Friday, June 14, 2013

What Can Go Wrong With The Spine?


The thumbnail sized facet joints are situated in the back of the spine on either side. These articulating joints are at each level and allow the spine a very significant range of motion in many directions. At various levels of the spinal cord, which is situated inside the back part of each vertebrae and protected by the bones, nerve branches provide connections to one's arms and legs.

Quite a few conditions represent things that can go wrong with one's spine. The soft cushions between the vertebral bodies are called spinal disks, and are like jelly-filled donuts. They may get little tears or disk bulges; sometimes these tears result in larger cervical or lumbar disk herniations, and are large enough to press on spinal nerves. This results in burning down one's legs, called sciatica. If the pain is in the arms, the fancy term is radiculopathy for the pain.

Another condition that can push pressure on spinal nerves is from arthritis and represents bony and soft tissue overgrowth. This occurs usually in older patients.

What are the options for spine pain? Medications include simple over-the-counter analgesics to opioid narcotics, and in-between are medications that are different than what is traditionally seen. One type of medication is gabapentin, a neuropathic pain medication, which is usually given for epilepsy but often used for pain. Some antidepressants are used for relief of neuropathic painful conditions.

Along with medications, physical therapy is a very beneficial treatment for neck and back pain. That involves core strengthening, strengthening the stomach and the back muscles, the bladder floor, and the diaphragm. Chiropractic treatment has plenty of research to back it up for neck pain along with acute low back pain. Other treatments include spinal decompression, which is a revolutionary intermittent traction designed to provide increased nutrients to the disc for healing. Electrical stimulation, laser, ice and heat, and acupuncture may also provide substantial relief.

Apart from physical therapy, medications, and alternative treatments, a few injection options are available which can help avoid surgery and can be quite effective for spine pain. There are some studies backing up the use of cortisone shots to these facet joint areas; if it works and then wears off a follow up procedure called radio frequency ablation may be used. This may provide relief for over a year.

Another form of injection involves epidural treatments. In pain patients, these procedures are done with the addition of x-ray fluoroscopy, which helps locate the needle for more accurate placement. The idea is to provide some cortisone along with numbing medicine to irritated nerve roots and help simmer down on the swelling and alleviate sciatic, or radicular pain. It is typically quite effective.

There are 3 ways epidural injections are usually done. One is an intra-laminar approach, which is how the injections were done when epidural injections were first started. Another is a transforaminal approach, or a selective nerve root approach, where the medication is injected into the exiting tunnel in a more precise fashion. A third injection is called the caudal approach, which is above the coccyx in a small tunnel at the base of the sacrum.

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