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Sat 06th Sep,2008   
Frequently Asked Questions
What are emergency type signs that all patients must be aware of?

There are a few warning signs that if present can represent a serious spinal problem. If you experience any of these symptoms, seek medical attention immediately.

Loss of control of the bowel or bladder, or retention of urine, may indicate potentially dangerous damage to the spine's cauda equina nerves. Numbness around the rectum is also very important to address. The cauda equina is a bundle of nerves in the low back where the spinal cord ends. Damage to these nerves can be permanent if not treated quickly – within a day or so. This problem should be seen within 24 hours by a spine specialist, or go to an emergency room if necessary.

Weakness or numbness in a leg or arm, especially if it is severe—and it is getting worse—also points to nerve damage. This includes "foot drop," a condition where the muscles of the leg and foot are too weak to raise the foot up as the individual attempts to walk. Again, nerve damage associated with these symptoms can be permanent if not treated immediately. If a foot drop develops rapidly you should be seen within 24 hours by a spine specialist.

Any numbness, pain or tingling that radiates into an arm or leg is also a source for concern and should be seen within a few days by a spine specialist.

High fever accompanied by back pain, may indicate a possible infection of the spine and should be seen within 24 hours.

What are the most common symptoms of a pinched nerve?

The most important things that patients may notice with a pinched nerve include numbness in the fingers or toes, weakness in a limb, persistent severe pain despite medications and radicular type pain. This is pain that starts in the neck or back and radiates past the elbow or knee respectively. With any combination of these, a spine specialist should be consulted urgently.

What are discs?

Discs are the pads between the vertebrae of the spine. There are twenty-four mobile vertebrae and five that are fused together to form the sacrum. The 24 mobile discs include cervical (7), thoracic (12) and lumbar (5). Discs are vulnerable to injury because they have the difficult job of being flexible enough to move, but strong enough to take enormous stress.

The discs between the lower lumbar vertebrae are the most commonly injured because they support the weight of the entire upper body. The structure of the disc determines the extent of injury, as some have weak outer fibers (annulus) to allow the core material (nucleus pulposis) to move outside of the ring.

What is a disc herniation?

Disc herniation, rupture, protrusion, and extrusion are all terms that describe this injury. There are subtle differences between these terms, but they all refer to a tear in the outer ring, which allows some of the inner core to escape. A herniation occurs when a portion of the soft inner core (nucleus pulposis) escapes through the outer ring (annulus).

The disc may look like a solid piece of padding between the vertebrae, but it is far more complex. Discs are composed of two parts that work together to carry the load.

* The strong outer ring or annulus, is firmly attached to the vertebrae above and below the disc. The ring has strong crosshatched fibers much like the steel belts of a car tire. This outer ring is about 1/4 inch thick, and by itself, doesn't have much compressive strength. If this ring were empty, it would collapse when weight was applied to the bone above. The outer ring holds the nucleus pulposis in place.
* The nucleus pulposis is located inside the annulus. This is a soft gelatin-like cartilage with a very high water content which provides cushioning while evenly supporting the weight of the body. This cartilage transmits the load from bone to bone.

What is a disc bulge?

This occurs when the entire disc moves outside the normal boundaries within the vertebrae space. The actually disc material is not escaping. Many people have mild disc bulges that cause no pain or symptoms. Many people have a disc bulge without ever knowing it. Surgery is not performed for a disc bulge.

What is the purpose of a disc?

The disc has two functions:

* it transmits the weight of the body from the bone above to the bone below.
* it allows the spine to be flexible.

The lumbar (lower back) discs must support the weight of the entire upper body plus whatever is picked up or carried. Because the body's center of gravity is in front of the discs, loads on the disc are increased by leverage. The disc attempts to distribute weight evenly and position the bodys center of gravity. The cervical discs only support the weight of the head and usually only herniated by trauma.

Why do discs herniate?

The outer ring of the disc is subject to continuous stresses that sometimes cause small tears to develop. If one of these tears is large enough and the stresses inside the disc strong enough, some of the pulposis can leak through the tear. The disc is most vulnerable to injury at the weakest parts of the outer ring, where nerves pass through the spinal canal and exit toward the legs. If disc material compresses one of these nerves, there can be pain both in the back and down the leg. Many small traumas or one large trauma typically lead to disc movement.

What are different types of medications that may be prescribed?

Careful consideration is given to all patients individually before choosing the proper medication regimen. The most important considerations include allergies, medical problems and other medications being taken. Drug-drug interaction is crucial when deciding which pain medication to pick. There are several classes of medications which are considered from simple to complex.

  1. Simple Analgesics such as Tylenol are the most basic and can be given safely with consideration of liver disease. These are widely used for mild pains and are over the counter.
  2. NSAID’s (Non-Steroidal Anti-Inflammatory Drugs) are frequently used after an injury when some inflammation is suspected. There are over the counter strengths (ie. Advil) and prescription doses( Motrin, Celebrex). Careful consideration is given to monitor kidney function and to those with ulcers or reflux disease.
  3. Oral Steroids are given to some people immediately after an injury to rapidly reduce swelling. A short tapering course is used due to many side effects.
  4. Narcotic Analgesics are much stronger and require a special prescription as most are controlled substances. Caution to addiction and habit formation are prevalent in some cases. Most cause constipation. These medications are carefully monitored and adjusted by the physician.
  5. Muscle Relaxers are used usually early in an injury when spasms are frequent and disabling. These are most often taken in the evening as they may cause drowsiness. It is recommended that the patient does not operate machinery after taking these, including driving a car.
  6. Topical Pain Medications are given to those that can not tolerate pills or have a drug interaction. These are typically pain patches which allows the medicine to be absorbed directly through the skin to the bloodstream to travel to the painful site. There are also creams which allow a numbing effect to the skin for pain relief.
  7. Injectable Pain Medications are usually narcotic type or steroidal type and injected directly into muscle or a joint space for pain relief. Trigger Point Injections also use a local anesthetic directly to a painful site.

Should a patient use heat or ICE at home after a recent injury?

There is no correct answer to this question. It is a topic of great debate in medicine. Commonly people use ICE for the first few days after an injury to reduce swelling and then use heat later on to improve mobility and reduce pain. ICE is also used to reduce muscle spasms.

Does an EMG cause pain or discomfort?

Pain is subjective and is experienced by everyone differently. Most people say that the test causes a funny sensation since electrical impulses are used and cause the limb to “jump” In the past the test caused more discomfort but as technology and equipment have improved over the past few years the exam is very well tolerated.

How do I prepare for an EMG?

The most important thing to do is NOT to use any creams, oils or lotions on the day of the test. These interfere with the electrodes that are used to adhere to the skin and make the test more difficult. There is no other special preparation. Take all medications as usual and go about your daily life. There are no side effects and you may return to activity immediately following the test. Test results are usually determined immediately following the exam and then the report is prepared for your doctor.

Should I continue going to the gym or exercise class after an injury?

After a new injury stop doing all extra physical activity until your diagnosis is determined. Some people may injure themselves even further after a trauma. It is also important that your doctor or treating healthcare providers review the proper mechanics of each exercise prior to performing. Many people hurt themselves using improper form.

How do I relieve muscle spasms?

ICE, stretching and medications used in the right combination are the best remedies for muscle spasms. Muscle cramps may cause disabling pain and an appropriate evaluation is important to determine the cause.

Do I need to take the medications prescribed if I am feeling no pain?

Follow your doctors guidance when taking medications. For proper pain management some medications are used to help “break” the pain cycle and some are used to continue the e reduction of swelling.

How soon should an MRI be considered after a pain starts?

An MRI is an expensive highly precise radiographic examination. The timing of ordering is a clinical decision made by your doctor based on neurologic symptoms and is sometimes done immediately. In most situations it is done after at least 6 weeks of conservative treatment if there is not significant improvement.

How long should I try conservative therapy before considering surgery?

Surgery is a major decision made between you and your doctor. The urgency of surgery depends on the clinical situation and the presence of neurologic abnormalities after injury. If there is bowel or bladder dysfunction after a back injury surgery is emergent. In most situations patients try conservative therapy for several weeks to months before considering surgery. See treatment options for all conservative treatments that SPINE OPTIONS offers.

Do I need to do the Home Exercise Program given to me if I regularly attend therapy sessions?

The Home exercise program is probably more important to comply with than attending treatment sessions. Remember that there are 168 hours per week and you attend treatment for less than 2 hours per week. It is important to do daily stretching and exercises given to you for your specific condition. Most people spend 15 to 30 minutes daily on the home program. This also helps you maintain a pain free state once you have recovered. It has been shown that those that do not comply with the home program have a higher rate of recurrent injury.

What is a Physiatrist?

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