they lost me. What does that mean? And why is it better than using your own bone?

There are different reasons to fuse the spine and different ways to do the fusion procedure. Surgeons are studying the results of fusion techniques to get an idea of which one works best for each problem. Fusing two or more vertebral bones together prevents motion at those segments and stabilizes the spine. Instrumentation such as screws or metal plates and screws may be used to perform the fusion.

I've been seeing a physical therapist recommended to me because she is trained in the McKenzie technique. I went on-line and read in Wikipedia about the fellow who started this method. But I couldn't really find any place that explained why this method works any better than other approaches.

The McKenzie method is one particular testing and treatment approach for neck and back pain. Robin McKenzie's idea is that if neck or back pain location or intensity level can be changed with some simple repeated movements, then it is possible to predict a favorable or unfavorable response to treatment using McKenzie principles.

I had a nerve block last year that was supposed to put a stop to my chronic back and leg pain. The procedure itself was very painful. But once the nerve was numb, I felt much better. Now I need another injection. The surgeon is going to use ultrasound to guide the needle. This is supposed to be a pain free process. Is it really?

According to a recent study involving 78 patients who had an ultrasound-guided nerve block for L5 radicular syndrome, the procedure is painless. They all reported a tapping sensation but no pain and no muscle contraction. L5 radicular syndrome refers to pressure on the spinal nerve root located at the bottom of the lumbar spine causing back and buttock and/or leg pain.

I'm very disappointed because I was hoping for a nerve block in my back to stop the constant back and leg pain I have. But the X-rays came back and I'm not a good candidate for the procedure. What does that mean? What makes me unacceptable for this treatment?

Nerve blocks to reduce low back pain caused by spinal nerve impingement or compression is a fairly common way to treat this problem. But the nerve root is usually located deep in the spine and it is underneath a tough ligament called the lumbosacral ligament. Getting to the nerve with a long, thin needle is essential.

X-rays No Longer Needed to Guide Nerve Blocks

Improvements in technology continue to change the way medicine is practiced. In this study from Japan, physicians used ultrasound instead of X-rays to guide a needle in performing a nerve block. The procedure was effective for 75 of the 78 patients in the study. And the method proved to be safe as no one felt pain during the procedure or had any negative effects from the treatment.

I hurt my back at work several weeks ago and every time I think it's getting better and make plans to go back to work, my back gets worse. My boss wants me to go back but I'm afraid that I will just hurt my back again or worse. How can I convince him that I'm not ready?

Only your doctor can help you decide when you are ready to return to work, so the first thing to do - if you've not done it already - is have a talk with him or her. Discuss your pain, the type of work you do, and your fears about re-injuring yourself.

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