Recently we have updated the educational resources on our Indiana Spine Group web site.  With this update, we included a few educational videos.  These videos include myself and other physicians with Indiana Spine Group discussing different topics; i.e. artificial cervical disc, spinal pain, spinal stenosis, etc.

Previously, I did a series of blog entries on osteoporosis and spinal fractures. In the next 25 years, the number of adults aged 65 and older are expected to double, according to a study by the Department of Health & Human Services Administration on Aging. With this increased longevity, it is also projected that the incidence of osteoporosis and subsequent spinal fractures will increase.

To help protect your bone health, which should begin as early as childhood, the Surgeon General’s office prepared a helpful resource. This resource entitled Bone Health and Osteoporosis, summarizes a two-year, 400 page report prepared by the country’s top experts on osteoporosis. To review this report, click here. Learn the facts about osteoporosis and how you can help prevent osteoporosis and improve your bone’s health. 

Another type of diagnostic procedure for back pain used by minimally invasive spine specialists is facet joint injections.   The facet joints are the joints that connect the vertebrae in the spine. Each vertebra has two pairs of facet joints. For a more detailed description and anatomical drawing of facet joints, click here.

When a person presents with back pain, a facet joint injection may be one of the diagnostic tests used to help determine the specific cause of the back pain. During this procedure a local anesthetic and sometimes steroids are injected into the facet joint. If the patient experiences near complete or complete pain relief following the spinal injection, the specific facet joint(s) is/are strongly suspected as a source of spinal pain. 

One test for diagnosing back pain for patients suffering from chronic lower back pain (lumbar spine) is a discogram. The objective of this diagnostic test is to determine if a suspected disc, or discs, is/are a potential source to a patient’s lower back pain.

To perform this spinal diagnostic test, the patient is given medicine intravenously for mild sedation. Using an X-ray machine called a fluoroscope, a needle is placed into the spinal disc(s) that are suspected to be causing low back pain, as well as an unsuspecting adjacent disc to serve as a ‘control.’ A dye is then injected into the disc(s) of which creates pressure in the disc and outlines its internal structure. 

In a normal disc, the patient typically experiences a slight pressure sensation in the back, and the X-ray image of the disc typically appears intact. If a disc is a source to a patient’s low back pain, the patient should experience pain similar in character and location of their usual low back pain. The X-ray image of a painful characteristically demonstrates a tear extending from the inner ‘nucleus’ through the outer ‘anulus.’

With this blog entry, I will answer a question recently asked by one of my patients.  What is celiac disease and is there a link between celiac disease and osteoporosis?

Celiac disease is a genetic, autoimmune disease affecting the digestive system.  In this disease, the lining of the small intestine is damaged by a protein called gluten.  This damage to the small intestine interferes with the absorption of nutrients.    Gluten is found in wheat, rye, barley – and also some medications/vitamins.  To learn more about celiac disease – visit this link.   

In respect to osteoporosis; one side effect of celiac disease is “brittle bones”.  Often celiac disease goes undiagnosed or is misdiagnosed, in that the symptoms vary in people and mimic other common aliments.  As a result of this, a research study was conducted at the Washington University Bone Clinic to determine if there was a link between celiac disease and osteoporosis.  This study concluded that celiac disease is uncommon, but individuals with osteoporosis were more likely to have celiac disease.  As a result of this study, researchers recommend that individuals diagnosed with osteoporosis to be screened for celiac disease (blood test). 

When you hear about osteoporosis, generally you think of it as a of older women.  Yes, osteoporosis is more common in females, than males.  But according to the National Osteoporosis Foundation, it is estimated that approximately two million males in the U.S. have osteoporosis.  It is also predicted that about 12 million men are at risk for developing osteoporosis. 

For men, here are some of the risk factors as identified by the National Osteoporosis Foundation:

1. Prolonged use of certain medications. For example, steroids to treat asthma or arthritis, anticonvulsants, aluminum-containing antacids and certain cancer treatments.
2. Chronic diseases that affect hormone levels such as diseases that affect the kidneys, lungs, stomach or intestines.
3. Undiagnosed low levels of testosterone.

Other risk factors for men, that are also risk factors for women include:  lifestyle, age, heredity and race. 

Diagnosing vertebral compression fractures can be difficult – in that X-rays do not always show the fracture.  In this instance, if the patient has back pain and an X-ray does not show a fracture – many times it is assumed that the back pain is caused by muscle strain.

That is why sometimes, it is important to see a spine specialist; i.e. a minimally invasive spine specialist that focuses on spine diagnosis and treatment.  One key component in diagnosing spinal fractures is the patient’s medical history.  Additionally, a clinical exam is important to determine the sensitivity and tenderness around the affected vertebrae. 

If a vertebral compression fracture is suspected, even if an X-ray does not show a fracture – other diagnostic tests may be ordered as a result of the patient’s medical history and clinical exam.  These tests can include a CAT scan, MRI or nuclear bone scan. 

If a vertebral compression fracture is diagnosed – it is important to determine the cause for effective treatment.  The most common cause of a vertebral compression fracture is osteoporosis but other causes are trauma or some types of cancer. 

If the cause of the vertebral compression fracture is determined to be osteoporosis, common treatment options include bracing, analgesics, medications to help sustain or restore bone mass, and vertebral augmentation. In vertebral augmentation, the goals of treatment are to stabilize and eliminate the pain caused by the vertebral compression fracture.  The two types of vertebral augmentation available include vertebroplasty and kyphoplasty. 

One of the most common causes of spine fractures – referred to as vertebral compression fractures, is osteoporosis.  One statistic projects that there are approximately 750,000 spine fractures resulting from osteoporosis per year in the U.S.

Many times, spine fractures resulting from osteoporosis are overlooked and not diagnosed.  Frequently, when older people complain of back pain – it is thought to be related to muscle strains or normal aches and pains due to aging.  It is important for individuals to recognize that if they have sudden acute back pain – following an activity such as golf (or other twisting), lifting or even a small fall – this could be the result of a fractured vertebra.  Following the acute pain resulting from the fracture – the pain may then lead to chronic back pain and therefore many times is thought of as just that – back pain.

When you think about osteoporosis and vertebral compression fractures – this does not just occur in the elderly.  Anyone who is 40 or over is susceptible to this – depending on their risk factors for osteoporosis.

If you suspect that your back pain is a result of a vertebral compression fracture, see your physician or a minimally invasive spine specialist.  For more information, call our office at 317.228.7000. 

One common term used to describe pain is sciatica.  Sciatica is used to describe the pain that radiates along the sciatic nerve.  The sciatic nerve is the longest and largest nerve in the body – connecting the spinal cord with the leg and foot muscles.  When someone has sciatic pain, they generally describe it as “shooting pain”. 

This pain is caused when the nerves in the lower spine are either compressed or irritated.  There are many causes of sciatica and a few include:  pinching or stretching of the sciatic nerve, herniated disc, spinal stenosis or spondylolisthesis, just to name a few.  

Many times, this pain will go away with minimal treatments; i.e. avoiding the activity that causes the pain, cold / heat treatments, pain relievers and/or exercise.  If this pain continues for more than 6 weeks or becomes severe, it is recommended that the individual see their physician or a spine specialist. 

There are many statistics out there about the prevalence about back pain.  The most common one is that back pain will affect 80% or 8 out of 10 individuals at some point in their life. 

There are four main types of back pain.  Here is an overview:

Acute Back Pain – This is short-term severe pain which is self-limiting.  This means that the back pain will generally go away within a few weeks.  Additionally, this pain generally causes you to limit the activities causing the pain – thereby reducing the chance for tissue damage.

Chronic Back Pain – This pain is ongoing and is persistent and is usually the symptom of an underlying cause.

Nociceptive Pain – This is localized pain that is caused by tissue damage to the joints, bones or muscles.  This pain has been described as sharp, throbbing or aching.

Neuropathic Pain – This is pain that occurs as a result of nerve damage.  It has been described as tingling, burning, or a squeezing pain.  Additionally, the individual may feel a shooting type of pain.

One of the tools that we use to diagnose back pain is selective nerve injections (SNI).  Imaging studies, such as MRI’s, do not always show which nerve is causing the back pain, and selective nerve injections are effective in helping us to isolate the source of the patient’s pain. 

With diagnostic selective nerve injection, just enough medication is used to numb one or two spinal nerves.  This medication is then injected, and this helps us to determine if the nerve root is causing the pain. 

Additionally, a study that I co-investigated concluded that selective nerve injections were also a valuable tool for patients requiring surgery for radiculopathy; a lumbar cervical decompression.  This study determined that selective nerve injections can accurately determine the presence of a specific painful nerve root in cases where physical exam and/or MRI findings are equivocal.  This helps spine surgeons determine their surgical treatment and oftentimes limiting its scope.  Here is a link to the research study. 

When osteoporosis results in a fractured vertebra, called vertebral compression fractures (VCF), a patient can have persistent pain.  This pain may interfere with normal activities.  Fortunately, there are treatment options.  The goals of treatment are to reduce the back pain, and to stabilize and strengthen the vertebral body reducing the risk for additional fractures.

In the treatment of patients, there are a few minimally invasive spine treatment options available.  Treatment recommendations are made based upon the patient’s specific medical needs.

One treatment option is vertebroplasty.  During this procedure, specially formulated bone cement is injected through a hollow-needle (that is guided by X-ray imaging) directly into the fractured vertebra.  This creates an internal cast that stabilizes the bone. 

Another treatment option is called balloon kyphoplasty.  With this procedure, orthopaedic balloons are used to lift the fractured bone and return it to the correct position.   

Both of these procedures can be done on an outpatient basis.  Patient’s are either awake with conscious sedation or are given a general anesthesia.  The procedures take approximately an hour to 90-minutes. 

Individuals with osteoporosis are at risk of a spinal fracture – referred to as vertebral compression fractures (VCF).  Depending on the severity of osteoporosis – these fractures can occur with even a mild strain to the spine – such as twisting while lifting or a simple fall.  For individuals with advanced cases of osteoporosis a fracture can even result from normal activities such as bending forward.   

Generally a person with a fractured vertebra will have persistent back pain, although they usually do not realize that this is the cause. Since one fractured vertebra can easily lead to another, it is important for early diagnosis and treatment.

Here are some of the main symptoms of a vertebral fracture – that may occur alone or in combination:   

• Sudden onset of back pain
• Back pain that worsens while standing or walking
• Limited spinal mobility
• Height loss
• Deformity and disability

If you have noticed any of the above symptom(s), talk to your doctor. 

According to the National Osteoporosis Foundation (NOF) – osteoporosis is a major health threat for 55 percent of the Americans over the age of 50.  Additionally, the NOF estimates that 10 million Americans already have osteoporosis and 34 million are at risk. Commonly a disease that affects women – approximately 20% of those with osteoporosis are men.

Because it is usually not diagnosed until an individual fractures a bone, it is referred to as the “silent disease”.   Typically, the fracture is a result of a fall – generally a fractured hip, wrist, arm or leg, and unfortunately these can be painful. But spinal fractures can occur – even doing simple household chores.

When conservative management or minimally invasive spine procedures are not effective in treating lumbar radiulopathy (lumbar degenerative disc disease), the patient may require surgery.  A common spine surgery procedure is surgical decompression.  The goal of this surgery is to eliminate the compression of the spinal cord on the nerves to reduce the back pain.

People with back problems – may have more than just back pain.  Sometimes, if you suffer from leg pain – this can be related to your spine.  If a person has ongoing leg pain that is persistent and increases as you lift your knee to your chest or bend over – it could be related to your back.  One back problem – that causes a shooting pain down your leg referred to as “sciatica” is lumbar radiculopathy. 

Back pain is one of the most common reasons individuals see their physician.  It is estimated that at some time 80% of all adults will suffer from back pain.  Approximately 70 to 80% of spine problems can be conservatively managed with medications, with or without physical therapy.  Symptoms typically resolve within a few weeks. 

If the back pain does not go away with simple conservative measures, then people would see a spine specialist.  At this point, a specific cause of the pain may be necessary.

To diagnose the cause, in addition to a detailed patient history and examination; other diagnostic imaging tests may be required.  Here is a link, which provides an overview of some of the diagnostic imaging considered.  
 

Many times, an injection into a specific structure of the spine, including a nerve, disc or joint, is necessary for precision diagnosis.  

Once the painful source is determined, a specific treatment plan is tailored to the patient.  This may require a minimally invasive therapy which may be done in conjunction with physical therapy or oral medications.  Only 5% of patients with spinal problems will require surgery.

Minimally invasive procedures typically include an injection of medications directed at the focal area of pain generation, radiofrequency neurotomy or intradiscal therapy.  

To learn more about minimally invasive spine procedures and Indiana Spine Group visit our web site or call 317.228.7000.