Spinal Fusion Options - Roads to Recovery

spinal stenosis

Spinal fusion has become a very common surgical procedure in the United States over the past 10 years. There are many diagnoses that range from fractures of the spine to severe degenerative disc disease that prevent patients from being able to stand or walk are best treated with a surgical remedy. This article is intended to provide a basic review of the many spinal fusion options that are available. It is best to talk to a fellowship-trained spine surgeon who will be able to give you a complete picture of all of the devices available that are recognized for quality and reliability or to help you rule out those that are not recommended.

As the number of spinal fusions has increased, the variety of procedures and hardware alternatives that are available has also increased. It may be easier to understand why there are so many types of fusions if you consider how fractures need to be fixed with fusion. With broken bones, there is usually little question about the wisdom of providing casts or plates and screws to stabilize bones that need to be realigned or stabilized. Spinal fusion provides the same stability for the spine as is used for other fractured bones. What is a spinal fusion? Screws and rods in the spine are used to keep bones from moving as the bone graft that is placed allows the stabilized bones to form a connection across a previously mobile disc space. The growth of bone between 2 previously mobile bones is called fusion.

Standard fusion technique: Initially, fusion of the vertebral bones was done by laying bone graft between the bones, to provide a scaffolding across which the native bone cells could grow. As the patient's bone cells move across the bone graft, they are able to incorporate the bone graft into the patient's own bone structure, forming a complete connection called a fusion. Bone graft is of primary importance in allowing the vertebral bones to fuse across a previously mobile segment. Studies of patient's with fusions done with bone graft alone have shown a relatively good rate of incorporation when patients are placed in back braces for 3 months or more. Because of the inconvenience and discomfort of the bracing, pedicle screws and rods have been added to provide an internal support that obviates the need for external supports. Internal screws and rods have increased successful fusion rates, as well as allowed patients to become mobile very quickly after the spinal fusion.

Interbody fusion cages: As the skill of the surgeon's has grown when applying screws and rods to the spine, we have, in turn, looked for better ways to gain improved results. Now, we are able to put bone graft around the back of the spine, as well as into the disc spaces. With these improved grafting methods, we are able to safely access the lumbar disc from the back of the spine. Adding bone graft to the disc increases the surface area for healing and should improve the overall success rate of the spinal fusion. Interbody grafting can be done from several different approaches, as access to the disc space can be achieved from multiple directions.

XLIF: This acronym stands for extreme lateral interbody fusion. XLIF is a newer device designed to provide a carrier for bone graft and support to the disc space. It is placed through an incision on the patient's flank. By making an incision on the patient's side, the abdominal contents can be moved out of the way for a good view of the spine. Unfortunately, there are some significant nerves in the front of the spine that are very sensitive to being moved. This type of access to the spine can lead to weakness in one leg because of the sensitivity of these nerves. At this time, there are no long-term studies that demonstrate success of this procedure.

AxiaLif: This is another fusion device that has received some attention, due to its being touted as the "least invasive spine fusion". This device is placed across the lowest disc space by access from the front of the sacrum (a large, triangular bone at the base of the spine, inserted like a wedge between the two hip bones). By placing instruments through a small incision near the rectum towards the spine, the disc is accessed through a series of cannulas (hollow surgical tubes) and drills. This allows the disc material to be removed from the disc space. After the disc material is removed, bone grafting can be placed into the hole that is created. This disc space is then supported by a tapered screw placed into the bones. So far, this device has had minimal post-surgical study and is most likely best done in conjunction with standard screw and rod fusion techniques.

Flexible Rods: There has been some recent excitement around rod and screw systems that are so-called "non-fusion" fusion devices. This confusing name infers that, although the intent of the screws and rods is for the bones to not move, these devices are designed to allow some movement. As was discussed earlier in this article, fusion is the solid connection of bones that had previously moved. The idea of these flexible rods is to provide "enough" stability to allow the bones to fuse together, but not enough to change the forces in the spine. This is termed a "soft-fusion". At this point, there is no consensus as to how much or how little support is needed to achieve this goal. It is known that current screw and rod systems provide enough support to allow a fusion to occur while providing complete immobility of the vertebrae. Other than this complete connection, the amount of support less than complete immobility has not been defined and at this point is still under investigation.

Disc Replacement: Disc replacement was developed as an alternative to fusion and is suggested for those discs that have ruptured, but in which the bone structure is still good. If only the disc has gone bad, removal of the disc leaves a space that we normally fill with bone graft to promote fusion in the neck or lower back. With the development of the disc replacement, the space that is left from disc removal can be filled with a device that allows motion, rather than fusion. This is a complete reversal in the approach to disc removal; from complete immobility to complete mobility. Disc replacement is intended to maintain the motion in the spine. This reconstruction of the spine should maintain the forces across the discs in the spine to prevent the other discs from deteriorating any more rapidly than their normal degenerative process. Disc replacement in the lumbar spine has met with some success in well-selected patients. It has not been a panacea for all patients with low back pain or degenerative disc disease. Disc replacement in the cervical spine has had good success, as most neck fusions are done for bad discs with the bones being in good condition.

Improved training, including advanced specialty training in fellowship programs, as well as improved implants, has decreased most surgical procedure times to 2 hours or less. Historically, older techniques have been known to take 4-6 hours for the operation alone. By decreasing operative times, surgeons have seen decreased complications from the anesthesia, as well as decreased risks of infection and blood loss. Most surgeries under 2 hours will not require a blood transfusion.

A well-informed patient, who understands the benefits and the risks of their surgery, can fully participate in the choices that need to be made about their surgery. If you have been told that you need a spine fusion, ask questions and do your research. It is appropriate to ask your surgeon about their experience performing spinal fusions, how many of the fusion procedures they perform, how long the operation will take and the likelihood of needing a blood transfusion. Selecting a well-qualified surgeon can help ensure the best outcome for you and the success of your spinal fusion.

Pinched Nerves Cause Back Pain

spinal stenosis

Everyone has at one time or another applied too much pressure to the "funny bone" in their elbow which is actually the ulnar nerve. This physical pressure disrupts the nerve's function causing pain, tingling, numbness or weakness from the elbow into the fingers of the hand. Too much pressure applied for too long to a nerve along the spine results in much the same sensations. Where these sensations occur naturally depends upon the pathway of the specific involved nerve as illustrated above.

Nerve pain resulting from direct physical pressure is called an entrapment neuropathy because the nerve is trapped or pinched by some structure. This term helps to distinguish them from neuropathies resulting from infection or disease where the nerve pain is more often referred to as neuritis or neuralgia.

Radiculitis / Radiculopathy

These are not specific conditions, but rather describe a nerve that is being pinched at or very near the spinal cord at the beginning or ''root'' of the nerve. Radiculitis is from Latin radiculo for root plus itis for inflammation. Radiculopathy comes from the same Latin radiculo for root plus Greek pathos for suffering. There may be slight technical differences between the two words but in truth they are often used interchangeably without clear distinction.

In a radiculitis or radiculopathy the pinch is occurring at or near the root of the nerve along the spinal cord. The most common cause of this physical pressure is a herniated or protruding spinal intervertebral disc crushing the nerve against the bone resulting in pain at that level of the spine in the neck or back, and of course, along the pathway of the adjacent nerve root itself resulting in arm pain or leg pain through a process called referred pain or radicular pain. For example, a nerve root impingement in the neck, or cervical spine, can produce pain, motor weakness, or sensory paresthesia in the shoulder, arm or hand which is called brachial radiculitis from Latin brachio for arm or more simply a cervical radiculitis or cervical radiculopathy. Likewise, a nerve root impingement in the lower back or lumbar-sacral spine can be manifested with symptoms in the lower extremity, a lumbar radiculitis or lumbar radiculopathy. This can result in pain, weakness, numbness, or paresthesia in the butt, hip, leg or foot. This is often called sciatica, a reference to the nerve that is being pinched. Sciatica due to compression of one of the lumbar nerve roots is one of the most common forms of radiculopathy.

Neuritis / Neuralgia

Neuritis is from itis for inflammation and neuro for nerve. Neuralgia is from the Greek algos for pain and neuro for nerve. The difference between neuritis and neuralgia are again technical and these terms too are often used interchangeably. The most common cause of neuritis or neuralgia are generalized metabolic issues such as those that occur as a result of diabetes or alcoholism, and as such, the nerve dysfunction is generalized and widespread as opposed to being one specific nerve root such as in sciatica that is caused by direct physical pressure. Acute or chronic Poisoning most commonly by lead, arsenic, mercury, copper and phosphorus also results in widespread nerve dysfunction also correctly termed a neuritis or a neuralgia.

Alternative Treatment for Degenerative Disk Disease

spinal stenosis

Intervertebral discs are the cushions of cartilage in between every vertebra in the spine. If the spine experiences even the smallest amount of trauma it can then rupture, cause inflammation, or bulge the disc.

Numbness and tingling in the bilateral extremities, with radiating pain, is a common sign of someone with degenerative disc disease, even worse if the disease is irritating adjacent nerve roots. Symptoms normally appear when the disc puts pressure on the nerve root. The chiropractic approach to disc degeneration is to reduce inflammation and improve the motion in the spine. If the chiropractor sees it necessary to help with his diagnosis, he may send the patient for an MRI or CT scan for further evaluation. There are three types of spinal manipulations for disc problems:

Flexion-distraction technique: A non-thrusting technique that is normally used on herniated disks or the treatment of spinal stenosis.

Specific spinal manipulation: The restricted joints are identified and treated by the chiropractor, restoring movement back into the joints.

Instrument-assisted manipulation: This technique is performed with a handheld instrument, typically an activator.

Many chiropractors offer manual therapy to their patients in addition to the spinal adjustment. Trigger point therapy involves pressure being put on the painful spots to relieve the tension. Therapeutic exercises, such as stretching and resistance techniques, help prevent symptoms from getting worse.

Degenerative disc disease is most commonly diagnosed in people who have suffered an injury to their disc because they degenerate quicker. There are a few different types of disc injuries:

Disc tear: Located in the outer cartilage where fluid starts to leak out.

Bulging disc: The jelly substance centered in the middle of the disc is pushed to one side and begins to swell.

Herniated disc: The jelly substance ruptures through the fibers on the outside and extends past the normal position.

Prolapsed disc: A fragment of the disc breaks away becomes a free-floating piece.

Desiccated disc: The disc loses the fluid inside, degenerates, and wears down. This takes place right before the bones start to fuse together.

Optimal functioning of the musculoskeletal system is a necessity for good health. 60% of the human body consists of bones, muscles, tissue, and nerves which are all part of the musculoskeletal system. Chiropractors are experts in this area, so it's only wise to seek out and receive chiropractic treatment for degenerative disc disease. Many patients have avoided unnecessary surgery or a pill dependency because they chose the best approach to natural healing.

Herniated Disc Treatment Options You Should Consider

spinal stenosis

Without the require for any kind of herniated disc exercises and herniated disc treatment, many research have revealed that the the vast majority of herniated disc cases and its symptoms will deal with themselves in about six weeks. Noticeable development was confirmed in 73% of patients after 12 weeks even without surgery. Naturally, as a result of chemical radiculitis, a doctor may prescribe NSAIDs to relieve lower back pain. Prolonged use of NSAIDs however, may bring about cardiovascular and gastrointestinal health complications.

Epidural Steroid Injections. These have been observed to give only temporary alleviation in a few selected instances and may also lead to serious side effects. Precisely focusing on TNF to reduce discomfort, etanercept is one medication that is in its experimental stage. However, if employed as part of a herniated disk treatment, it may be a very costly answer for any patient.

Chiropractic Care. Medical trials on osteopathic and chiropractic spinal manipulation have generated contradicting results. Though allowed for patients who have encountered relief with this procedure, the WHO has disapproved spinal manipulation in cases of frank disc herniation accompanied by signs of progressive neurological deficiencies.

Spinal Decompression. This is an appealing treatment that has displayed efficiency in providing alleviation not only to disc herniation patients but also to chronic lower back pain caused by other problems. Usually mistaken for typical traction, spinal decompression involves accumulating negative pressure into the spine that would draw extruded materials back into the disc center. This is specifically productive in sciatica. An in depth discussion on spinal decompression can be seen in the page.

Surgery. This is done as well for slipped disc treatment, is only considered when all conventional treatment choices have been taken and healing of the disc herniation and pain alleviation has not been achieved. In instances of significant neurological deficits like caude equina syndrome, surgery may also be necessary. The goals of surgery are the relief of nerve compression (in order to improve healing of the afflicted nerve), alleviation from the accompanying back pain, and the repair of normal function in the patient.

The following are surgical choices for herniated discs:

• Discectomy/Microdiscectomy - Nerve compression alleviation;


• Hemilaminectomy/Laminectomy - Performed to ease compressed nerve and address spinal stenosis;


• Chemonucleolysis: Conducted to fix protruding, bulging, or ripped discs;


• Lumbar fusion - Patients with repeating lumbar disc herniations should undertake this procedure;


• Dynamic stabilization - Uses bendable materials to strengthen the spine if it is affected by degenerative variations;


• Intradiscal Electrothermal Therapy (IDET) - A heat probe is used to shrink disc tissues and cauterize small disc nerves;


• Nucleoplasty - Tissues in the nucleus pulposus are ablated and taken away using Coblation簧 technology and this disc decompression procedure is minimally invasive

Artificial Disc Replacement. The stem cell therapy is one type of herniated disc treatment presently being researched. Intervertebral disc degeneration can be stopped or partial regrowth of the disc is plausible with the autogenic mesenchymal stem cells being experimented on animal specimens.

What Is Sciatic Nerve Pain?

spinal stenosis

Sciatic nerve pain is more commonly referred to as sciatica. It's a type of pain that is due to an irritation in the sciatic nerve. Usually, the pain starts on the lower back or lumbar area and then spreads down the thigh, until the knee. The reason behind this is that the sciatic nerve is located from the spinal cord in the lumbar area and extends down the buttocks. It is the largest nerve in the body.

The pain can also radiate to the hips. It can make walking extremely difficult or even impossible. Aside from the pain, sciatica also has other symptoms. A person may also feel numbness and tingling or burning sensations from the lower back area, upper buttocks, thigh or the back of his legs. Sometimes, these symptoms are worsened by bending the waist or by walking. It may be partially or completely relieved by lying down.

There are several causes for lower back pain. Usually it is caused by a lumbar disc hernia that presses directly on the nerve. This could either cause an inflammation or irritation in the sciatic nerve. Other causes can include tumor growths, infection, internal bleeding, trauma, and different injuries. The nerve can also be irritated by any adjacent muscle or bone. On some cases, it could also be caused by pregnancy.

The three common causes of sciatica are spinal disc herniation, spinal stenosis and piriformis syndrome. In a spinal disc herniation occurs when a person suddenly bends or twists their waist. When the spinal disc is herniated, it can press on a nerve and cause swelling on the surrounding tissues, which further progresses on the nerve. With lumbar spinal stenosis, the space for the spinal cord is narrowed. It pinches and irritates the nerves including the sciatic nerve. Piriformis syndrome is a condition wherein the sciatic nerve goes through the piriformis muscle instead of underneath it. When this muscle is overused or injured in people with this syndrome, it compresses or strangles the sciatic nerve, causing lower back pain.

In order for lower back pain to be treated, it needs to be diagnosed first. Checking for the symptoms, along with a physical exam and medical history will help with the diagnosis. Diagnostic tests such as electromyogram, X-rays, MRI and CT scans are helpful for determining what the exact cause is.

There are several treatment options for sciatica. Aside from treating the underlying cause, medications and physical therapy are also helpful. The main goal of medications is the relief of pain and inflammation. On the other hand, physical therapy focuses on strengthening the back. Lower back stretching and conditioning exercises greatly help people with their recovery. Although bed rest is not an absolute essential for recovery, it still helps relieve symptoms and it is still being encouraged. On some cases, surgery is needed to treat sciatic nerve pain. It is indicated for persisting and chronic sciatica that is due to a compression of a nerve in the lower back area. Other times, specialists on pain management are consulted to help people treat with chronic sciatic nerve pain.

Correlation Between Reduced Cervical Lordosis (Curvature) and Neck Complaints

spinal stenosis

An average person takes approximately 10,000 steps per day. At the very top of your spine rests a 4 kilogram object called your head that bounces up and down with every single step. The cervical spine, also known as the neck, takes most of the compressive forces from this undulating motion. The neck should have a curvature somewhere between 31-40 degrees. However, if this is reduced, the force gets distributed unevenly and leads to early degeneration, neck pain, headaches, and many other neck related symptoms.

The Correlation

The neck is composed of 7 vertebrae that protect the spinal cord. Many of the nerves that exit the neck control the upper back, arms and hands, and the entire head and face. The curvature of the cervical spine allows for weight to be transferred evenly which distributes the force onto the rest of the spine. According to a study published in the JMPT in 2005, a "clinically normal" range for cervical lordosis should be between 31 and 40 degrees. It was also found in the same study that "the odds that a patient with cervical pain had a lordosis of 0 degrees or less was 18 times greater than for a patient with a noncervical complaint."

Cervical pain and headaches are two of the most common and debilitating spinal problems. There is a direct correlation between the structure and function of the cervical spine and the symptoms that ensue.

In the study mentioned above, the entire sample set had an average cervical curve of 14.5 degrees whilst the average symptomatic curve was just 9.6 degrees. There appears to be no trend seen in age. Also, a study entitled "Cervical Lordosis and Headaches" linked the relationship of "altered cervical curve configuration to the presence of chronic headache pain."

The primary goal is prevention. The development of the cervical lordosis happens when an infant begins to crawl. A more normal curvature can be attained later in life, but is much more difficult to achieve.

Chiropractic Care

Chiropractic care addresses the underlying problem and helps to promote and restore proper cervical structure and function. A chiropractic adjustment can help alleviate the stress placed onto the nervous system, but the patient needs to also change postural habits and other contributing factors. The largest factor that reduces the cervical lordosis is poor posture.

In today's computer-reliant society, there is more and more degeneration of the cervical spine. Chronic forward head carriage leads to a reduced cervical lordosis which then translates to a plethora of neck symptoms in most cases.

A key component to caring for a person with cervicogenic symptoms is restoration of cervical lordosis.

Very gentle stretches and exercises may be added during the care process but should also be monitored closely. The focus should be on neck support to better stabilize the head and distribute the weight and force of the head onto the neck properly. Balance may also be another underlying cause contributing to poor neck posture. The brain may have conflicting information signalling where the body is in space and therefore positioning is altered.

Most importantly, people need to be aware of how they use their body on a daily basis. Headaches and neck pain are not normal and should never occur. I cannot stress the importance of good posture enough and the impact it can have.

How To Use Magnetic Therapy To Treat The Pain Associated With Cervical Spondylosis?

spinal stenosis

What is Spondylosis?

Spondylosis (spinal osteoarthritis) is a degenerative disorder that may cause loss of normal spinal structure and function. Although aging is the primary cause, the location and rate of degeneration is individual. The degenerative process of spondylosis may impact the cervical, thoracic, and/or lumbar regions of the spine affecting the inter-vertebral discs and facet joints.

Lumbar spondylosis refers to any narrowing of the spinal canal. Cervical Spondylosis refers to a degenerative process of the cervical spine producing narrowing of the spinal canal producing compression of the spinal cord and nerve roots.

Causes and symptoms:

As people age, shrinkage of the vertebral disks prompts the vertebrae to form osteophytes to stabilize the back bone. However, the position and alignment of the disks and vertebrae may shift despite the osteophytes. Symptoms may arise from problems with one or more disks or vertebrae.
Osteophyte formation and other changes do not necessarily lead to symptoms, but after age 50, half of the population experiences occasional neck pain and stiffness. As disks degenerate, the cervical spine becomes less stable, and the neck is more vulnerable to injuries, including muscle and ligament strains. Contact between the edges of the vertebrae can also cause pain. In some people, this pain may be referred (that is, perceived as occurring in the head, shoulders, or chest, rather than the neck). Other symptoms may include vertigo (a type of dizziness) or ringing in the ears.
The neck pain and stiffness can be intermittent, as can symptoms of trapped nerves (radiculopathy). Radiculopathy refers to compression on the base of nerves that lead away from the spinal cord. Normally, these nerves fit comfortably through spaces between the vertebrae. These spaces are called intervertebral foramina. As the osteophytes form, they can press on this area and gradually make the fit between the vertebrae too snug.

The poor fit increases the chances that a minor incident, such as overdoing normal activities, may place excess pressure on the nerve root, sometimes referred to as a pinched nerve. Pressure may also accumulate as a direct consequence of osteophyte formation. The pressure on the nerve root causes severe shooting pain in the neck, arms, shoulder, and/or upper back, depending on which nerve roots of the cervical spine are affected. The pain is often aggravated by movement, but in most cases, symptoms resolve within four to six weeks.

Cervical spondylosis can cause pressure on the spinal cord. Spinal stenosis is a narrowing of the spinal canal-- the area through the center of the vertebral column occupied by the spinal cord. Stenosis occurs because of misaligned vertebrae and out-of-place or degenerating disks. The problems created by spondylosis can be exacerbated if a person has a naturally narrow spinal canal. Pressure against the spinal cord can also be created by osteophytes forming on the inner surface of vertebrae and pushing against the spinal cord. Stenosis or osteophytes can compress the spinal cord and its blood vessels, impeding or choking off needed nutrients to the spinal cord cells; in effect, the cells starve to death.

With the death of these cells, the functions that they once performed are impaired. These functions may include conveying sensory information to the brain or transmitting the brain's commands to voluntary muscles. Pain is usually absent, but a person may experience leg numbness and an inability to make the legs move properly. Other symptoms can include clumsiness and weakness in the hands, stiffness and weakness in the legs, and spontaneous twitches in the legs. A person's ability to walk is affected, and a wide-legged, shuffling gait is sometimes adopted to compensate for the lack of sensation in the legs and the accompanying, realistic fear of falling. In very few cases, bladder control becomes a problem.

Magnetic therapy treatment of Spondylosis:

It is relatively easy to treat Spondylosis with magnetic therapy. As stated above the main causes of pain in spondylosis is muscle and ligament strains plus pressure in the nerves in the neck and spinal cord. Placing magnets around the area damaged by spondylosis will speed up the healing process in muscle and ligament damage and reduce the pressure on the nerves. Because much of the pain that is experienced from spondylosis is referred, this means the cause is in one area e.g. the neck ad the pain appears elsewhere e.g the arm and hand, you do not have to treat all of the painful areas individually. For example if you have spondylosis in the neck the swelling and pressure upon the nerves in the neck can cause pain, pins and needles and numbness to radiate down the arm and into the hand and fingers. There is no injury in the arm or hand but the pain is caused by the neck is felt there. By applying magnets to the cause of the problem, which is spondylosis in the neck, as soon as the symptoms in the neck have been relieved then the pain and numbness in the arm will reduce as well.

There are many magnetic therapy devices that can treat the neck, shoulders and back area. Although spondylosis is mainly thought of as a neck and shoulder ailment it is also possible to have lumber (lower spine) spondylosis. The treatment for lumber spondylosis remains the same to treat the area of injury with the magnets and any referred pain will also be reduced.

Common magnetic therapy treatments for cervical (neck)spondylosis are:

1. A magnetic therapy necklace or neck wrap. Most magnetic necklaces are higher strength than functional wraps. To efficiently treat widespread spondylosis that affects the neck, shoulders, head and arms, super strength magnets (2,500-3,000 gauss/250-300 millitesla) need to be applied. If a necklace or wrap is worn with a least 8 of these magnets the magnetic field will be able to reduce the symptoms in the neck plus the shoulders, head and arm areas with out any other magnets.

2. Magnetic therapy pillow pad. If a person is unable or does not want to wear magnets around the neck area, a magnetic pillow pad can be used as an alternative. The pads are placed into the pillow case and only used at night time. It is advocated that magnets are worn 24 hours a day 7 days a week until the symptoms are gone, but if they ca not be tolerated during the day then the best alternative is to use them at night time, as this is the time when the body enters it's healing phase, so the penetration and uptake of the magnetic field is at its strongest during sleep.

Common magnetic therapy treatments for lumbar spondylosis are:

1. A functional magnetic therapy back strap or support. The strap or support needs to be placed directly over the area of damage. Magnetic straps tend to be narrow around 1.5 inches wide so they are very easy to wear. They can be placed low around the back over the hips to ensure they contact with low lumbar spondylosis, but they can also be worn high around the thoracic (chest) area in high lumbar or thoracic spondylosis. Most narrow straps have adjustable fastenings to give the wearer flexibility of placement. These types of straps are the most comfortable and easy to wear. How ever if the damaged area is around waist height a wider more supportive belt may be required, provide support whilst bending. Supports are most beneficial to people with an active lifestyle who make vigorous movements through the waist area, such as golfers and builders. Whether a narrow strap or a wide support is chosen the same rule applies it must be worn night and day until the pain has gone, so it is advisable to try both types of strap before purchasing.