Anatomy of the Spine
The spine is one of the most important bone structures in the body. It provides support and stability during almost any activity. The spine also functions as protection for the spinal cord, a bundle of nerves that begins in the brain and ends in the lumbar portion of the spine. The spinal cord is responsible for sending many signals from the brain to the rest of the body.
There are three major regions of the spine. The Cervical portion of the spine exists in the neck and upper back. The Thoracic spine is located in the middle of the back. The Lumbar spine exists in the lower back above the pelvis. Each region of the spine has a fixed amount of vertebrae.
Vertebrae are protected by discs that act as cushions between bones. Many spinal injuries are a result of deteriorated or dislocated discs. Some of the most common causes of back pain are:
- Bulging or Herniated Discs: discs in the spine can come out of their normal positions and place pressure on the spinal cord. Pain is commonly felt in the area where a disc is dislocated. Treatment consists of realigning the spine and participating in fewer activities that add stress to the spine.
- Misalignment of the Spine: poor posture or conditions such as scoliosis can cause microtrauma to the spine. A buildup of small injuries can lead to pain later in life.
- Arthritis: back pain from arthritis mostly occurs in the lower back. Treatments may include exercise, practicing good posture, and medication.
- Strained Muscles or Ligaments: some activities can place a strain on the muscles and ligaments that support the back. Strains are most often caused by activities such as lifting or bending over. Treatment for these types of injury involves resting the muscles.
Diagnosing Spinal Injury
When back pain becomes too intense to perform daily activities, it is time to see a medical professional. Doctors will begin by observing the patient’s posture and performing minimally invasive exercises involving the back to locate the source of the pain. Some injuries can be diagnosed with a simple medical evaluation, but many doctors will order further testing to diagnose the problem. These tests may include:
- X-Ray: this type of imaging can produce images of bones, which may indicate a broken vertebrae or misalignment of the spine. X-Rays do not show soft tissue, so if the injury is caused by a strained muscle or slipped disc, it will not appear on an X-Ray.
- MRI: if an injury is caused by an issue in the soft tissue, an MRI (Magnetic Resonance Imaging) can produce an image of the issue.
- CT Scan: this imaging technique also produces an image of the soft tissue in the spine.
- Electromyography: also referred to as EMG or “Nerve Studies”, doctors can send an electrical impulse through the body and measure the amount of time it takes to reach a part of the body. A slow travel time can be indicative of nerve damage.
- Blood Tests: doctors may run tests on the blood to look for the presence of something that may be causing or contributing to pain, such as an infection.
Back pain that is diagnosed in its beginning stages can often be treated with nonsurgical methods. Healing from spinal injuries can take weeks and even months depending on the cause and an individual’s commitment to recovery.
Conventional Treatment Methods for Back Pain
Once a diagnosis has been made, doctors can begin to create a treatment plan that is specific to each patient’s needs. Some factors that might influence treatment include overall fitness level, diabetic status, and financial flexibility, for example.
Most back injuries do not require surgery and respond well to conventional treatments such as:
- Medication: doctors may suggest over-the-counter NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as Ibuprofen to help relieve back pain. They may also suggest prescription painkillers depending on the level of pain. These may be prescription NSAIDs or narcotics such as oxycodone. Taking prescription painkillers should be closely monitored by a doctor as it can be dangerous.
- Muscle Relaxant: medication that relaxes muscles can be a good option for an individual who has suffered from a strain or whose spine has become misaligned.
- Corticosteroid Injections: on option for individuals who have back pain is corticosteroid injections. Doctors inject a powerful synthetic dose of the hormone cortisol, which can relieve pain in the short-term. These injections have proven to damage soft tissue over time, however, so they should be closely monitored by a doctor.
- Heat and Salves: some pain relief can be found by applying heat to the affected area. Some individuals also elect to try topical pain relief in the form of lotions or salves.
- Physical Therapy: one of the most successful treatments of back pain is physical therapy. This works well for many patients because physical therapists work with the patient’s specific needs. Physical therapists are also able to inform patients of what exercises they can do to relieve pain at home, as well as things like what sleeping position is best for their condition. Physical therapy may last weeks or months depending on the patient’s progress.
- Surgery: most individuals who experience back pain do not need to consider surgery, as conventional treatments are often enough to relieve pain or fix the underlying problem. If a patient goes six months without significant improvements, however, doctors may consider surgery. Some of the most common types of surgery for back pain include:
- Spinal Fusion: this form of surgery involves removing the problematic disc and fusing two vertebrae together. Spinal fusion is considered a major surgery and can have a recovery period of six months to a year. Most doctors will recommend other surgeries before considering spinal fusion, as it is seen as a last resort for treating back pain.
- Disc Replacement: doctors may recommend a disc replacement surgery. A surgeon removes the problematic disc and replaces it with a synthetic disc made of metal and plastic. As this surgery is less invasive than spinal fusion, the recovery time is shorter – about two to three months.
- Decompression: also referred to as a Laminectomy, this type of surgery involves cutting bone or muscle that is placing pressure on the spinal cord so that the nerve is no longer under stress. This is the least invasive form of spinal surgery. The recovery time is under two months.
There are some other types of spinal surgery that may be recommended; it is up to the doctors and surgeons to determine which is best for each patient. The aforementioned surgeries are the most common that are used to treat back pain.
Making the Decision
Spinal surgeries are almost always elective, which means that it is the patient’s decision to undergo surgery. It is important to maintain an open dialog with medical professionals so that any questions can be answered and recovery is as quick and painless as possible. When deciding to undergo surgery.
Many factors may influence a patient’s decision to undergo surgery, including money, taking time off of work, extent of daily disruption, and support system. Knowing what to expect before, during, and after surgery can be extremely beneficial to a patient. Being aware of what exactly is going to happen and the potential risks can greatly ease any anxiety or stress that comes with making the decision.
Understanding the risks of surgery is important going in – these include infection, blood clots, or a reaction to anesthesia – though there may be more risks that are important to discuss with professionals.
Spinal Surgery Timeline
Each recovery is different, as each patient is different. This timeline is meant to serve as a general guide for what to expect after spinal fusion, disc replacement, and decompression. Always ask doctors or surgeons questions you would like to be answered throughout the recovery process.
- Preparing for Surgery: some steps need to be taken before the surgery begins. This may include taking time off of work, arranging a ride home from the hospital, scheduling blood work, and packing an extra change of clothes, for example. Some surgeries require that the patient does not eat or drink for a certain period of time before the operation. Be sure to learn exactly what is expected within the week leading up to surgery. Preparing as much as possible can ease some of the anxiety associated with surgery.
- The Procedure: an anesthesiologist will be present to apply general anesthesia, and possibly local anesthesia to help with pain in the hours after surgery. The biggest risks of anesthesia are stroke, blood clots, and pneumonia. An IV will be placed in the arm and a catheter will be used. Some patients have a tube inserted into the spine to drain excess fluid.
- Two to Four Hours After Surgery: patients who have undergone surgery are placed in a “recovery room” until the anesthesia wears off and the patient wakes up. Once awake, patients are taken to their own hospital room. Depending on the patient’s condition, it may be recommended to do certain exercises to help maintain strength. During this time period, many medical professionals may visit, such as nurses and physiotherapists who are working on a long-term recovery plan. Some patients may receive instructions for breathing exercises that will be helpful throughout the process.
- The First 24 Hours After Surgery: many physiotherapists will try to get patients up and moving around within the first 24 hours after surgery. These medical professionals will teach patients how to perform exercises at home so that they can continue the recovery process on their own. The success of a surgery depends heavily on how closely these postoperative instructions are followed.
- 1 to 4 Days After Surgery: most patients are discharged from the hospital within four days after surgery. Those who have caretakers at home are allowed to return; some patients choose to live in a care facility while they recover if they do not have friends or loved ones to help them recover at home.
- 1 Week After Surgery: patients should have a routine within one week of the surgery that consists of physical therapy and participating in care practices that have been recommended.
- 2 to 4 Weeks After Surgery: after the first month most patients will be able to drive again, and some may return to work if their job does not require strenuous physical activity.
- 3 Months After Surgery: if the patient has been diligent about their recovery exercises, they can return to more strenuous physical activity. This activity may be observed by a professional before being approved, or the technique may be discussed or changed to prevent further injury.
- 6 Months After Surgery: most physical activity can be resumed at this point, even if it is strenuous. Be sure to consult with a physiotherapist or doctor before attempting strenuous activity.
- 12 to 18 Months After Surgery: the bone should be fully healed after 18 months.
Some factors that may impact the recovery timeline include age, obesity, diabetes, and smoking status. These factors can slow down the recovery process, but staying dedicated and consistent with the physical therapy can improve the odds of a full recovery.
Recovery can be difficult, as it is physically and mentally challenging. Regenerative medicine may offer hope for a less painful and faster recovery. In some cases, regenerative medicine can prevent the need for surgery altogether.
The Role of Regenerative Medicine in Spinal Surgery
The burgeoning field of regenerative medicine seeks to enhance a patient’s naturally-occuring cells. Using stem cells or platelet-rich plasma, some doctors are able to treat issues such as back pain before surgery is necessary. These treatments can also be used for pain relief after a surgery has occurred. The two types of regenerative therapy offered at CELLAXYS are:
- Stem Cell Therapy: a patient’s stem cells are extracted from fat tissue, blood cells, or bone marrow. The cells are then processed so that they are more concentrated. Once the stem cells are ready, they are injected into the problematic area of the spine. Doctors use imaging techniques such as MRI or Ultrasound to determine where the injury is so that the solution can be injected into it directly. The body already sends stem cells to injuries to help them heal, so injecting a higher concentration seeks to help the injury heal more quickly. For spinal fusion surgery, this treatment can help the bones heal together.
- Platelet-Rich Plasma (PRP) Therapy: blood is drawn from the patient and placed in a centrifuge to separate platelets from other components in the blood. Once concentrated, the platelets are injected into the surgery or injury site. Proteins and growth factors are found in platelets, which the body uses to heal itself. An injury could heal faster with more of these components nearby.
Some patients experience some pain at the injection site, but this typically goes away in a matter of days. These therapies are used to not only relieve pain, but also to help the body heal more quickly. There is a relatively low risk as it is using the patient’s own cells. Relieving pain can make it easier to complete physiotherapy.
Back pain can be mildly inconvenient or it can be completely debilitating. Though most conventional treatments are enough to relieve pain or help the spine heal, sometimes surgery is necessary if pain persists. The recovery timeline for spinal surgery is short relative to other major surgeries, but should not be taken lightly. Remaining diligent with physical therapy and other recovery techniques can help the process go more smoothly. Regenerative medicine could be a great option for someone who is looking to relieve back pain, and it can be useful for patients who have already undergone surgery. Staying informed about the recovery process can ease some of the anxiety associated with spinal surgery. Though some conditions may make recovery more difficult or take longer, there is hope for everyone who is suffering from chronic pain.