On this page, we’ve answered some of the most frequently asked questions about spinal surgery and other back pain treatments. We regularly update our FAQs, but if you don’t find what you are looking for, just ask one of our spine experts by calling 727-MY-SPINE.
Q: Which part of the spine is the most flexible, and why?
A: The amount of flexibility or mobility in each segment of the spine depends on the shape, size, and spacing of the vertebrae. It also depends on their attachment to surrounding structures. For example, the thoracic segment is the least flexible portion of the spine because each thoracic vertebra is tethered to a pair of ribs. Nevertheless, the thoracic vertebrae do bear weight and allow rotational movement. Your cervical spine is the most flexible segment, followed by the lumbar spine.
Conservative Back Pain Treatments
Q: What does “conservative treatment” mean?
A: In the wide range of treatment options for back and neck pain, you may hear the term “conservative therapy”, “conservative treatment” or “conservative care”. This applies to a number of non-surgical (non-invasive or less-invasive) therapies which should be tried before you even consider spine surgery.
Physical therapy, chiropractic care, and over-the-counter pain medications are among the most common first line treatments which can help manage or improve your back condition. Other complementary and alternative medical (CAM) treatments that may be recommended are acupuncture, massage and even yoga.
If pain and physical limitations persist after three to six months of conservative care, your doctor may recommend a course of epidural spinal injections (steroid shots) or other pain management treatment.
The bad news is, it may take up to a year to find an effective way to stop your back pain. The good news, however, is that up to 90% of spinal problems can be resolved without surgery. For more information on Inspired Spine’s conservative therapy protocols, please refer to our non-surgical Back Pain Treatments.
Q: What does Complementary and Alternative Medicine refer to?
A: Complementary and Alternative Medicine, also known as CAM, is commonly used to describe treatment approaches that are outside the realm of traditional Western medicine. Examples would include Acupuncture, Chiropractic Care, and even Yoga. Recently, the National Institutes of Health has divided this concept into 2 separate categories:
- If a non-mainstream practice is used together with conventional medicine, it’s considered “complementary.”
- If a non-mainstream practice is used in place of conventional medicine, it’s considered “alternative.”
In reality, most people in the US who use non-mainstream approaches use them along with conventional treatments and the two approaches are becoming more integrated into our healthcare system.
Q: What is Transcutaneous Electrical Nerve Stimulation (TENS)
A: TENS therapy is a pain management treatment that uses a small battery-powered unit to deliver a low-voltage electrical current to painful muscles in the back. This sensation may trick the brain into focusing on the harmless electrical stimulation generated by the TENS unit, rather than on pain signals arising from the same area.
Q: What is Ultrasound Therapy?
A: If “an ultrasound” conjures up those cute pre-natal pictures that excited parents-to-be post on Facebook, you’re thinking of diagnostic ultrasound imaging–just one use for this soundwave-based technology. However, ultrasound treatment for back pain is actually a very popular physical therapy technique that has nothing to do with imaging.
Ultrasound therapy uses very high frequency sound waves to focus energy on soft tissue deep within your body. The resulting heat increases blood flow, reduces inflammation and promotes healing. What’s more, therapeutic ultrasound is quite painless and doesn’t require any needles or incisions. All that’s needed is to apply a jelly-like substance to the skin area to prevent friction as the ultrasound device gently massages the affected area of your back.
Diagnosing Back Pain
Q: What is a discogram?
A: A discogram is a diagnostic test that is used to help identify exactly which disc (or discs) of your spine cause your back pain. Spoiler Alert: it’s not very pleasant. Because the whole purpose of the test is to make the painful disc act up.
Here’s how a discogram works: using a fluoroscope (a video x-ray machine) as a guide, the doctor injects the suspect discs with a dye, one at a time. The dye increases the pressure on the disc and surrounding nerves, making a bad situation worse. In short, getting the diseased disc to cry out in pain.
Q: Why is a discogram necessary?
A: A discogram is painful, so why would your doctor want to torture you? (See “What is a discogram?” above.) The simple answer is: to avoid unnecessary surgery.
You see, an MRI or CT scan doesn’t always get the whole picture. Or course, they can accurately spot degenerated or herniated discs, bone spurs, osteoarthritis and many other visible signs of spinal disease. However, these are merely anatomical signs of wear and tear that commonly show up as we age. In fact, degenerated disc disease is so common that it’s found in 90% of people over 65. Most cases don’t cause any back pain at all, and fewer than 10% need surgery.
So, in order to treat the pain, and not the anatomy, a discogram may be required to ensure that any subsequent treatment or surgery addresses the true source of your pain.
Q: What causes pressure on the cervical spinal cord?
Q: What is OPLL?
A: OPLL is short for Ossification of the Posterior Longitudinal Ligament—and it’s a fancy way of saying that a normally pliable ligament has changed into a bone or bone-like substance. This calcification of soft tissue is common in elderly east Asian populations. In Japan, OPLL is the leading cause of a painful compression of the spinal cord, called myelopathy.
Q: What is the Oswestry scale?
A: The Oswestry Disability Index (ODI) is an index derived from the Oswestry Low Back Pain Questionnaire used by medical professionals to measure the quality of life impairment of a person with low back pain. Zero is the least amount of disability and 100 is the maximum disability possible.
The questionnaire covers ten topics of everyday life ranging from intensity of pain to social life and sleep quality. Patients are given different scenarios on each topic that indicate varying degrees of disability and asked to check the one that most closely resembles what they are experiencing or feeling. Each question is then scored to obtain a disability index.
Q: Why am I asked to rate my pain at every visit?
A: Different patients experience pain differently and the 1-to-10 pain scale commonly used in the medical community is an attempt to quantify each patient’s subjective rating of her pain. What one person may rate a 7 (Very Severe Pain), another may rate a 4 (Moderate Pain). (For more information on the pain scale, see this article on our blog.) Therefore, the best measure of whether your condition is getting better or worse, is to compare your own pain assessment from one visit to the next or before or after treatment. That’s why you are asked to rate your pain every time you visit the doctor.
Q: What is Subluxation?
A: Subluxation refers to a misalignment of the vertebrae (from sub-, meaning “less than” and -luxation, meaning “dislocation”). It literally means a “partial dislocation”. It is commonly used in chiropractic theory, which holds that slight misalignment of the vertebrae can be the cause of many health problems. However, in traditional medical practice, it is one of the major indications of a spinal condition called spondylolisthesis.
Keyhole Back Surgery
Q: What is keyhole spine surgery?
A: Keyhole spine surgery is a minimally invasive approach that accesses your spine through a small portal (just 10 millimeters or smaller than a dime), rather than making a large open incision in your back. The portal avoids cutting, disrupting or damaging back muscles and ligament structures. As a result, you have less pain, a smaller scar and you get better quicker.
Q: How is keyhole spine surgery performed?
A: Keyhole spine surgery is performed by inserting long, thin surgical instruments through a narrow sheath that protects the surrounding muscles and nerves. The surgeon uses magnified fluoroscopic images (see “How is Fluoroscopy Used” FAQ below) displayed on TV-like monitors to guide the procedure.
Q: How is fluoroscopy used in keyhole spine surgery?
A: Fluoroscopy is used in keyhole spine surgery to provide what is called “indirect visualization”. Indirect visualization allows the surgeon to work through a small keyhole portal, rather than cutting down to the spine and pulling back all the muscles and surrounding tissue with retractors to expose it to direct view (known as “direct visualization).
Fluoroscopy is something like an x-ray movie. Radiographic C-shaped arms, called C-arms, provide a 360-degree view of the spine and the entire procedure in real time. With these highly magnified images projected on monitors, the surgeon has full view of his instruments as he works around the nerves and structures of the spine at all times—better than the view in direct visualization. In this way, the procedure can be guided more accurately, without damaging back muscles or surrounding tissue.
Q: What are the advantages of keyhole spine surgery?
A: The advantages of keyhole spine surgery are that you have a smaller wound, your back muscles are still intact and attached to your spine, and the operation is substantially shorter. This means you will:
- Have less bleeding and a reduced risk of infection and complications
- Have a shorter hospital stay – or go home same day
- Have less pain from the operation
- Recover faster and get back to your normal activities sooner
- Have a smaller scar
While all patients can benefit from the advantages of keyhole spine surgery, for some it can be literally be a life-saver. Most elderly patients with adult degenerative scoliosis (ADS), for example, could not endure a 4- to 5-hour open spinal fusion operation—nor the lengthy or demanding rehabilitation process it requires. Keyhole spine surgery, with its low risk, low surgical trauma and easier, faster recovery process, is the only surgical option for patients like these.
Q: How long does keyhole spine surgery take?
A: Operating times vary by the complexity of the procedure. For example, a single-level lumbar fusion (our keyhole OLLIF) takes about 45 to 60 minutes–approximately half the time of open lumbar fusion surgery. Less time in the OR means less anesthesia, significantly reducing the risk of the operation.
Q: What is intraoperative neuro-monitoring?
A: Intraoperative neuro-monitoring–short for intraoperative neurophysiologic monitoring (IONM)–is a standard safeguard employed in spinal surgery to reduce the possibility of nerve damage. Many different methods of testing electrical activity in the nerves can be used to detect any changes in nerve function during the operation and ensure that the flow of stimuli from the spinal cord through the nerves is not compromised in any way during the procedure.