Surgery for Lumbar Spinal Stenosis Provides More Pain Relief than Nonsurgical Treatment
April 1, 2007
by: Sylvia Marten
Surgery is more effective than nonsurgical treatment in providing pain relief for patients with lumbar spinal stenosis, new study results find.
At all update points, both the study participants who had surgery and who had non-surgical treatments showed improvement: however, the participants who had a laminectomy showed greater improvement in their pain levels and ability to function, while those who had non-surgical stenosis treatments showed only a moderate improvement. The improvements were maintained at 2 years of followup.
These above results stem from the Spine Patient Outcomes Research Trial (SPORT), a large 7-year trial undertaken at 13 prominent spine centers and sponsored by the National Institutes of Health. The study included 654 patients with lumbar spinal stenosis (without associated degenerative spondylolisthesis).
All study participants were candidates for surgery for their spinal stenosis, meaning that they had moderate to severe leg pain (sciatica) for at least 12 weeks. Lumbar spinal stenosis typically causes leg pain due to a narrowing of the spinal canal that pinches the nerve root and causes pain down the sciatic nerve.
Study participants who had the spinal stenosis surgery had standard posterior decompressive laminectomy, and those who had non-surgical care had one or a combination of at least active physical therapy (such as stretching, exercise), education for home exercise and ergonomics, and possibly nonsteroidal anti-inflammatory drugs.
Source: New England Journal of Medicine. 2008;358:794-810.
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The Spine-health.com blog is an educational and editorial tool authored and maintained by Spine-health.com staff. Unlike most Spine-health.com articles, this is area is not peer-reviewed. Specific questions concerning your health should always be discussed with your doctor.
Comments are published on the fly, but are moderated by our medical director, Dr. Peter Ullrich, Jr., Spine-health.com medical advisors, and Spine-health.com staff. Thanks for using the Spine-health.com blog - be sure to subscribe to this blog in your RSS reader!
Peter Ullrich, Jr., MD
Doctor Ullrich is an orthopedic spine surgeon at the NeuroSpine Center of Wisconsin and co-founder and Medical Director for Spine-health.com.
He started Spine-health.com and is actively committed to it because he believes that patients deserve the same quality of medical information as physicians – that is, information that has been independently peer reviewed by other physicians to ensure accuracy, completeness, and lack of any commercial influence.
Now, in addition to the peer reviewed back pain articles, Dr. Ullrich blogs – as often as he can – about personal opinions and issues he wants to address regarding spine medicine and in particular spine surgery. Read more about Dr. Ullrich at his practice page.
Stephanie Burke
Stephanie co-founded Spine-health.com and runs the day to day operations of the site. She frequently contributes to the blog, commenting on breaking news, insights and - especially - information sent in from the thousands of people visiting Spine-health.com everyday. All in the hope that full information will help individuals make better choices. Read more about Stephanie. Contact Stephanie at Sburke at spine-health.com.
Sylvia Marten
Sylvia Marten heads up the marketing efforts at Spine-health.com. In her role, Sylvia leverages over 11 years of experience in sales and marketing, business development, and strategic consulting to create successful experiences between Spine-health’s unique chronic pain consumers/patients and physicians - and the companies that wish to market to them.
Sylvia will occasionally blog about trends and events in the chronic pain market, in online media and in marketing as they pertain to the health information space. She has a special interest in osteoporosis, exercise and fitness, and health on the Internet. Contact Sylvia at Smarten at spine-health.com.
Fibromyalgia: Cortisol May Help
March 20, 2008
by: Stephanie
New research shows that fibromyalgia symptoms of pain and fatigue may be alleviated by administration of Cortisol, a naturally occurring hormone in the body.
Kent Holtorf, MD, Medical Director of the Holtorf Medical Group Center for Endocrine, Neurological and Infection Related Illness, has concluded that most patients diagnosed with fibromyalgia and/or chronic fatigue syndrome have abnormal adrenal function (based on a review of 50 published studies that assessed adrenal function in this patient population).
Doctor Holtorf's study, recently published in the Journal of Chronic Fatigue Syndrome, demonstrated that patients that were given cortisol as part of a multi-system treatment experienced significant improvement in their symptoms, including reduced pain and more energy.
Dr. Holtorf's research was confirmed in an observational study he conducted that followed 500 patients from his clinic, where all of the patients were given cortisol as part of their treatment protocol:
94% showed improvement by the fourth visit;
75% noted significant improvement;
As shown in the study published in Journal of Chronic Fatigue Syndrome, cortisol doses of 5-to-15 mg a day were shown to have little or no associated risk while having the potential for significant benefit for patients with fibromyalgia or chronic fatigue syndrome.
Source:
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Posted by: Stephanie
5 Tips for Flying Back Pain Free
March 12, 2008
by: Stephanie
With spring break around the corner, and travel season looming, many people with chronic back pain aren't looking forward to vacation; they're worried about how to manage the pain associated with a long flight.
Forum member Tallguy, who is preparing for a grueling 12 hour flight from Taiwan to the US, recently asked for advice on how to fly comfortably despite back pain caused by disc degeneration. Several members responded with suggestions to help minimize his back pain and make his trip more tolerable.
Move.
Get up and walk and stretch as frequently as possible. Go to the back of the plane and do back bends, etc. Consider bringing a doctor's note and alert the flight crew prior to boarding that you have a back condition and will need to move about more often than normal passengers.Smart Flight Scheduling.
Try to book a flight for a time of day when the plane is likely to be on the empty side. If there are any empty rows, ask to be moved to one so you can lie down across the seats. This will help keep pressure off of your back.Posture Perfect.
Bring a back roll or ask for extra pillows to put behind your back to keep your spine straight and prevent slouching. This will alleviate pain and pressure. If you are on the shorter side, bring something to prop up your feet to keep your knees at a right angle.Bring the Heat and Chill.
Bring gel packs that can be frozen or heated (or bring one of each). These are great for treating swelling, sore muscles, back pain and even headaches. Be sure to have the physician's note about your back condition handy in case airport security has issues with the gel pack in your carry-on luggage; medically necessary items over the 3 oz. limit are permitted through the security checkpoint.Pain Medication.
OTC pain killers like acetaminophen and NSAIDs, or prescription drugs like narcotics or muscle relaxants, can help "take the edge" off during and after the flight. (Read more about back pain medication). Again, a letter from your doctor stating your need for any prescribed pain medications will help with possible airport security issues; and always be sure to keep medications in their original bottles.
Using a combination of the tips above should make travel as easy on your back as possible. Happy trails!
Posted by: Stephanie
Read more:Smoking and Low Back Pain
March 4, 2008
by: Sylvia Marten
The fact that smoking is not good for your health is not exactly news, but most people do not associate smoking with pain.
Lifestyle issues such as smoking, as well as lack of exercise and obesity, hamper the patient’s ability to find sufficient pain relief over the long term. In fact, research has shown that smoking causes back pain.
In my own personal experience with treating back pain patients, I have seen that chronic smokers rarely ever recover from chronic pain conditions even with a variety of treatments.
While quitting smoking is a necessary component of any patients’ personal rehabilitation from low back pain, it is rarely a sufficient means, and other pain treatments such as injections, surgery, medication, and exercising are essential.
As far as spinal fusion surgery for patients with low back pain, quitting smoking prior to surgery is critical. There is a lot of research showing that smoking is detrimental to obtaining a solid fusion, but now there is also research showing that even if a smoker gets a solid fusion, their ultimate result is not nearly as good as a non-smoker. A recent study by Dr. Steven Glassman found that smokers who did not quit at least a month prior to their surgery were far more likely to return to smoking within a year. Given the expense, pain and lengthy recovery of any lumbar fusion surgery it is only reasonable to have the best biological situation for a successful outcome.
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For many patients, there is a distinct choice between continuing to live in pain or going through the challenge and discomfort of quitting smoking. When the pain gets bad enough, the choice can be easy enough, especially if the patient realizes that smoking is very closely related to the pain.
Posted by: Peter Ullrich, Jr., MD
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How Chronic Pain Leads to Depression
February 21, 2008
by: Sylvia Marten
People who live with chronic pain have long been saying that the non-stop physical pain is not the only challenge in their lives, but along with the pain comes a host of other challenges, such as:
Now new research findings confirm this. The recent study, conducted at Northwestern University’s Feinberg School of Medicine, found that physical changes in the brain caused by chronic pain are likely to lead to depression as well as other pain-related symptoms.
In the study, the researchers demonstrated that the wiring in the brain of someone dealing with chronic pain is different than that of pain-free individuals. In a the brain of a pain-free individual, all the regions of the brain exist in a complementary state, meaning that if one region of the brain is active the other regions are at rest. But in people with chronic pain, a front region of the cortex mostly associated with emotion is constantly active.
“The areas that are affected fail to deactivate when they should.” said Dante Chialvo, lead author and associate research professor of physiology at the Feinberg School. “They are stuck on full throttle, wearing out neurons and altering their connections to each other. “
‘If you are a chronic pain patient, you have pain 24 hours a day, seven days a week, every minute of your life,” Chialvo said. “That permanent perception of pain in your brain makes these areas in your brain continuously active. This continuous dysfunction in the equilibrium of the brain can change the wiring forever and could hurt the brain.”
Chialvo hypothesized: “It could be that pain produces depression and the other reported abnormalities because it disturbs the balance of the brain as a whole.”
Importantly, Chialvo notes that the research findings “show it is essential to study new approaches to treat chronic patients not just to control their pain but also to evaluate and prevent the dysfunction that may be generated in the brain by the chronic pain.” The research results are being published in the Journal of Neuroscience.
Source: http://www.chialvo.net/
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First Cervical Disc Replacement Surgery with ProDisc-C
January 25, 2008
by: Sylvia Marten
The very first ProDisc-C surgery was performed last week since the FDA approved the device in December 2007.
Michael E. Janssen, DO, a Denver surgeon and a Spine-health.com Member, became the first physician in the United States to perform two cervical disc arthroplasties using the ProDisc-C Total Disc Replacement System. The ProDisc is designed to treat patients suffering from cervical disc degeneration and disc herniation, which occurs when natural shock absorbers in the cervical spine become worn and start to degenerate, often resulting in pain, discomfort, and impaired cervical mobility creating neck and upper arm pain.
One of the patients was an active 35 year old male with cervical disc degeneration that developed as a result of a traumatic hockey injury, causing pain, stiffness, and numbness in his left-hand. The second patient was a 53 year old female accountant who had been suffering with neck and upper extremity pain from a disc herniation compressing her spinal cord.
Both surgeries were performed on January 16, 2008, and both patients pre-operative symptoms were gone the following day. The patients were discharged from the surgery center on January 17, 2008 with minimal pain.
The full story is available here.
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3 Empowering Health Resolutions for 2008
January 4, 2008
by: Sylvia Marten
Like most of us, you probably start out each new year with the best of intentions: full of hope that THIS is the year you'll finally do "X" (fill in the blank with your #1 item). If you're like me, I dutifully make my list of New Year's Resolutions (usually at least 10 items long), only to get discouraged by late January and in pretty much full abandonment by March.
So, if we have to pick and choose a focus for our resolutions this year, I pick HEALTH. Why? As one of the most personal and potentially all-encompassing factors in our lives, there's little that is more important than our own good health. Above all else - money, careers, a home or a car, even sex - health is the one thing we can't live without and arguably the most influential factor of our quality of life. For people with chronic health conditions, such as chronic back pain, I can't think of a better focus than health and healthy living for 2008.
My top 3 picks for 2008 Health Resolutions:
Exercising. I don't mean just starting to exercise or saying you'll finally try yoga, I mean committing to making exercise part of your normal weekly routine for the rest of your life. The necessity of exercise in the combat of just about every kind of health issue and pain condition is well known. The tougher part is to accept that exercise won't be very helpful if done in fits and starts, and that just thinking about exercising doesn't count.
The most popular excuse for not exercising? "I'm too busy," which translates to "I won't." Keep in mind that even the President of the United States finds time to keep himself fit. The key, according to a 1/1/08 Chicago Tribune article, is "...make exercise a habit that you do every day at the same time. Pick the time that's best for you and just do it." So, if you're not a morning person, don't plan to do a 6am aerobics class. Whatever time and type of exercise you choose, remember the incredible benefits of exercise you will reap: looking and feeling better, reducing stress, reducing pain, and slowing or preventing certain diseases (e.g., osteoporosis, hypertension).
Quit Smoking. No brainer, right? You would think so, given the known linkages of smoking to cancer, heart disease, lung disorders, etc. Well, if you smoke and have a chronic back pain problem, you need to know two things: one is that smoking can significantly worsen your back pain, and two is that most back surgeons will refuse to operate on your back if you smoke because it inhibits the body's ability to heal after surgery. The key with smoking cessation is to surround yourself with the kind of support network you need to quit and stay smoke free. Talk to your doctor about which of the various stop smoking aids available (gums, patches, oral medications, support groups, etc.) are right for you and keep trying until you find something that works. Like exercising, the state of being called "I don't smoke" is one you need to be in for the rest of your life. Period.
Getting organized. Most people simply have accumulated too much stuff over the course of their lives and now have the dreaded "c" word: clutter. One of the worst impacts of clutter? Stress. Clutter stress at home can cause feelings of being overwhelmed and out of control, leading to overeating and feeling like there's no time to do other things such as exercise (see #1 above). Stress is also a known cause of back pain and can exacerbate many chronic health conditions. Eliminating household clutter can be liberating and euphoric, freeing up time (less clutter is easier to clean and organize) and space (making room for that new elliptical trainer or yoga mat). The key to de-cluttering: pick the clutter that is most bothersome and tackle it one project at a time, and then commit to keeping it that way.
One of the commonalities among all three resolutions is commitment. They will all take incredible self discipline and will power to achieve, not only initially but over the long haul too. The good news is that there is outside help available, if you need it, for each and every one of these. Best of all, I'm willing to bet that the physical, mental, and emotional health benefits will become the only motivator you need to stay the course. Best wishes for a healthy 2008!
Additional resources to help get you started:
How I Decided to Have Back Surgery
December 21, 2007
by: Dawn
This is my story about having back surgery that went very well. I think the key for me is that the surgery was done for the right reasons, I had researched my surgeon by talking to other patient’s of his who had the same spinal fusion done, and I had read up on the Internet on some good sites, including www.spine-health.com, to help with my decision to have surgery and help with my expectations.
2 1/2 years ago I was diagnosed with Spondylolisthesis Grade 2. After many years of pain in my legs now I finally knew why. I tried just about everything to avoid the surgery. I used a natural anti-inflammatory (Wobenzyme) to keep the inflammation down, I used a rolling pin and rolled my legs everyday to help lessen my leg pain through-out the day. I also tried numerous therapies. I read some of the bad stories on message boards on the internet and didn't want anything to do with the surgery. I really felt that the message boards were discouraging, there wasn’t anything positive regarding the surgery, and everything I read was so disheartening.
I was out to dinner one night and ran into a woman who also had spondylolisthesis. She had surgery to correct the spondylolisthesis 5 years earlier and has had no complications. She had the same surgeon that I had.
In September of 2007 I finally decided to go ahead with the surgery. At this point my leg pain was so bad I could not sleep through the night; I would wake up in pain and toss 5 or 6 times per night. I could not stand for more than a minute, sometimes two. I would have to sit down, and sometimes it didn't matter where I was – my leg pain was nearly unbearable. I could not stand in a grocery line or at the movies.
The anxiety of spinal fusion surgery was another obstacle. With surgery, the “What if’s” are horrible.
- What if I end up in a wheel chair?
- What if the surgeon slips?
- What if they fix the wrong thing?
- And then there is the ultimate" what if I die"? I don't want my children left without a Mother.
Like I said "What if's are terrible!" I even talked to yet another patient (with the same surgeon) who had the same surgery for spondylolisthesis a few months earlier. She gave me the extra strength I needed to go ahead with it.
Admission into the hospital on Oct 1, 2007 at 5:30am, now the stressful “sit and wait game” started 5:30AM; the next 2 hours were the longest 2 hours of my life. Finally they took me into the operating room it was about 7:30am. I asked how many people get up, change their minds and leave. And I felt myself float off.
I was out of surgery at 9:30AM and awake at 11:00AM. By 1:00 I was drinking broth and visiting. At 1:30 I took my first walk down the hall and stood at the end of the hall. As I stood there tears filled my eyes, I turned and looked at Tom (who’s arm I held) and remarked “I'm standing and I have no pain”! I was standing there in the middle of the isle, I let go of him and stood there for a few minutes. This was the first time I stood in one place for more than a minute, possibly 2, without being in horrible pain, and sitting down. While walking or standing I was always looking for a place to sit because I knew it would not be long before I was forced into sitting down. And I was still standing! It was like a taste of freedom, being trapped in a body that can't do the things you would like to do is horrible. I HAD NO PAIN! I STILL HAVE NO PAIN!
I checked out of the hospital the following morning, once home I began walking a 1/2 mile the first day, 1 mile the second day. I'm walking 1-3 miles per day. I have no pain in my legs!! I sleep without pain!! I have truly gotten a part of my life back that I thought was gone. I hiked a mountain in Utah last week; I'm looking forward to so much now. Thanks to my surgeon.
I am not writing this to encourage surgery. It’s just that when I was thinking about spinal fusion for my spondylolisthesis I read so much negative stuff on the Internet, I wanted to write to let people know about a positive experience.
Sincerely,
Dawn
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December 14, 2007
by: Stephanie
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