The last few spine wellness blog entries have discussed the effects of smoking and the spine.  For example smoking can increase your risk for lower back pain, increasing healing time following spine surgery and increase your risk for osteoporosis. 

For a spine wellness fact sheet about smoking and your spine's wellness, click here.

A prior spine wellness blog entry highlighted the Great American Smokeout, held on November 19.  This spine wellness blog entry will address smoking and your spine.  Usually when you think about the health effects of smoking – you think about cancer and heart disease.  But smoking also affects your spine wellness and as a recent study indicated, can contribute to lower back pain.

Study results published on Spine-Health.com indicated that there is a link between smoking and lower back pain.  The study concluded that the development of lower back pain was linked to smoking history and hypertension.  Additionally, the development of lumbar spondylosis was also associated with smoking history and hypertension.

When an individual continues to have chronic back pain and/or leg pain following back surgery; it is referred to as failed back syndrome. A few treatments for this can include physical therapy or non-steroidal anti-inflammatory medications (NSAID). If medical management is ineffective another treatment option available is a spinal cord stimulator.

A spinal cord stimulator is an implantable device that uses an electrical current to provide a tingling sensation that helps to mask the chronic pain. Dr. Gentile describes it as “a kind of pacemaker for pain.”

In this video, Dr. Gentile describes the procedure for implanting a spinal cord stimulator. Dr. Jonathan Gentile is a minimally invasive spine specialist with Indiana Spine Group.

This procedure is available at Indiana Spine Group. For more information, call 317.228.7000 or toll-free 866.947.7463.

Spinal stenosis is a general term that refers to the narrowing of the spinal canal. Often this is a degenerative condition resulting from aging. More commonly found in the lumbar (lower back) spine, it also occurs in the cervical (neck) spine. 

Learn more about spinal stenosis, the diagnosis and treatment with this education video featuring Dr. Kenneth Renkens.   Dr. Renkens is a neurosurgical spine surgeon with Indiana Spine Group. Orthopaedic spine surgeons with Indiana Spine Group include Rick Sasso, M.D., Thomas Reilly, M.D., and Paul Kraemer, M.D.

In the movie Princess Dairies there is a scene where Mia, played by Anne Hathaway, is practicing good posture with a book on her head and walking across the room. 
Although books are not required, good posture is important in preventing lower back pain. 

This spine wellness tip will highlight how to evaluate your posture. 

1. Stand with your heels against the wall.
2. Your head, shoulders, calves and buttocks should be touching the wall. (Once you do this, you should be able to place your hand behind the small of your back).
3. Now, take a step forward – this is how your posture should be.

Another session at Back Talk, the continuing medical education symposium for physicians and health care practitioners will address the failed back. Sometimes called failed back syndrome, failed back surgery or post-laminectomy syndrome – these patients continue to have ongoing back pain following spine surgery. 

This session will be presented by minimally invasive spine specialists Jonathan Gentile, MD, and John Arbuckle, MD, and spine surgeon Paul Kraemer, MD. With Indiana Spine Group, these physicians treat patients at our offices located on the north side of Indianapolis. 

During this continuing medical education session, the tools for physicians and health care practitioners to perform a diagnostic assessment of patients with chronic back pain following spine surgery will be highlighted. This diagnostic assessment will help caregivers to understand the underlying causes of ongoing back pain, and the mechanism of failed back. Additionally, medical and interventional treatments for failed back will be discussed – their indications and expected outcomes.

Many times, when people have chronic lower back pain – they experience a greater level of depression than individuals without chronic back pain. This continuing medical education session at “Back Talk” will provide physicians and health care practitioners insight into learning to recognize and assess psychological risk factors of patients with acute and chronic back pain. 

During this session entitled "Psychological Barriers," Ricks Warren, PhD, ABPP, will identify psychological issues in patients with chronic back pain and malingering. Additionally, he will review the psychological barriers for effective treatment of acute and chronic spinal problems – and identify the warning signs and when referral to a metal health professional is indicated. 

Ricks Warren, PhD, ABPP joins the Back Talk continuing medical education  faculty from Michigan. Dr. Warren is a clinical lecturer and psychologist with the Department of Psychiatry at the University of Michigan Medical School in Ann Arbor. 

I was recently interviewed for a news story that announced the FDA approval of the Bryan™ Cervical Disc. The Bryan Cervical Disc is an artificial disc used in cervical arthroplasty. 

This story also appeared on their web site which generated a few reader’s comments/questions. This blog entry – will address some of those questions. 

Blogger question: Can it be used in the lower back?

The Bryan Cervical Disc can only be used in the cervical (neck area) spine. There are two FDA approved artificial discs for the lower back (lumbar spine). They are: CHARITE Artificial Disc, approved by the FDA in 2004 and the ProDisc. Artificial lumbar discs are a surgical option for some patients who are being treated for degenerative disc disease or other related spinal conditions. These links provides more information about the artificial lumbar disc - (article one and article two).

Blogger question: Does this work for someone who has had a fusion done 10 years ago?

The answer to this is no. When a spinal fusion is performed, two bones are “fused” together; meaning that they are attached. In that this procedure is done with the goal of a permanency – it can not really be undone to have cervical arthroplasty performed. 

This break out session, at the continuing medical education symposium “Back Talk”, will focus on spine and sports. It is estimated that 20% of all injuries that occur in sports involve the lower back or neck. During this session, Dr. Paul Kraemer a spine surgeon with Indiana Spine Group, and Nate Blume, DC, a chiropractic physician will highlight common spinal injuries that result from organized and recreational sports; i.e. football, basketball, golf. They will discuss assessment guidelines and treatment protocols for spinal injuries resulting from sports. Additionally, initial on-site assessment and treatment, as well as recommendation guidelines for ‘continuing to play’ will be discussed during this medical education session.

As travel costs increase, most people find that if they are flying, they are flying coach. The good news is the savings – the bad news is the space. Sometimes – you may feel like a “sardine” in a can. Depending on the duration of your flight, these close quarters can result in back or neck pain. 

This spine wellness tip provides a few hints to avoid neck and back pain.

·         To help avoid back pain – support your lower back. To do this, roll two airline blankets or take two pillows, and place them on each side of your lower back. This will provide lower back support. 

·         To help avoid neck pain – use an inflatable pillow – place this around your neck if you are sleeping. 

Another spine wellness tip while flying is to try to keep the space under the seat in front of you clear. This will allow you to stretch your legs. If this is not possible, then place your
item(s) in the middle, and place your legs on each side. 

With spring time around the corner, now is the time many of us are brushing up on our golf game – getting ready for the season. But did you know that golfing, although a low-level physical activity does provide a potential risk for injury? 

One common injury that golfers suffer is lower back pain. This lower back pain is attributed to poor swinging technique and poor conditioning. An article in Spine Universe, “Don’t Let Back Pain Handicap Your Golf Game”, states that eight times your body weight is forced through your spine as you make contact with the ball. 

This spine wellness tip, will provide helpful information for golfers. To help prevent golf injuries, the American Academy of Orthopaedic Surgeons recommends that before you tee off - that you first do some stretching exercises. Also take the time to hit a few balls on the driving range, before you start your game. For more exercise tips, to help avoid lower back pain, and golfer’s elblow, click here. 

This blog entry will answer a few common questions asked about spinal cord stimulators. 

What are spinal cord stimulators used for? 

Generally spinal cord stimulators are used to treat chronic / ongoing lower back pain that continues following back / spine surgery. Back pain following spine surgery is a condition called post-laminectomy syndrome, also referred to as failed back syndrome.

When are spinal cord stimulators considered as a treatment option?

Spinal cord stimulators are a treatment option for lower back pain, when other medical management treatment options are ineffective; i.e. epidural injections and/or medications. 

What is a spinal cord stimulator?

A spinal cord stimulator is also called a neurostimulator – and this is a device that is a programmable generator that is the size of a stop watch, which has electrical leads/electrodes. The electrodes are placed in the epidural space near the spinal cord.

How does a spinal cord stimulator work?

With spinal cord stimulation electrical impulses are generated to relieve the chronic pain. The electrical impulses that are created interfere with the transmission of pain signals to the brain, and eliminate the sensation of pain that the patient would normal feel. Rather than pain, the patient feels a tingling sensation - which is called paresthesia. 

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.’

In an earlier blog, the results of a spinal cord stimulator study for the treatment of axial back pain were summarized.  This blog entry will provide a definition for axial back pain. 

Axial back pain is one of the most common types of lower back pain. Usually it is non-specific – which means that the exact cause is not identified in that many times this pain is limited and will go away. It is estimated that 90% of patients with axial back pain recover within six weeks. 

A few characteristics of axial back pain include:

·        The pain is localized in the back and does not radiate to extremities.

·        The lower back pain gets worse with certain activities and positions; i.e. sitting a long time.

·        The back pain can be relieved with rest. 

One of the most common forms of arthritis, osteoarthritis, affects up to 30 million Americans.  More commonly found in females, osteoarthritis is a degenerative joint disease in which the cartilage that covers the end of the bones deteriorates, and as a result bone rubs against bone in the joint area. 

Osteoarthritis is a common cause of back pain.  Arthritis in the back is called spinal arthritis, and this is the mechanical breakdown of the cartilage in the facet joints.  As a result of this breakdown, these vertebral joints become inflamed and as the joint degenerates this creates more frictional pain. 

The two types of osteoarthritis in the spine are lumbosacral arthritis and cervical spondylosis.  As the names imply – lumbosacral arthritis is osteoarthrithis of the lower back (lumbar spine), and cervical spondylosis is osteoarthritis of the cervical spine (neck). 

A study presented at the 23^rd annual meeting of the American Academy of Pain Medicine early last year – presented the results of the effectiveness of spinal cord stimulators to treat axial lower back pain in individuals with Failed Back Surgery Syndrome (FBSS). 

In this multi-center study, there were 226 patients from 14 different sites.  In the screening phase of the study – which was the 5- 10-day trials, 76% (176) had an average decrease in back pain of 40%.   Following this phase of the study, 159 patients received permanent spinal cord stimulator implants. 

The study concluded that there was a significant reduction of axial low back pain as a result of the spinal cord stimulator.  Preliminary data indicates that the spinal cord stimulator will effectively reduce low back pain on a long term basis, and that results should be similar to what was observed in the shorter time period.

Ankylosing Spondylitis is defined as a chronic inflammatory disease which primarily affects the sacroiliac joints, spine and hip joints. (The sacroiliac joints are the joints where the spine attaches to the pelvis.)  With ankylosing spondylitis the inflammation of these joints can lead to the bony fusion of the joints.  A bony fusion is where the fibrous ligament transforms to bone – then these joints permanently grow or fuse together. 

Ankylosing spondylitis is more common in young adult men, and once developed lasts their lifetime.  The cause of ankylosing spondylitis is unknown but studies have shown a strong link with a specific genetic marker.  In blood tests of individuals diagnosed with ankylosing spondylitis 90 percent of them had the genetic marker HLA-B27.

One of the most common and first symptoms of ankylosing spondylitis is lower back pain and stiffness.  And unlike lower back pain caused by over-exertion or another type of injury that will subside with rest, with ankylosing spondylitis the lower back pain may get worse after rest.  Another common symptom of ankylosing spondylitis, is sacroilitis.  This is where there is inflammation of the sacroiliac joint, the joint that connects the spine to the pelvis, and this inflammation results in pain in the buttocks that may radiate down the thighs, but not below the knees.   

Once diagnosed, at this time, there is no treatment to prevent the progression of ankylosing spondylitis.  Treatment focuses on minimizing the symptoms of lower back pain, and may include exercise/physical therapy and medications. 

One type of arthritis that affects the spine/back is rheumatoid arthritis.  This common type of arthritis is an autoimmune disease that causes chronic inflammation of the tissue around the joints and other organs.  One of the most debilitating types of arthritis, according to the Arthritis Foundation, rheumatoid arthritis affects approximately 1.3 million Americans.  This disease is more common in females, than males; there are 2.5 times more women with rheumatoid arthritis than men.

When rheumatoid arthritis affects the spine, generally it is the cervical spine (neck).  Rheumatoid arthritis rarely affects the lumbar (lower back) or thoracic (chest area) spine.A few symptoms of this rheumatoid arthritis affecting the spine may include headache, neck pain or stiffness or weakness in the arms and legs.  Once rheumatoid arthritis is diagnosed, if there are symptoms that indicate the cervical spine is affected, an X-ray of the cervical spine will be taken.  This X-ray can be used to assess the joints and intervertebral disc spacing and the overall structure.  Additionally, a MRI or CT Scan may be performed to evaluate if there is any spinal cord compression.

Physicians with Indiana Spine Group presented at the fall conference of the Indiana State Chiropractic Association this past weekend, on November 1 and 2. 

On Saturday Dr. Kevin Macadaeg, a minimally invasive spine specialist, spoke on minimally invasive techniques used to help manage spinal pain.  Additionally, he addressed diagnostic and therapeutic spinal injections.  Spine surgeons - Dr. Thomas Reilly, Dr. Kenneth Renkens and Dr. Rick Sasso also spoke on Saturday.  Dr. Reilly discussed when spine surgery is a potential treatment option.  Dr. Renkens’ talk entitled “Understanding Lumbar Surgery”, focused on the lower back and reviewed spine surgery options and indications for the lumbar spine.  Additionally, he discussed the different types of lumbar fusions and their applications.  Dr. Rick Sasso focused on cervical surgery, and his talk was entitled “The ABC’s of Cervical Surgery”.  In this talk, he discussed common cervical surgical procedures; including spinal fusion and cervical artificial disc replacement. 

On Sunday, minimally invasive spine specialists Dr. Jonathan Gentile and Dr. John Arbuckle reviewed case studies of minimally invasive diagnostic and therapeutic techniques.  Spine surgeons Dr. Thomas Reilly and Dr. Paul Kraemer also reviewed case studies of surgery patients.

For more information about this conference, click here.