Below are links to articles posted in November, 2018
Research shows beyond any shadow of a doubt that cigarette smoking negatively affects spinal fusion surgery. In fact, the rate of non-fusion (or pseudarthrosis) in smoking patients is twice as much as that found in those who do not smoke. Of course, studies on non-fusion rates vary wildly as they depend on a variety of factors. That being said, there is most certainly a correlation between non-fusion rates and cigarette smoking. The prevailing theory is that nicotine adversely affects bone growth, which is a vital part of the fusion process.
Because nicotine is the problem here, that means that any tobacco product–patches, vaping, and so on–can affect fusion. This may be hard to hear, as there are many people who have been smoking for decades. However, it is absolutely vital to quit smoking if you have a fusion procedure planned ahead of you. If you cut back on tobacco products or use substitutes instead, there is still a small chance that you may end up back in the operating room.
Smoking and Spinal Fusion Surgery
As we have already established, nicotine affects the bone healing process as well as fusion. Additionally, the use of other tobacco products such as patches and e-cigarettes are either known or suspected to cause the same problems. The effects of the latter are not exactly known yet, so medical experts still suggest eliminating e-cigarette use as well. Additionally, once the patient has undergone spinal fusion surgery, doctors recommend ceasing to smoke for at least 6 weeks to avoid postoperative complications. Similarly, medical experts also suggest that the patient stops smoking at least a month prior to the procedure. Obviously, doctors urge even more strongly that you quit altogether, but that is another story.
Tobacco products do not just affect fusion, they also affect blood circulation in smaller vessels. Blood circulation plays a vital part in carrying oxygen and nutrients to hungry cells. In the context of the spine, reduced circulation has a particularly harsh effect on the shock-absorbing spinal discs. When blood flow reduces, less oxygen and nutrients are able to travel to the discs. Smoking also deters wound healing after surgery, leading to a higher risk of infection
It is important to mention that not all doctors require tobacco cessation prior to fusion. Instead, they may recommend that a patient quits smoking to avoid failed back surgery syndrome. If a patient has particular trouble with dropping the habit, then their doctor will assist them in any way possible. For one, doctors address wound complications via minimally invasive techniques. As far as fusion goes, doctors are able to optimize the process by using bone morphogenetic proteins (BMP), which encourage bone growth.
Use of BMPs in Spinal Fusion Surgery
BMPs are one of the newest approaches that doctors use to help mitigate the risks associated with smoking before spinal fusion. These proteins are known for their ability to promote bone and cartilage formation. For this treatment, the doctor places the BMP before the procedure with the goal of enhancing bone growth. More specifically, the goal is to accelerate bone growth beyond what would be considered normal bone growth from autografting.
So far, studies show that BMPs help the success rate of fusion procedures in patients who smoke. One such study shows that out of a group of patients who were followed for over two years, 95% of smokers had a successful procedure. This number is much higher than groups of smokers that did not have BMPs and suggests a strong correlation. It, however, is still important to note that even though these fusions were successful, the results were not nearly as positive as the non-smoker fusions. For non-smokers, the fusion procedures showed measurably higher functionality and symptom alleviation from chronic back pain.
Difficulty Of Quitting After Surgery
If the patient has not quit smoking before fusion surgery, then it is most likely that they will continue to smoke afterward. In most cases, patients will either continue smoking or quit for only a brief period of time.
Post-operative smoking cessation is incredibly difficult for a variety of reasons. The main reason for this is that the recovery period from a spinal fusion is very hard on a person. It is stressful, both physically and mentally. And, many people smoke in order to reduce such stressors. Additionally, recovery from any medical procedure is hardly exciting or fun. It is difficult for some patients to pass the time, so they may look to cigarettes as a means of handling the boredom or dealing with the stress.
It is possible to decrease the chance of post-operative smoking, and that is by quitting as soon as possible. Studies show that the longer a person has been off cigarettes, the easier it is to stay off cigarettes. This is a useful piece of advice for patients preparing for surgery, as well as for the post-operative doldrum.
How To Quit Smoking
There are many different ways to quit smoking, but by far the most common method is cold turkey (with no outside help). In fact, nine out of ten people try to quit smoking this way before trying anything else. Unfortunately, only a small minority (around 5% to 7%) are actually successful with this method. It certainly doesn’t hurt to try this method, but it is important to understand that it likely will not work for you.
Cognitive Behavioral Therapy
This method involves receiving advice from a specialist or guidance counselor to find useful coping techniques for you. The goal is to discover what your triggers are (what makes you reach for a cigarette) and how to avoid those situations. Sometimes, however, those situations are not avoidable. In these cases, the counselor will guide you with coping mechanisms for dealing with these cravings.
Smoking cessation programs are also known to yield good results when it comes to kicking the habit. Cessation programs are very similar to cognitive behavioral therapy in a lot of cases, with the difference being that they are conducted in a group environment instead of on a one-on-one basis.
Nicotine Replacement Therapy
This method is more of a supplementary treatment that patients can use to get off on the right foot. For patients who are going to undergo spinal fusion, it is important to understand that nicotine is still harmful. That being said, this method does help smokers quit cigarettes. This is especially true when patients use this method in tandem with cognitive behavioral therapy. Nicotine replacements come in a variety of forms, such as gum, patches, and lozenges. The key to this method is to think of it as a temporary crutch, and not a full-time replacement.
Prescription medicines such as Chantix or Wellbutrin are known to help smokers deal with the cravings and withdrawal symptoms of cessation. Additionally, these medications contain no nicotine in them and thus are not a form of nicotine replacement therapy. Ask your doctor about these medications, because they may or may not be right for you.
Exercise is a well-known aid when it comes to smoking cessation, and is probably the most effective natural treatment. Though not as documented, many people claim that acupuncture and meditation have helped them kick the habit. Ultimately, the best approach for you will depend on your personal preferences. Any of these methods listed here are very effective supplementary treatments to any of the other techniques detailed above.
If you need spinal fusion surgery, please contact us at (855) 853-6542. OLLS is regarded as the best spine center in Florida for minimally invasive surgery, and its employees are well-versed in conservative methods. The back doctors at OLSS will go above and beyond to ensure that you receive a treatment plan that serves your specific needs–and this includes helping you receive the resources you need to quit smoking before fusion surgery.
A discogram is a diagnostic imaging procedure that doctors use to evaluate back pain. Sometimes called a discography, this method uses x-ray imaging to reveal abnormalities in the intervertebral discs of the spine. With the aid of a special dye and a fluoroscope, discograms are able to locate the cause of the patient’s back pain. The procedure may vary slightly between discographers, but the general purpose is always the same. It’s a diagnostic tool that doctors use to identify probable causes for a patient’s symptoms.
Do I Need a Discogram?
Medical experts consider discographies as an invasive test. Naturally, this means that it is not usually the first treatment that doctors use for evaluating the patient’s condition. In most cases, your doctor will try to treat your back pain using more conservative methods. This may include treatments such as physical therapy or medication. If these non-surgical techniques do not prevail, your doctor will then consider more drastic solutions.
Sometimes, when a patient needs lumbar spinal fusion surgery, the doctor on the case will perform a discogram before the procedure. The diagnostic test is useful here, as it reveals the affected discs in the spine beforehand. While this may be so, it is important to illustrate that discograms do not always provide accurate results. Some doctors instead prefer using other techniques, such as MRI and CT scans. The method that will be used for your specific case will depend on a variety of factors. It will depend on your doctor, your condition, your medical history, and you. Make sure that you communicate with your doctor if you have any preferences for any procedure.
A doctor may consider using a discogram if the patient has the following conditions:
These are just a few general examples. Because discs act as the shock absorber between spinal bones, there are a lot of potential problems associated with them. Constant pressure and impact on these structures may lead to problems like the ones listed above.
Discogram Associated Risks
Discograms are quite safe, with complications happening only rarely. These risks are often minimized when the procedure is performed by a skilled specialist using modern discography methods. Although they are rare, the following complications may occur during this test:
- Allergic Reaction: Some patients are sensitive to the contrast dye used in the test, which results in an allergic reaction. Usually, this risk is averted by providing your doctor with an extensive medical history beforehand. Aside from reactions with the dye, there is also a chance for the patient to be allergic to anesthesia. You should communicate all medication allergies to your doctor before getting a discogram.
- Disc Space Infection: This is the most serious complication associated with discograms. Disc space infections are very rare but when they occur they are very hard to treat. Luckily, advances in sterilization have made this complication virtually nonexistent.
- Nerve Root Injury: Discograms inject the contrast dye into the affected area using a needle that passes quite close to nerve roots. Because the needle travels so close to these structures, there is a very small chance of nerve injury. This complication leads to additional pain that the patient feels after the procedure.
- Excessive Bleeding: Make sure to tell your doctor if you have any bleeding disorders before receiving any invasive treatment. Additionally, you should notify your doctor if you take any blood-thinning medications, such as aspirin. If you communicate with your doctor, the chances of this complication are very rare.
How is a Discogram Performed?
Firstly, the doctor must prepare the patient by using a local anesthesia and a sedative. This will relax the patient and reduce uncomfortable sensations during the test. The doctor will then either lie the patient face down or on the side for access to the back. After the doctor sterilizes the injection site, the hollow needle is inserted where it is needed.
To make the injection go as smoothly as possible, a radiologist will often aid navigation using fluoroscopic guidance. Once the doctor determines that the needle is at the affected site, the contrast dye is injected. This may intensify uncomfortable symptoms, causing the patient some level of discomfort. Though this may be the case, it is important that the patient stays still for the procedure to be a success.
Finally, the doctor removes the needle and takes x-ray images of the affected site. Again, in order to obtain accurate images, it is vital that the patient stays still. In some cases, the doctor may perform a subsequent CT scan after the procedure.
Although the procedure is more invasive than conservative methods, it is still a minimally invasive technique. Additionally, discograms are also outpatient procedures, as the patient is able to go home the same day. Typically, the medical staff will observe the patient for 30 minutes directly after the test. Once the patient is home, medical experts recommend that he or she rest for the next 24 hours. Some patients may experience headaches after having a discogram. In these cases, the patient should take ibuprofen or Tylenol, but never aspirin.
If you have back pain that does not resolve on its own, please contact us at (855) 853-6542. At OLSS, you will find an efficient facility filled with caring spine doctors whose goal is to treat your ailments. Our doctors will take the time to understand the specifics of your case and they will come up with a treatment plan that best serves your needs.
Lower back pain—it affects millions of Americans every year and its causes can be numerous and often complex. Usually, we refer to lower back pain as exactly that, but the true medical term for this condition is lumbago. In actuality, medical professionals coined this moniker for lower back pain around 400 years ago. Like many terms of great antiquity, lumbago derives from Latin, roughly translating to weakness in the lower back.
Great philosophers and enlightened sages may suggest that lower back pain is an offshoot of existence itself. Perhaps, there is a grain of truth in such a statement. Most likely, you have either experienced lower back pain or will in the future. In fact, doctors believe that as many as 80% of the workforce experiences lower back pain on a weekly basis. It is widely accepted that the ubiquity of lumbago stems from our progression into a more modern, sedentary civilization. In fairness, there is a correlation of evidence for such a claim. That being said, lumbago is also caused by underlying conditions, such as arthritis and other degenerative diseases. If your lower back pain is affecting your daily activities, then it is time to consider a medical consultation.
Lumbago Risk Factors
Everyone has a slightly different body structure. Simply put, some people are more affected by certain triggers than are others. Sadly, there is no litmus test for these predispositions, so it is best to avoid any unnecessary strain on the body. Examples of such risk factors include:
- Psychological Stressors: It is commonly accepted that stress makes pain worse, but in some cases, stress itself leads to back pain. Typically, stress is manageable through lifestyle changes and therapy. In other scenarios, the stress is chemically induced and must be remedied through medication and monitoring. In either situation, however, stress-induced pain may happen and it is very real.
- Sedentary Lifestyle: Many modern jobs require people to sit at desks for prolonged periods of time. This causes extra strain on your back and greatly increases your chance of developing lumbago. Additionally, sleeping in awkward positions produces similar risk susceptibility.
- Improper Lifting Technique: Even if this doesn’t lead to lumbar damage immediately, it will over time. Using the back to bear weight instead of the legs and twisting the body the wrong way are two of the most common lifting mistakes.
- Obesity: This is just a natural consequence of physics. If the spine has to support more weight, it will become more susceptible to wear-and-tear.
- The Natural Aging Process: The structures within the body deteriorate over time, which may lead to lumbar degenerative disc diseases.
- Repetitive Physiological Stress: Repetitive activities will put stress on bodily structures over time. For example, lengthy or intense bouts of jogging may lead to lumbar back pain as running is a repetitive impact activity.
Conditions That Lead to Lumbago
Lower back pain is interesting in the sense that it is both a condition and a symptom. A person may have chronic lower back pain, or they may have a problem that causes it. The following conditions may lead to pain in the lumbar area:
- Lumbar Degenerative Disc Disease: This condition occurs when the lumbar spinal discs deteriorate naturally as we age. To an extent, everyone experiences some degree of disc degeneration. However, doctors only use this term when the degeneration leads to pain.
- Lumbar Herniated Disc: In the most basic terms, the spine is an alternating column of discs and vertebrae. Vertebrae are the bones that compose your spine and discs are the softer material between them. Over time, these discs may wiggle out of alignment or rupture, which is what doctors refer to as a herniated disc.
- Lumbar Spinal Stenosis: There are many passageways surrounding the spine through which nerves must travel. When these passageways are narrowed, it puts pressure on these nerves and causes lumbar radiculopathy (aka, a pinched nerve in the lower back). However, not all cases of spinal stenosis lead to pinched nerves or sciatic nerve pain. In fact, sometimes this condition has no negative symptoms at all. That said, the condition may also worsen with time.
- Facet Hypertrophy: The facet joints exist at every level of the spine to provide flexibility and support. Sometimes, the body responds to spinal degeneration by enlarging these joints as a countermeasure to stress. (Think of it as building up a callous.) This “hypertrophy” may put pressure on nearby nerves, causing lumbago.
- Lumbar Spondylolisthesis: This condition occurs when stress fractures from a vertebral injury lead to structural weakness. When the spine weakens like this, the vertebra may slip out of place causing spondylolisthesis.
Symptoms of Lumbago
Pain is much more broad and nebulous than people typically realize. We often imagine pain in a very isolated sense, like a sharp cut or a bruise, but it doesn’t end there. For example, lumbar back pain may be nociceptive, neuropathic, or psychogenic, etc. However, doctors usually categorize pain as acute or chronic first.
- Chronic Pain: A persistent pain that lasts for a very long time. Usually, doctors consider pain as chronic if it lasts for 3-6 months or longer. Chronic pain has varying levels of intensity, but it is always persistent.
- Acute Pain: Basically, the opposite of chronic pain, acute pain is sharp and sudden. Usually, it has a specific underlying cause and it does not last longer than 6 months. In most cases, it resolves and does not return. Many people believe this is worse than chronic pain in severity, but that is case dependent.
- Nociceptive Pain: This classification is quite broad and breaks down into many subcategories, but there is a common thread. Nociceptive pain occurs when sensory nerve fibers receive stimuli that exceed a certain level of intensity. Usually, this pain is associated with inflammation, extreme temperatures, and mechanical damage.
- Neuropathic Pain: When the nervous system is diseased or damaged, it causes this type of pain. Medical experts describe this pain as a tingling or ‘pins and needles’ sensation.
- Psychogenic Pain: Mentioned earlier in the risk factors section, this pain results from mental and emotional factors. Some insist that this pain is not real, but that is simply not the case—as anyone who suffers from fibromyalgia can attest.
Lumbago doesn’t always just end at pain. In some cases, lower back pain causes muscle spasms, nausea, and fevers. And, in the most extreme cases, a patient may even lose control over his or her bowels/bladder.
How to Relieve Lower Back Pain
There are both conservative treatment options as well as minimally invasive spine surgeries that alleviate back pain. In most cases, a doctor will exhaust conservative options first before considering surgery. If conservative treatments do not provide adequate pain management, then the doctor will consider surgery. General conservative treatment options include:
- Chiropractic & Physical Therapy
- Pain medication (prescription or over the counter NSAIDs)
- Lower back exercises
- Posture correction
- Heat application
These are just a few examples of the viable conservative treatment options for lumbago. Because lumbago is so broad, the best treatment will depend on the specifics of your case. In order to figure out the best treatment plan for you, good communication with your healthcare provider is key.
Surgical Treatments for Lumbago
As with conservative treatments, there are many minimally invasive procedures that alleviate lumbago. Your doctor will present you with options that are best suited for treating your specific case. In more severe cases, your doctor may need to replace minimally invasive procedures with more traditional methods. Some common minimally invasive procedures for lumbago include:
- Epidural Steroid Injection: The doctor uses fluoroscopic guidance to inject a needle through the skin and at the affected site. Doctors almost always use a local anesthetic for this procedure, with mild sedation being optional at some centers.
- Laminectomy: If spinal stenosis is causing your lumbago, a doctor may suggest a laminectomy. During this procedure, the surgeon removes a portion of the affected lamina (backside of the vertebrae). This creates more space around the compressed nerves, thus alleviating your pain.
If you are suffering from lower back pain, consider contacting our team of back pain doctors today. Orthopedic Laser and Spine Surgery employs only the most highly skilled spine specialists. Our team of doctors will work tirelessly to craft a treatment plan that suits your individual needs.