What are the differences between the different kinds of grafts?
The are three kinds of grafts that are in general use for spinal fusion operations: Autograft bone (usually harvested from the hip), Allograft bone (processed bone from cadaveric source), and Synthetic graft (Aka PEEK). The choice of the graft material used in your surgery is highly individualized and depends on several factors, such as, your age, smoking history, osteoporosis, and your preference. For example, some patients prefer their own bone, while others don't want to suffer from hip pain from the harvest procedure. While others are concerned about disease transmission with allografts. Overall, all three grafting material produce high degree of fusion with reliable and lasting results. Consult your surgeon for more details.
What is the affect of fusion surgery on my neck?
Single level anterior cervical fusion general does not result in any appreciable loss of motion. The most common levels for surgical intervention and fusion are the C5-C6, and C6-C7 levels. These levels contribute to a minor percentage of motion. Patient's with degenerative cervical disc disease in fact report better neck movement and less pain, since the fusion removes the offending degenerated painful disc.
How much pain will I have after the surgery?
Although all patients will have a degree of pain and discomfort after surgery, use of minimally invasive procedures and elimination of hip graft harvest from most of the anterior cervical procedures have significantly reduced postoperative pain and discomfort. Anterior cervical procedures are performed through a muscle-sparring technique with minimal blood loss. Most one and two level cervical fusion patients are in hospital for only an over-night stay.
Does the fusion take care of my neck pain and arm pain?
By design, anterior cervical discectomy and fusion removes the offending degenerated disc while removing bone spurs or herniated disc that cause nerve compression and arm pain. A great number of patients experience good to excellent outcomes as far as their radicular symptoms (i.e. arm weakness, numbness and tingling). To a lesser degree do we see total resolution of neck pain. Postoperative physical therapy and neck muscle strengthening play central role in postoperative recuperation of patients.
How about the risks of surgery?
Neck fusion, like any other surgery, carries the risks of infection, bleeding, and general anesthesia. If you are in good general health and pass your pre-operative physical, these general risks are very low. Specific risks related to the anterior cervical discectomy and fusion are related to damage in the structures of the neck, such as, the carotid and vertebral artery injury causing a stroke, vagus nerve injury causing vocal cord paralysis, vocal, esophageal injury, spinal cord and nerve root injury and cerebrospinal fluid leakage. Chances of serious and life-threatening complications are extremely low with a reported rate 1-3%. At DISC we are blessed with an even lower rate of such complications. Please talk to your surgeon for more details.
Will I have to wear a collar after surgery?
Indications for neck support and immobilization after surgery depend on several factors, such as, the number of levels fused, history of osteoporosis, smoking, and other pre-existing medical conditions that can impact the fusion rate. In an otherwise healthy patient who has undergone a one-level uncomplicated surgery with plate and screw supplementation, need for hard collar immobilization is obviated.
When will I be back to my normal activities like driving?
If your surgeon has not prescribed a postoperative cervical collar, you can start driving in about four to five days. It is not recommended to drive with the neck collar as it limits your ability to turn your neck. Once your surgeon has cleared you from wearing the collar, he/she will advise you regarding driving and resuming regular activities. Additionally, we ask you not to drive if you are still taking narcotic pain medication, or other medication that can impair your judgment.
The last time I had back pain, I heard the doctor use the term "conservative treatment." What does that mean?
In the medical world, conservative treatment is usually any treatment that is not invasive or surgical. That means, nothing is inserted into your body and no surgery is performed. In the case of treating a neck injury, conservative treatment could mean physiotherapy, medications, exercise, heat/cold treatments, or bracing to keep your neck steady. Unless it is urgent that surgery be done, as can be in some cases, conservative treatment is usually among the first options.
What does it mean when they say multidisciplinary treatment works for chronic back pain sufferers? I've had back pain for years. Maybe something like this would work for me.
The problem of chronic low back pain (LBP) is faced by many people each day. Finding a way to manage it is the goal of many research studies. Taking a look at studies done all over the world has shown us that many different therapies combined together may make the difference. That's what is referred to as a multidisciplinary approach. It starts with intensive physical exercises along with behavioral therapy. Cognitive and behavioral therapy helps patients change the way they think about and respond to pain. Instruction to help educate patients is essential. Improving skills for coping psychologically and emotionally is also included. The goal is to increase function and activity even if pain levels don't change. Many patients want to get back to work. This may be possible with work-related and vocational training. Studies show that people seem to do better when they get instruction and education to help explain their back pain there may be neurological/orthopedic spinal surgeons, physical medicine and rehabilitation specialists, chiropractic/soft tissue care, pain management physicians along with alternative practitioners of acupuncture and oriental medicine on the team. At D.I.S.C. we provide this multidisciplinary approach offering a wide range of therapies which may help improve your pain and increase your functional abilities
I had surgery for spinal stenosis six months ago. I suppose I should be thankful that my back pain is all gone. I can walk now without stopping every few feet. I do have some residual numbness and weakness on that side that I'm not happy about. Is there anything that can be done about this?
When conservative measures fail with spinal stenosis, surgery may be the next step. Stenosis refers to a narrowing of the spinal canal. Congenital narrowing, combined with degenerative changes that come with aging, often bring on painful symptoms. Conservative care is always the first line of treatment. Rest, antiinflammatory drugs, and steroid injections often work well. But when nonoperative care doesn't change the symptoms, then decompressive surgery is considered. In this operation, a portion of the bone around the spinal cord is removed. This takes the pressure off the spinal cord or spinal nerves. But sometimes the neural structures were pinched long enough and hard enough before surgery that there is some loss in sensory and/or motor control. This may be temporary or permanent. Nerve tissue can heal but it's a very slow process. Time can help resolve these final symptoms without further surgery. In some cases, a rehab program may also be beneficial.
I have always been very active and in good shape. Now at age 72, I find out I have spinal stenosis. How can this happen when I exercise every day, eat right, and take good care of myself?
Spinal stenosis is no respecter of persons as the old expression goes. It is a degenerative condition of the spine brought on by aging, not activity. Stenosis refers to a narrowing of the spinal canal and openings for the spinal nerves. Changes in the bones, soft tissues, and joints contribute to stenosis. For example, the broad band of ligament that runs down the spine called the ligamentum flavum (LF) starts to thicken. It can even get pinched between the vertebral bones causing additional pain. The vertebral bodies start to weaken and compress. The discs thin out and lose their soft flexibility. The vertebrae and joints start to move closer together. Bone spurs form around the joints. The joints may become misshapen and lose their normal ability to slide and glide. The joints may no longer fit together and move smoothly. This adds to the problem. Some people are born with a narrow spinal canal. This is not a problem during the younger years. But with the changes described here, the spinal opening is gradually closed off. Pressure on the spinal cord or spinal nerves causes back and/or leg pain.
My doctor is suggesting that I have back surgery to help my chronic pain. What should I consider before agreeing to it?
Without knowing exactly what the problem is and the type of surgery your doctor is proposing, it's not possible to get specific. However, most surgeries do have the same types of issues. First, how bad is your pain? Is it affecting your lifestyle? Have you tried various pain relieving medications and/or physiotherapy, or other treatments? Has it affected your ability to move around or control your bladder or bowels? These are some things to consider. You will need to weigh the potential benefit of surgery against the potential complications. Like most surgeries, there is a chance of infection, bleeding, or blood clots. And, of course, there is always the chance that the surgery is not successful. This is something you must discuss with your doctor before you make any decisions.
What is the difference between a bulging disk, a slipped disk, and a herniated disk?
It can be confusing when you hear different terms being used for the same thing. Bulging, slipped and herniated disks are all the same thing. Other names used are: compressed, prolapsed, and ruptured disks. Your backbone is made up of small bones called vertebrae. There is a gel-like substance between the disks that cushion them and keep them in place. Sometimes, a back injury results in a disk moving and pressing on a nerve. That's what causes the pain.
I knew I had a bad lumbar disc but I put off having surgery. Now I've developed a drop foot from pressure on the nerve. Did I wait too long?
Drop foot (sometimes called foot drop) is caused by pressure on the spinal nerve root as it leaves the spinal cord. A bulging disc or other degenerative disorder of the lumbar spine can have this effect. Nerve impairment can result in muscle weakness. When the L5 nerve is affected, motor loss of the tibialis anterior muscle can occur. The tibialis anterior is the muscle along the front of the lower leg. It pulls the foot up toward the face. Weakness of this muscle results in the toes dragging along the floor as the foot and leg move forward. Surgery to remove pressure from the nerve can prevent this problem from happening. For those patients who don't have the surgery soon enough, drop foot can be permanent. The sooner surgery is done, the better your chances are for full recovery. In a recent study from Japan, researchers found that more than half the patients did recover function. Only about one-third had a complete recovery. These patients were younger, had greater strength of the tibialis anterior muscle before surgery, and a shorter duration of symptoms. You have a much better chance of recovery with the surgery than without. Talk to your surgeon about what to expect. Motor recovery can be a slow process taking up to two full years for complete return of strength