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What are the common causes of back pain?
The common causes of back pain are ligament strains, muscle strains or herniated nucleus pulposus.

How do disc injuries cause back pain?
Disc injuries cause back pain through mechanism, either mechanical or chemical. The mechanical nature is that the disc is of such magnitude that it actually compresses on the neural elements that produce the back and/or leg pain. The chemical entity consist of pain mediators that are inflammatory in nature, which leak onto the spinal neural elements and onto the dorsal root ganglion of the nerve root that exacerbates or produces the pain that the pain interpreting.

What are the symptoms of a herniated disc?
The symptoms of a herniated disc usually consist of back pain and leg pain. It may be a radiating type symptom going down into the legs. It could be a burning type sensation, but typically it is a pain that occurs in various entities depending on the size, quantity and the length of time the disc has been herniated.

What is the treatment for a herniated disc?
The treatment for a herniated disc usually consists of anti-inflammatory medicines and physical therapy, which usually resolves the problem about 92 percent of the time. However, if this does not work, usually the patient can try a series of epidural steroid injections. If those do not work, the patient may be a candidate for surgery, either consisting of a decompression, fusion, or disc arthroplasty.

What is degenerative disc disease (DDD)?
Degenerative disc disease is just a natural degenerative cascade that the human spine undergoes. It begins when the disc is unable to maintain the normal hydration quality and then the disc undergoes collapsing at a slow rate. When this happens, bulges, fissures and herniations result. This produces a slight instability to the spine, and the body will then adapt by causing hypertrophy of the ligaments and the facet joints, and may produce osteophytes, which will attempt to produce more stability to the spine.

What is spinal stenosis?
The treatment for spinal stenosis usually consists of anti-inflammatory medicine and physical therapy. If this does not work the patient may have a trial of epidural steroid injections. If this does not work, the patient may need a decompression combined with a possible fusion.

When is surgery necessary for a patient with spine problems?
Patients with spine problems need spinal surgery if they have intractable back pain, a neurological deficit, or if they have bowel/bladder disruption due to some type of entity causing compression on the neural elements. Of the majority of patients who suffer from back or spinal problems, usually only 8 percent of them will ultimately require spinal surgery. This would consist of continued debilitating back pain, continued radicular pain due to a herniated disc, or compression f the neural elements.

My doctor told me that I have arthritis of my spine and that I should live with the pain. Is this true?
This is not true. Usually arthritis can be treated. Again, the symptomatology can be treated with physical therapy, anti-inflammatory medicines and various other pain modalities. However, if these fail, there are certain indications where surgical intervention may significantly improve the patient's quality of life.

My spinal specialist said I need a fusion. Is that true?
In most cases a patient does not need a fusion. A patient only requires a fusion if they have any evidence of spinal instability, thus, causing interference of daily activities and quality of life. In such a case, a patient would certainly require a neurocompression or a normal routine decompression procedure. If more bony elements need to be removed, and initially anticipated, then the patient may need a fusion.

If I have a fusion, does that mean I will never be able to bend?
This is not true. The other aspects of the spine will adapt and the patient will have motion in his/her back, depending on the levels that are needed to be fused.

Will fusing my spine cause damage to adjacent areas?
This is actually true. It will not cause damage per say, but usually one segment of the spine will increase the load to the levels above and below the fusion, which normally accelerates the degeneration process.

Why do some surgeons approach the spine from the back and others through the abdomen?
This is true in the lumbar spine. If the individual who needs a disc replacement has a severely bad degenerative disc causing back pain – called discogenic back pain – then that patient may be best served by going through the abdomen to completely remove the disc and to reconstruct the spine, getting it back into its normal alignment. This will increase the height of the spine, to secondarily decompress the neuroforamen, allowing these to go back into their pre-existing height before the degeneration process occurred. However, if the individual is of such size and magnitude that it is unfavorable to go from the anterior approach, then the majority of spine surgery can be done through the lumbar spine. Even a 360-degree fusion can be done by going through the posterior aspect of the lumbar spine.

What is a herniated disc?
A herniated disc is an extension of the disc material beyond the posterior vertebral body endplate.

Why is spine surgery often done through the front of the neck?
Spine surgery is often done through the front of the neck because it is much easier on the patient and is easier on the surgeon. There is an avascular plane that can be easily approached at the front of the spine. The disc can be taken out thoroughly, and it's a tried and true safe procedure. Also, the spinal cord in both neuroforamen can be totally addressed and decompressed by going through the front of the neck. The recovery tine for the patient is much shorter going from the anterior of the neck as opposed to going from the posterior of the neck.

Is a plate necessary? Will I set off metal detectors?
May years ago, a plate was never used, which required the patient to wear a hard collar for six to 12 weeks. Now, with new instrumentation, usually a collar is not necessary. With the new titanium plates, this will not set off a metal detector.

Should I have allograft bone or autograft bone?
Autograft bone is considered to be the "gold standard," and does have a safety factor in that the individual must now worry about getting subjected to any type of immune suppression type infection. However, many studies have been done regarding allograft bone that is now machined and commercialized compared to autograft bone, and has nearly the same fusion rate as doing a single level in a two-level fusion rate with a pate augmentation. However, if an individual I having more than two levels done, the studies have shown the autograft fusion does have a higher fusion rate than allograft fusion. Because the autograft bone usually has a higher morbidity for the patient, as increasing their pain, blood loss and surgical time, allograft bone has shown to be safe and as effective as autograft bone – thanks to today's sterilization techniques – and markedly diminishes the patient's post operative morbidity, pain and blood loss.

Will I have pain after the surgery?
It is expected that a patient will have some pain after the surgery. Usually, it is just incisional pain or pain that occurs from the approach of the surgery. This should dissipate once the soft tissue healing process occurs.

What are my chances for success?
Chances for success are dictated by the fact that you must have the right patient for the right procedure, coupled with the right physician. If an individual has the right mindset, the right psychological aspect, and has true physical findings consistent with radiographic criteria that can show where the patient's pain and etiology are located, then the chances for success in spine surgery are quite high.

The information on this website is for informational purposes only and is not intended for diagnosis or treatment.

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