Spine General (involves multiple spine areas)

Five Key Questions in Diagnosing and Treating Ankylosing Spondylitis

Two professors of medicine offer five key questions to consider when evaluating patients for ankylosing spondylitis (AS). Making an early diagnosis is important in developing a plan of care that will control symptoms. But making the diagnosis early can be a challenge because hallmark signs of AS seen on X-rays don't show up for seven to 10 years. These five questions can help doctors stay alert to the possibility of AS:

  • When should the physician consider AS as a possibility?

  • What's the difference between acupuncture and trigger point therapy? I've had both for chronic neck and back pain. I can't see that they are any different in how the treatment is done or the effects.

    Although both forms of treatment involve poking the muscles, the actual treatment method, approach, and philosophy are very different. Acupuncture is an ancient form of Chinese medicine. Thin, tiny needles are placed in specific points along an invisible line called a meridian.

    My sister has chronic headaches that seem to be connected with neck and shoulder muscle tension. She's going to try something called trigger point injections. What are these? How do they work?

    A trigger point (TrP) is an area of hyperirritability within a taut band of muscle. When pressed or palpated these points create a pattern of local and referred pain. Referred means the pain occurs at quite a distance from the points of local tenderness.

    If someone has pressure on the nerves in the spine, can they be permanently damaged?

    Yes, if there is heavy pressure and/or prolonged pressure on the nerve roots in the spine, it is entirely possible that the nerves become permanently damaged. If, however, the problem is removed as soon as possible, there is a chance that some recovery occurs.

    Alex Gitelman, MD, et al. Cauda Equina Syndrome: A Comprehensive Review. In The American Journal of Orthopedics. December 2008. Vol. 37. no. 11. Pp. 556-562.

    Trigger Point Therapy: Is It Safe? Does It Work?

    If you've ever suffered from chronic (day in and day out) neck, back, shoulder, or other muscle pain, you may have tried trigger point therapy. Needles are placed in painful areas of the muscles. Then a numbing agent and/or inflammatory drug such as steroids is injected at that spot. This treatment technique is the form of treatment we call trigger point therapy. Some people swear by it. Others receive little or no apparent benefit.

    What should I ask a doctor if I'm trying to find out more about him and his ability to do surgery on my back?

    It's always a good idea to make sure you feel comfortable with your surgeon. This means asking questions that may help you make your decision.

    I'm confused. I have a slipped disc in my back and I don't know if I want to have surgery. What are the risks of back surgery?

    Any type of surgery has its risks, back surgery is no different. If you have a surgery for a herniated, or slipped, disc, the risks involve a bit more than if you were having surgery on your knee though.

    My mother has spinal stenosis and her doctor wants to operate. I am against it because I know that if anything happens to her back in surgery, she may be worse off than she was before. What should I say to her?

    If your mother has had this discussion with her surgery and they both agree that this is the best thing, there may be no reason for you to try to talk her out of it. If you're concerned about the surgery, you could try to convince your mother to go for a second opinion to A) see if the surgery would help and B) if the second surgeon would do the same type of surgery or maybe suggest another one.

    Arguments Against Biopsychosocial Model of Spine Care

    Recently, a researcher, B.K. Weiner, published an article that focused on back pain being deemed biopsychosocial, related to biology, psychology, and social aspects of life. He combined this with the heuristic approach, which means problem solving for the most appropriate solution one step at a time, not necessarily the best solution.

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