Spine

ISI Patient Education Resources

Self Help Spine Exercises

  for Neck Pain (coming soon)
  for Back Pain (coming soon)

Understanding Common Spine Problems

  Acute Mechanical Pain
  Degenerative Disc Disease
  Herniated Disc
  Spinal Stenosis
  Osteoporosis
  Compression Fracture

Understanding Spine Surgeries

  Cervical Discectomy & Fusion
  Lumbar Discectomy & Decompression
  Lumbar Fusion

Understanding Spine Injections

  General Information
  Epidural Steroid Injection
  Transforaminal Epidural
  Facet Joint Injection
  Facet Radiofrequency Rhizotomy
  Sacroiliac Joint Injection
  Coccygeal Injection


Understanding Common Spine Problems

  Acute Mechanical Pain

Acute mechanical back or neck pain is the most common type of spine ailment. Studies indicate that more than 80% of the adult population will suffer from this type of spine pain at some point during their life. Mechanical pain is characterized by pain localized to the neck or back that does not radiate to the extremities. Mechanical pain is usually of short duration and resolves without aggressive treatment. Pain that is severe, that lasts more than 4 weeks, or that involves pain in the arms or legs should be evaluated by a medical provider.

Self treatment of acute mechanical pain includes decrease in physical activity or rest for the first 48 hours, followed by careful return to comfortable activity. Prolonged bed rest is not helpful. Over the counter anti-inflammatory medication can be helpful in decreasing pain. Ice in the first 24-48 hours can also decrease pain. After 48 hours, using heat to relax tight muscles and encourage blood flow is helpful. Alternating ice and heat is also effective for some people. Be sure to use caution with ice and heat to avoid causing skin damage.

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  Degenerative Disc Disease

Degenerative disc disease is a spine specific form of osteoarthritis. Osteoarthritis is joint damage caused by accumulated wear and trauma. This wear results in fluid los from the disc, leading to alteration of the physical structure of the disc, and abnormal motion. The incidence of degenerative disc disease increases with age, and becomes common in the mid-thirties to early forties. Degenerative disc disease is characterized by morning stiffness which may last up to an hour. Pain usually diminishes somewhat with moderate activity, but returns after periods of inactivity or rest. Transition activities, such as moving from a sitting to standing position, are often painful. Bending, twisting and improper lifting can cause pain, as can repetitive motion activities. These activities can result in significant pain flares as well. Pain that is severe, that lasts more than 4 weeks, or that involves pain in the arms or legs should be evaluated by a medical provider.

Self treatment of pain flare caused by degenerative disc disease includes decrease in physical activity or rest for the first 48 hours, followed by careful return to comfortable activity. Prolonged bed rest is not helpful. Over the counter anti-inflammatory medication can be helpful in decreasing pain. Ice in the first 24-48 hours can also decrease pain. After 48 hours, using heat to relax tight muscles and encourage blood flow is helpful. Alternating ice and heat is also effective for some people. Be sure to use caution with ice and heat to avoid causing skin damage.

Prevention of future pain flare episodes is considered optimum management of degenerative disc disease. This is accomplished through education in proper body mechanics, and teaching of exercises designed to maximize trunk strength and endurance. This may also include modification of some lifestyle activities to decrease future injury risk.

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  Herniated Disc

Disc herniation means that a portion of the interior of the disc protrudes through a tear in the outer disc covering. Disc herniation often results in compression of nearby nerves, causing pain in the arm or leg that the nerve serves. Nerve compression can also cause numbness, weakness and atrophy in the affected limb. Disc herniation may be the result of a single traumatic injury or be the result of multiple smaller injuries. Degenerative disc disease can also progress to disc herniation.

Self treatment of disc herniation includes decreasing or avoiding painful activity. Moderate, comfortable activity is encouraged. Over the counter anti-inflammatory medications may reduce pain. Persistent arm or leg pain, or limb pain that is accompanied by sensation or strength loss should be medically evaluated as soon as practical.

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  Spinal Stenosis

Spinal Stenosis denotes narrowing of the spinal openings through which nerves pass. Spinal stenosis can occur in several locations within the spine, and symptoms vary based upon the location of the narrowing. Spinal stenosis is commonly a result of aging and degenerative spine changes (see Degenerative Disc Disease). Spinal Stenosis is characterized by back pain and radiation to one or more limbs.

Spinal stenosis symptoms vary in intensity with position and activity. Patients with stenosis in the cervical (neck) region often see symptoms worsen with rotation or extension of the neck. Symptoms are often relieved with flexion. Patients with lumbar (low back) stenosis often have progressive pain with standing or walking, often accompanied by increasing weakness and/or numbness. Symptoms are relieved by bending or sitting.

Effective self treatment of spinal stenosis is limited. Avoidance of aggravating activity is helpful, but symptoms of spinal stenosis should be evaluated by a medical provider.

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  Osteoporosis

Osteoporosis is a bone abnormality caused by progressive loss of bone mass which causes the bones to become weakened. While osteoporosis may occur as a consequence of medical disease, it is most often a result of again and decreased sexual hormone production. Osteoporosis is a relatively slow progressing condition that is painless. Discovery of osteoporosis often occurs when bone weakness leads to fracture. Osteoporosis affects women more often than men, due to the loss of estrogen that occurs with menopause. Men who have low testosterone levels are also more susceptible, however.

Menopausal women should be evaluated for risk of osteoporosis by a medical provider. Several risk factors need to be considered when determining when and how often to screen patients for this condition.

Self treatment of osteoporosis includes maintaining adequate stores of Vitamin D and calcium. Regularly weight bearing exercise is also recommended to encourage bone strength.

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  Compression Fracture

Compression fracture denotes a vertical collapse of a vertebra, due to trauma or weakening (see Osteoporosis). Compression fracture symptoms are variable. Some patients experience sudden severe back pain that is debilitating. Other patients experience few symptoms, and their compression fractures are discovered long after they have healed.

Compression fractures can continue to collapse, leading kyphosis (an exaggerated forward curve). Some compression fractures can also cause compression of the spinal nerves or spinal cord. When injury, age, or concern about pain severity are present, prompt evaluation for compression fracture is important.

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Understanding Spine Surgeries

  Cervical Discectomy & Fusion

Cervical discectomy and fusion is the standard operative treatment for most common neck problems. A small lateral skin incision is made at the front of the neck. The unique anatomy of the neck allows the structures under the skin to be moved aside, allowing direct access to the front of the spine. The disc is removed completely to allow the surgeon to eliminate any pressure on the nerves or spinal cord. Removal of the disc also makes removal of bone spurs and opening of the nerve tunnels possible. To preserve the room that the nerves require to exit the spine properly, a small bone graft implant is placed in the disc space. A small metal plate is then placed at the front of the spine to maintain proper alignment and stability while the graft heals.

Cervical Discectomy and fusion requires approximately one hour to perform. Most patients leave the hospital in 1 - 2 days after surgery. Your surgeon may ask you to wear a neck brace for safety. Recovery from surgery takes approximately 6 - 8 weeks. You will be asked to return for follow up after surgery and x-rays will be done to assess healing. Success rates are very high and complication rates low.

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  Lumbar Microdiscectomy & Decompression

Lumbar microdiscectomy and decompression is the standard operative treatment for conditions that cause low back and leg pain. The procedure is performed under magnification to minimize the size of the incision. A small vertical incision is made over the problem level. The underlying tissue is carefully divided to provide a visual field for the procedure. A small amount of bone is removed from the back of the spine to enhance the visual field. The problem level is then explored, and any disc material or bone causing nerve compression is removed. The nerve tunnels are explore to ensure that they are open as well.

Lumbar discectomy and decompression requires approximately one hour to perform. Most patients leave the hospital in one or two days. Recovery from surgery takes approximately 4 - 6 weeks. During the first 3 weeks you will be asked to avoid sitting for more than 15 minutes each hour. You may stand, walk or lie down as you like. Success rates are very high, with very few complications.

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  Lumbar Fusion

Lumbar Fusion is the standard operative treatment for chronic back pain resulting from instability, structural defect, or chronic pain refractory to non-surgical management. There are several variations of lumbar fusion, and your surgeon can provide information specific to your condition.

The goal of lumbar fusion is to eliminate instability and painful motion in the lumbar spine. This is accomplished by the insertion of medical hardware combined with grafted bone. Lumbar Fusion requires 1 - 3 hours to perform, depending on the type of surgery and number of levels treated. Most patients leave the hospital in 2 - 3 days. Your surgeon may ask you to wear a brace for safety. Recovery from surgery takes approximately 6 - 12 weeks, and your surgeon may ask you to return for follow-up for up to 6 months. Periodic x-rays are taken to evaluate healing. Success rates are high, and complication rates low.

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Understanding Spine Injections

  General Information

Spinal injections have relatively few risks, however they are not risk free. Discomfort, tenderness and bruising at the injection site can occur, and is not usually a problem. More common risks from these types of injections include infection, bleeding, and allergic reaction to medication. Spinal fluid leak is a possibility with the epidural procedures, and may cause a temporary headache, requiring rest and increased fluid intake. Very rare complications include nerve pain or damage, and bone changes as a result of repeated steroid use.

Be sure to tell your provider if you are diabetic, as the steroid can increase your blood sugar. Also be sure to tell your provider if you are taking blood thinners such as Coumadin (warfarin), heparin, Lovenox, Orgaran, Innohep, Fragmin, Argatroban, Plavix, ReoPro, Ticlid, Trental, Persantine or Predaxa. You may need to stop these medications in order to safely perform these procedures, and this requires permission from the prescribing provider.

You may experience temporary changes in strength or sensation in your extremities as a result of your injection. Therefore, for your safety, please ensure that you have someone with you to drive you home.

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  Epidural Steroid Injection

An epidural steroid injection (also referred to as interlaminar or translaminar) is a procedure designed to deliver medication into the central spinal canal. The central spinal canal contains the spinal cord and nerve roots, encased in a protective sac called the dura. The word epidural literally means “outside the dura”, so the purpose of this injection is to deliver medication into the central spinal canal, but outside the dural sac. This allows the medication to help reduce inflammation in both spinal disks and nerves.

The procedure is performed with the patient lying on his/her stomach. The target area is sterilized using antibacterial soap, and is draped to keep it sterile. A fluoroscope (a type of real-time X-ray) is used to visualize the patient’s anatomy and verify the injection site. The skin is then anesthetized with a local anesthetic. Once the skin is anesthetized, a needle is advanced to the central spinal canal under fluoroscopic guidance. A small amount of contrast (a medication which is visible on X-ray) is injected to confirm that the needle is correctly placed. The medication (commonly a combination of steroid and anesthetic) is then injected. The needle is withdrawn, and the procedure is complete. The procedure usually takes about 10-15 minutes to perform. Relief from this type of injection usually begins in 3-7 days.

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  Transforaminal Epidural

A transforaminal epidural (also known as a selective nerve root block) is a procedure designed to deliver medication to a specific nerve in the spine. This injection is used for both diagnosis and treatment of nerve related spine problems.

The procedure is performed with the patient lying on his/her stomach. The target area is sterilized using antibacterial soap, and is draped to keep it sterile. A fluoroscope (a type of real-time X-ray) is used to visualize the patient’s anatomy and verify the injection site. The skin is then anesthetized with a local anesthetic. Once the skin is anesthetized, a needle is advanced under fluoroscopic guidance to the opening through which the target nerve exits the spine. A small amount of contrast is injected to verify correct position of the needle. A small amount of anesthetic, or anesthetic and steroid, is injected. The needle is withdrawn and the procedure is complete. This injection usually takes about 10-20 minutes to complete. You may notice an immediate decrease in pain from this injection because of the anesthetic effect on the nerve.

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  Facet Joint Injection

A facet joint injection is a procedure designed to deliver medication into one or more spinal facet joints (also known as zygoapophyseal joints). These joints are small accessory joints at the rear of the spine, whose job is to facilitate bending and limit twisting. This procedure is used to treat pain and inflammation arising from degenerative changes in these joints.

The procedure is performed with the patient lying on his/her stomach. The target area is sterilized using antibacterial soap, and is draped to keep it sterile. A fluoroscope (a type of real-time X-ray) is used to visualize the patient’s anatomy and verify the injection site. Depending on the size of the needle used and the number of joints to be injected, the skin may or may not be anesthetized with a local anesthetic. Your provider will discuss the proposed method with you prior to the procedure. For each joint injected, a needle is advanced into the facet joint under fluoroscopic guidance. A small amount of contrast is injected to verify the needle position. The medication is then injected. The needle is then removed. Often facet join injections are done at multiple levels simultaneously, and sometimes done on both sides as well. Your provider will discuss specifics with you prior to the procedure. This procedure may take from 10-30 minutes to perform, depending on the number of joints to be injected. You may notice some immediate decrease in pain as a result of anesthetic effect on the joint.

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  Facet Radiofrequency Rhizotomy

Facet rhizotomy is a procedure designed to provide long-term relief of back pain caused by the facet joints (also known as zygoapophyseal joints). These joints are small accessory joints at the rear of the spine, whose job is to facilitate bending and limit twisting. Rhizotomy refers to the propagation of radiofrequency waves through a needle to generate small areas of intense heat near the nerves that provide sensation to the facets. The heat destroys these nerves, relieving pain. This procedure is used to treat pain and inflammation arising from degenerative changes in these joints. Rhizotomy is designed to deliver longer lasting relief from facet related back pain when facet joint injections fail to provide prolonged relief.

Prior to rhizotomy you may be asked to undergo a procedure to anesthetize the nerves serving the facets. A positive response to this procedure usually indicates a greater chance of pain relief with rhizotomy.

The procedure is performed with the patient lying on his/her stomach. The target area is sterilized using antibacterial soap, and is draped to keep it sterile. A fluoroscope (a type of real-time X-ray) is used to visualize the patient’s anatomy and verify the injection site. For each joint treated, a special needle is advanced to the area of the facet nerves. A small amount of contrast is injected to verify correct placement. Introduction of radiofrequency waves through the needle cause the disruption of the nerve fibers. Often this procedure is performed on multiple levels and on both sides during a single encounter. This procedure may take between 20-60 minutes to perform, depending on the number of levels treated.

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  Sacroiliac Joint Injection

Sacroiliac injection is a procedure designed to deliver medication into one or both of the large joints that joins the spine and the pelvis. This procedure is designed to treat inflammatory and degenerative changes in these joints.

The procedure is performed with the patient lying on his/her stomach. The target area is sterilized using antibacterial soap, and is draped to keep it sterile. A fluoroscope (a type of real-time X-ray) is used to visualize the patient’s anatomy and verify the injection site. The skin is then anesthetized with a local anesthetic. Once the skin is anesthetized, a needle is advanced into the sacroiliac joint under fluoroscopic guidance. A small amount of contrast is injected to verify the needle position. A combination of steroid and local anesthetic is then injected into the joint. The needle is then removed. This procedure usually takes about 10-20 minutes to perform. You may notice immediate decrease in your pain as a result of the anesthetic effect.

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  Coccygeal Injection

Coccygeal injection is a procedure designed to deliver medication into the coccyx, or tailbone. This procedure is designed to treat inflammatory and degenerative changes in the coccyx.

The procedure is performed with the patient lying on his/her stomach. The target area is sterilized using antibacterial soap, and is draped to keep it sterile. A fluoroscope (a type of real-time X-ray) is used to visualize the patient’s anatomy and verify the injection site. The skin is then anesthetized with a local anesthetic. Once the skin is anesthetized, a needle is advanced into the sacroiliac joint under fluoroscopic guidance. A small amount of contrast is injected to verify the needle position. A combination of steroid and local anesthetic is then injected into the joint. The needle is then removed. This procedure usually takes about 10-20 minutes to perform. You may notice immediate decrease in your pain as a result of the anesthetic effect.

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