Notes

Is a spinal surgeon a doctor?
What is a Spine Surgeon? Spine surgeons are doctors that specialize in the treatment of conditions that affect the spine. Both ortho Surgeons and Neurosurgeons have been trained and are able to specialize in procedures for the spine. In some cases specificization training could an amalgamation of both orthopedic and neurosurgeons.

Overview

Spine surgeons are medical professionals, meaning they have an M.D. or D.O. Both degree titles require the same qualifications and post-medical instruction to be specialized in spinal surgery.

Following the completion of medical school doctors who aim for becoming spinal surgeons finish a residency program. Doctors who specialize in orthopedic Surgery or Neurological Surgery might choose to specialize in spine surgery. After their residency is completed, doctors must then spend at least a year in fellowship training so that they can specialize in spinal surgery.

Common Conditions To Be Treated

Spine surgeons treat a variety of back conditions that include disc herniations and fractures, or spinal stenosis. Often, the location in the spine is included in the description of the condition. The reason for these conditions vary, but they usually result due to trauma, disease or degeneration.

The conditions that cause pain and stiffness can be congenital, meaning they were present at birth, or could be caused by trauma, tumors or infections. Chiari malformation is an example of a congenital spinal disorder however many conditions can be congenital. For example, spinal deformities such as kyphosis, Scoliosis and lordosis can be present from birth.


Conditions may also be degenerative. This means they cause the structures they affect to slowly weaken or degrade over time. Degenerative disc disease, arthritis the condition known as spinal stenosis as well as herniated or ruptured discs are all instances of diseases that can result from degenerative. In the process of degeneration, joints and structures may be caused by wear-and-tear or aging, however it can also be due to the genetics of the person, lifestyle choices that are unhealthy and repetitive movements or excessive use.


Most common procedures performed

The options for surgery are based on the conditions and their degree of severity and location as well as other factors like your medical history or general health. To ensure your safety or the possibility of side effects, your doctor may not prescribe certain procedures. Every person's condition and anatomy is different, and you may not be a candidate for some procedures. Spinal fusion, foraminotomy, discectomy, and laminectomy are some of the procedures employed in spine surgeries. However, the procedure and procedure used to carry out these and other procedures varies in accordance with the condition, its location, and other factors.


The traditional spine surgery is characterized by long deep cuts into muscles, which can leave long-lasting scars that need a long healing time. Technology advancements and advances in surgical instrumentation have allowed surgeons to carry out some procedures in a less invasive way. In minimally invasive spine surgery an incision of a tiny size is made, and then the tubular dilators are introduced to open the incision for surgeons to access the region without cutting muscle tissue. Because the muscle tissue has been separated rather than cut, it's more likely to heal after the procedure is complete.


Your surgeon can also employ an Image Guidance Technique to make a digital image of your spine when the procedure is carried out. With this technology surgeons are competent to carry out the surgery with much more precise placement accuracy. This minimizes the possibility of the failure of fusion or non-union and makes it the most secure method for surgeons who are performing minimally surgical spine procedures.


The kind of procedures that are performed by spine surgeons varies slightly according to whether your physician are an orthopaedic surgeon, or neurosurgeon. In general, both types of surgeons carry out the same procedures however, some procedures may be better suited to specific specialties. For instance, certain conditions such as spinal cord tumors could be more likely to be treated by a neurosurgeon owing to their expertise on disorders that affect the nervous system. Also, orthopedic surgeons with a specialization in spinal disorders may be more likely to treat spinal disorders such as scoliosis. Orthopedic surgeons may also be more likely to perform procedures that require extensive instruments.


Relaxants for muscles. This drug acts as a depressant to the nervous system central and increases mobility of tense muscles, relieving pain from muscles spasms or tightness. Relaxants for muscles do not play a role in the management of chronic pain.


Narcotic pain medications. Narcotic medications, also called opioids or painkillers, alter one's perception of pain through weakening messages sent by the brain. Narcotic medicines are usually used for treating intense short-term pain like acute pain after an operation. Narcotics rarely are employed to treat chronic discomfort, since they carry many adverse effects and can quickly become addictive.


Back braces. A few patients have found the back brace can be used to provide comfort and even ease the pain. There is evidence to suggest that the use of an elastic corset-style braceworn regularly along in conjunction with an program, may speed up healing and decrease pain.1 A back brace may be beneficial after back surgery.


Epidural steroid injections. The injection is that is injected directly into the outer part in the sac dural, which surrounds the spinal cord. A live x-ray, known as fluoroscopy, helps guide the needle into the correct area. The goal of the injection is to temporarily relieve pain by decreasing inflammation around a compressed nerve root.



Alternative Treatments

Alternative treatments can be referred to as complementary or alternative care. The expression "alternative" does not mean that it is inferior, rather, it should be interpreted as not being conventional in accordance with western medical standards.


Back pain is a common reason for employees to be absent from working and for seeking medical treatment. It can be uncomfortable and can be debilitating.


It can result from injury, activity and some medical health conditions. Back pain can be a problem for people regardless of age, due to various reasons. As you age the probability of developing lower back pain is higher due to factors such as prior work experience as well as degenerative disk disease.


Lower back pain could be related to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs. The spinal cord nerves, muscles of the lower back as well as pelvic and abdominal organs, as well as the skin surrounding the lumbar area.


The pain in the upper back can be due to a disorder of the aorta or tumors in the chest, and spine inflammation.


Causes


Spinal problems such as osteoporosis can result in back pain.


The human back is composed of a complicated structure made up of muscles, ligaments, disks, tendons and bones, which work together to support the body and enable us to move around.


The vertebrae of the spine are cushioned with cartilage-like pads called disks.


The problem with any of these components could result in back pain. When it comes to back pain, the reason remains unclear.


Damage can result from injuries, medical conditions, and poor posture, for example.


Strain

Back pain is usually caused by strain, tension or an injury. Most often, the causes for back pain are:


The ligaments or muscles are stretched

a muscle spasm

tension in muscles

damaged disks

injuries, fractures, or falls

The activities that could cause spasms or strains include:


Unsafely lifting something

the lifting of something which is heavy

performing an abrupt and awkward movement

Structural problems

Many structural issues can also cause back pain.


Disrupted disks: Each vertebra within the spine is supported by disks. If the disk ruptures there will be more pressure on a nerve resulting in back pain.

Disks that bulge: Much the similar way to ruptured disks, a bulging disk could result in increased pressure on a nerve.

Sciatica: A sharp and shooting pain runs through the buttocks and the back of the leg as a result of an overly bulging or herniated disk pressing on a nerve.

Arthritis: Osteoarthritis may cause issues with joints in the hips, lower back and various other areas. In some cases the space around the spinal cord narrows. This is known as spinal narrowing.

Abnormal curvature of the spine: If the spine curves in an unusual way the back may suffer. An example is scoliosis, in which the spine curves to one side.

Osteoporosis: Bones, such as the vertebrae of the spinal column, become brittle and porous, making compression fractures more likely.

Kidney issues Kidney stones or kidney infections can cause back pain.

Moving and posture


Adopting a very hunched sitting in front of computers can cause back and shoulder issues in the course of time.


The back pain may also be a result from some everyday activities as well as poor posture.


Examples include:

twisting
Sneezing or coughing
muscle tension

over-stretching
bending awkwardly or for long periods
lifting, pushing or lifting the item
sitting or standing for prolonged periods
straining the neck forwards like when driving or using computer
long driving sessions , without a break, even if you're not bent over
sleeping on an unsupportive mattress will not allow for body support and keeps the spine straight
Other causes
Certain medical conditions can lead to back pain.

Cauda equina syndrome: The Cauda Equine is a spinal nerve roots which arise from the lower part of the spinal cord. Symptoms include a dull pain in the lower back and the upper buttocks. It can also cause feeling of numbness in the buttocks genitalia, and thighs. Sometimes, there are bowel and bladder function disorders.

The spine is a target for cancer: A tumor of the spine could press against nerves that causes back pain.

Infection of the spine: A fever and a tender, warm area on the back could be caused by an infected spine.

Other infections: Pelvic inflammation disease, bladder, or kidney infections can cause back pain.


Sleep disorders: People with sleep problems are more likely experience back pain, relative to others.

Shingles: An infection that could affect nerves can result in back pain. This is contingent on which nerves are affected.

Risk factors

The following factors are linked to a higher chance of developing back pain:

occupational activities
pregnancy
A lifestyle of sedentary
Physical fitness is not great
older age
obesity and excess weight
smoking
hard physical work or exercise or work that is strenuous, especially if done incorrectly
genetic elements
medical conditions, for example, cancer and arthritis
Lower back pain also tends to be more common in women than males, perhaps due to hormonal factors. Stress, mood disorders, anxiety, and depression have been associated with back pain.

When should you see a doctor

Get medical assistance when you feel any tingling or numbness or if you suffer from back discomfort:


which doesn't improve in the absence of rest
after an accident or following a fall
with numbness in the legs
with weakness
with the flu
without explanation of weight loss
Diagnosis
A doctor is usually in a position to recognize back pain following a discussion of symptoms and carrying out physical exam.

A scanning scan or other tests may be required when:


back pain is thought to stem from an injury

there could be an underlying reason that needs treatment

the pain persists over an extended time

A X-ray, MRI or CT scan can give information regarding the condition of the soft tissues of the back.


X-rays are able to show the alignment of bones and reveal indications of arthritis or broken bones. However, they do not always reveal the extent of injury to muscles, spinal cord disks or nerves.

MRI or CT scans can show herniated disks or issues with tendons, tissue, ligaments, nerves and blood vessels, muscles, as well as bones.

Bone scans are a way to detect bone tumors as well as compression fractures due to osteoporosis. A radioactive substance or tracer is placed into the vein. The tracer is then absorbed into the bones and assists the doctor spot bone disorders through a camera that is specifically designed.

Electromyography or EMG measures the electrical impulses that nerves produce when muscles are stimulated. It can be used to confirm nerve compression that could be caused by a herniated disk or spinal stenosis.

The doctor might also recommend a blood test if an infection is suspected.


Other diagnostic types

A chiropractor can diagnose a problem through the use of touch or palpation and a visual examination. Chiropractic is described as a direct approach that focuses on the adjustment of the spinal joints. A chiropractor may also need to check the results of scans and blood and urine tests.

An osteopath diagnoses also through palpation and visual inspection. Osteopathy is the practice of slow and repetitive stretching, known as pressure, mobilization as well as indirect approaches, as well as manipulation of joints and muscles.

A physical therapist concentrates on diagnosing problems in the joints and soft tissues that make up the body.

Pain that is acute or chronic?

Back pain is categorized in two categories:


Acute pain can be sudden and can last for up to 6 weeks.

Chronic or long-term pain can develop over a longer time period and lasts longer than 3 months, and is the cause of chronic issues.

If a person is suffering from both occasionally intense bouts pain and fairly continuous moderate low back pain may be hard for a doctor to tell if they suffer from chronic or acute back pain.


Treatment

Back pain is usually relieved by rest and home remedies, but sometimes medical treatment is needed.


Solutions for Home

Over-the-counter (OTC) medications for pain relief, usually nonsteroidal anti-inflammatory drugs (NSAID), such as ibuprofen which can help ease pain. Applying a hot or an ice cube to the painful spot may help reduce pain.


A break from vigorous activity can aid, however moving around will ease stiffness, ease pain and help prevent muscles from weakening.


Medical treatment

If home treatments do not relieve back pain, a physician could recommend the following drugs, physical therapy, or both.


Medication: Back pain that does not respond well to OTC painkillers might require prescription NSAID. Hydrocodone and codeine, which are both narcotics, can be prescribed for short durations. These require close monitoring by the doctor. In certain situations muscles relaxants are used.


Antidepressants like amitriptyline, may be prescribed, but studies are ongoing on their efficacy, and the evidence is conflicting.


The application of heat, ice, ultrasound, and electrical stimulation -- and also some muscle release techniques to back muscles and soft tissues can help ease pain.


If the pain gets worse The physical therapist could introduce some strength and flexibility exercises for the back and abdominal muscles. Techniques for improving posture may help.


Patients will be advised to keep practicing the exercises regularly, even after the pain has gone, to prevent back pain recurrence.


Cortisone injections: When other alternatives aren't working, these may be injected into the epidural area, around the spine. Cortisone is an anti-inflammatory drug. It can reduce inflammation around the nerve roots. Injections may also be used for numbing areas that may be causing the pain.


Botox: Botox (botulism toxin), according to some preliminary studies, is believed to ease pain by relaxing muscles that are spasming due to sprained muscles. Botox injections can be effective for about 3 to 4 months.


Traction: Weights and pulses are used to stretch the back. This can result in an injured disk moving back to its original position. It is also a way to relieve pain, however only while tension is applied.


Cognitive behavioral therapy (CBT) CBT is a technique that can aid in the management of chronic back pain by encouraging different approaches to thinking. It could involve relaxation techniques and methods of maintaining a positive attitude. Research has shown that people with CBT tend to become more active and exercise leading to a reduced risk of back pain recurrence.


Therapies for complementary disorders

Complementary therapies are often used alongside conventional therapies or on their on their own.


Chiropractors, osteopathy and shiatsu and acupuncture could help reduce back pain, while also allowing the patient to be relaxed.


An osteopath specializes in the treatment of the skeleton and muscles.

A chiropractor can treat bones, muscles and joint problems. The primary focus is on spine.

Shiatsu often referred to as the therapy of pressure with fingers, a type of massage that involves pressure being applied to energy lines within the body. Shiatsu therapists apply pressure with fingers or thumbs, as well as elbows.

Acupuncture is a practice that originated in China. It involves inserting fine needles as well as specific points within the body. Acupuncture can assist the body to release its natural painkillersthe endorphins as well as stimulating muscle and nerve tissue.

Yoga is an exercise that involves specific postures, movements, and breathing exercises. Some can aid in strengthening the back muscles as well as improve your posture. It is important to ensure to ensure that exercises do not cause back discomfort more severe.

Studies on complementary therapies have yielded mixed results. Certain individuals have seen substantial benefits, while others have not. It is vital when you are considering alternative treatments, to work with the services of a licensed and qualified therapist.


TENS, also known as transcutaneous electrical stimulation (TENS) is a popular treatment for those suffering from back pain that is chronic. The machine transmits small electrical impulses to the body via electrodes that are placed on the skin.


The experts believe that TENS stimulates the body to make endorphins and may block signals of pain that return into the brain. Studies on TENS have provided mixed results. Certain studies showed no benefit and others showed that it may be beneficial for some individuals.


A TENS machine should only be employed under the supervision by a medical professional.


It should not be used by someone who is:


is pregnant
is a victim of epilepsy with a history
includes a pacemaker
has a family history of heart disease.
TENS is described as "safe affordable, non-invasive, and patient friendly," and is believed to decrease pain, however more evidence is needed to confirm its effectiveness at increasing levels of activity.


Surgery

The procedure for back pain is not common. If a patient has an injury to the disk, surgery might be an option, especially in cases of chronic pain and nerve compression that may cause weakness in the muscles.


Some examples of surgical techniques are:


Fusion A vertebra is joined with the aid of a bone graft placed between them. The vertebrae are splinted together by screws, plates made of metal or cages. The vertebrae are at a greater risk of chance for arthritis to occur in the adjacent vertebrae.

Artificial disk: An artificial disk is implanted; it replaces the vertebral column cushion.

Diskectomy: A portion of a disc can be removed if irritating or pressing against nerves.

Partially removing a vertebra: A small portion of a vertebra may be removed if restricting the spinal cord or nerves.

Injecting cells into the spine to heal discs: Researchers who are from Duke University, North Carolina have developed biomaterials capable of delivering an increase shot of healing cells to the nucleus pulposus, effectively reducing pain caused by degenerative disc disease.


Prevention


Methods to lessen the risk of developing back pain are mainly of addressing some of these risk-factors.


Exercise: Regularly exercising helps strengthen your body and help you control weight. Exercises that are low-impact and guided are a great way to improve the health of your heart with no strain or strain on the back. Before beginning any exercise program, talk to the health professional.


There are two types of exercise that people can do to reduce the chance of developing back pain:


Core-strengthening exercises work the back and abdominal muscles, which helps strengthen muscles that protect the back.

The goal of flexibility training is to improve core flexibility, which includes the hips, spine, and upper legs.

Diet: Ensure that your diet includes enough calcium and vitamin D, because these are vital for bone health. A healthy diet can also help reduce body weight.


Smoking: A significantly higher proportion of smokers experience back pain incidents compared to non-smokers of the same ages as well as height and weight.


Length of body: amount of weight people carry and the area they put it influences the risk of developing back discomfort. The difference in back pain risk between obese and normal weight individuals is large. People who carry their weight in the abdominal region as opposed to the buttocks and hip area are also at a higher risk.



Position when standing: Make sure you have an ideal pelvis position. Sit upright, face towards the front, straight back, and distribute your weight evenly on both feet. Maintain your straight legs and your head aligned with your spine.


Posture while sitting An ideal seat to work from should include back support, arm rests and an adjustable base. When you sit, make sure to keep your knees and hips at an even level, and keep your feet straight on the floor or use a footstool. You should ideally be able to sit up straight with support on the lower part portion of your back. If you're using a keyboard, make sure that your elbows remain at right-angles and that your forearms are vertical.



Lifting: When you lift things do it with your legs. Use your legs to perform the lifting, and not your back.


Keep your back as straight as you can, keeping your feet spaced apart, with one leg slightly forward so that you are able to keep your balance. Only bend at your knees, and hold an object close to you, and straighten your legs by changing the position of your back as little as you can.


A slight back bend is unavoidable however, when you bend your back make sure you don't stoop, and ensure that you strengthen your abdominal muscles to the point that your pelvis is pulled up. Most important, do not straighten your legs before lifting or you'll have to use your back for most of the time.


Don't lift and twist simultaneously If something is weighty, ask if you can lift it by working with another person. While you are lifting keep your eyes straight ahead, and not up or down to ensure that the back of your neck forms a straight line that runs from your spine.


Moving things: It is best to use your back muscles to push things across the floor, with your leg strength instead of pulling them.


Shoes: Flat shoes place less of a strain to the spine.


Driving: It's important to have proper support for your back. Make sure that the side mirrors are in the proper position so that you do not have to twist. The pedals must be ahead of your feet. If you're taking the road for a long time, be sure to take ample breaks. Leave the vehicle and stroll around.


Bed: You should have a mattress that helps keep your spine straight while at the same time supporting the weight of your shoulders and buttocks. You can use a pillow but not one that sags your neck into a steep angle.





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