Disc, Joint Or Soft Tissue Pain

Bad Discs

Disc Degenerate Consequences?

Fusion Alternative – The Artificial Disc

Incoming Medical Innovations for Back Pain

Innovations That Enhance Bone Healing And Fusion
Osteoplasty And Kyphoplasty: New Methods For Spine Fractures

Compression Fractures – New Options

Pilates

As stated before, 80 percent of the people in this country will have back injury and pain at some point in their lives. Of these injuries, 80 percent will go away eventually. The other 20 percent of injuries may cause chronic pain that lingers for months or even years. For the people with this type of pain there is hope. Science and research is coming up with new technologies and different types of implants and procedures all the time that can relieve back pain.

Disc, Joint Or Soft Tissue Pain

Back pain is usually related to the discs, a joint, of soft tissue (muscle or ligament). For years spine doctors put all back pain into one of those three categories. With more research comes more knowledge about the possible origins of back pain. Back spasms used to be considered ligament or muscle strains but now it is thought that “internal disc disruption” can be a cause, meaning a disc could have tiny tears. In a disc herniation these tears are big enough to cause the gel-like center of the disc to seep out, but this is not the case with “disruption”. Experts believe these tiny tears send pain signals to the muscles and ligaments, thus causing spasms. If this is true, many experts believe that the discs are therefore the cause of most back pain.

For someone with a very badly damaged disc or one that is completely destroyed the options up until now have been limited to complicated surgery to remove the disc.

Bad Discs

There are a lot of things that determine if you will have bad discs. From heredity, to accidents, to playing sports, and jobs that can cause back pain, there is no telling when and if it can happen to you. The entire section called “Preventing Back Pain” can give you an idea of the lifestyles, occupations, and other things that may put you at risk for having disc problems.

Among the causes of bad discs are aging, spine injuries, heavy lifting, a sudden twist in the spine, obesity, and traumatic injuries. In other words, anyone is at risk for a bad disc.

Disc Degenerate Consequences?

Degenerative disc disease is what it is called when the discs of the spine begin to wear out. It is usually caused by aging. Because they are soft and are made to compress easily so they can absorb shock, these discs gradually breakdown as the body gets older.

Disc degeneration happens most often in the lumbar region and the cervical spine of the lower neck. The discs start to contain less water and this can cause them to shrink, reducing the ability to absorb shock. Tiny cracks can form in a disc over time that can eventually result in the disc rupturing.

As the degeneration of a disc occurs, arthritis due to wear and tear can build up in the spine. When a disc degenerates. more stress is put on the facet joints in the spine and osteoarthritis and bone spurs can begin to form. There is also an increase in the risk of disk herniation and even spinal stenosis.
Fusion Alternative – The Artificial Disc

Spinal fusion is often performed when a disc has completely degenerated. Fusion is a surgical procedure in which the damaged disc tissue is completely removed and bone or some man-made material is placed in between the two vertebrae. Today, another option is becoming available and that is having the degenerated disc replaced with an artificial disc.

Also referred to as a disc replacement, spine arthroplasty, or disc prosthesis, this procedure involves implanting a device into the spine that can replicate the functions of an actual disc. That function is to carry load and allow for motion.

There are a variety of artificial discs that fall into one of two categories:

1. Total disc replacement – With this procedure, most if not all of the disc tissue is taken out and a replacement artificial disc is implanted between the two vertebrae in the space where the disc was.

2. Disc nucleus replacement – As the name implies, in this procedure only the center of the disc, called the nucleus, is removed and replaced with an artificial device.

A completely artificial disc is made of either a plastic-like material or metal. Sometimes both materials are used to make a disc. In the most common designs for disc replacement devices there are two plates. One of the plates is attached to the vertebrae above the disc that was removed and one on the vertebrae below. Quite often a soft and compressible piece of material is placed in between the two plates.

The nucleus devices are usually made completely of the plastic biopolymer material. Materials like this can expand as they soak up water. The device is implanted into the nucleus of the disc and it hydrates causing it to fill up the entire cavity.

These disc replacement devices are used in the lumbar region of the spine. There are devices for the cervical region, but they have not been around long and may are still going through the FDA approval process.

Incoming Medical Innovations for Back Pain

Between research and clinical trials there is promise for some new and better types of spinal surgery. Biological and technological steps forward are being made all the time and between now and the end of the next decade we should see even more less intrusive techniques for performing back surgery and relieving pain. Some of the innovations we may see in the near future include:

· Spinal Navigation Technology – In the last ten years there has been a lot of progress in the techniques used to navigate the spine in order to perform intricate implants and remove degenerated disc material. See the chapter called “New Technology and Instrumentation” for information on SEXTANT and the FluoroNav system. These computer-assisted image guidance systems allow the surgeon to be more accurate in the placement of spinal instrumentation.

The future of spinal navigation will have the surgeon obtaining images of the spine during surgery. Computers will be able to take these images and create models of the patient’s spine that will help the surgeon navigate.

· Future Biomaterials for Spinal Implants – In the chapter called “The Latest Advances in Spine Surgery” spinal implants were discussed. The material used in the various implants is most commonly stainless steel. More recently, titanium has been used.

Another material used is bone graft, either taken from the patient’s own body, from a bone bank, or from cadavers. Because of the shortage of bone from cadavers or bone banks, the use of biomaterials is being researched more and more. Soon, Bone Morphegenetic Proteins (BMP) will be available for use is bone fusion and bone grafts for implants. BMPs are genetically-engineered proteins. These BMP will be put inside a sponge made of collagen or a ceramic implant and used instead of bone for fusion.

· Other materials being researched for use as bone grafts are plastics, polymers, and carbon fiber. Some of the polymers being studied have the potential to biodegrade. In other words, it holds the bone graft material and provides support long enough for the fusion to occur.

Innovations That Enhance Bone Healing And Fusion

There are a lot of newer innovations being used to speed up the healing process after spinal surgery.

· Electrical stimulation – Research has shown that direct current electrical stimulation using a device implanted in the spine combined with external stimulation with magnetic fields increases the rate at which the spine will fuse after surgery. It is believed that biochemical changes in the polarity and pH are brought about by the electrical stimulation. Some studies show that this method for speeding up healing is the most effective.

· More research is being conducted in the use of ultrasound to promote spinal fusion.

· Hyperbaric oxygen therapy is another procedure under investigation for the improvement of bone healing.

Osteoplasty And Kyphoplasty: New Methods For Spine Fractures

There are two relatively new, successful treatments for spine fractures. These procedures are often used for the type compression fracture that is associated with cancer or osteoporosis.

Osteoplasty

Osteoplasty is a mildly invasive procedure used to repair compression fractures in the spine. Through a small catheter inserted into the spine a specially made material is injected into the affected area. This material hardens, stabilizing the vertebra so that no further collapse is possible.

Kyphoplasty

Kyphoplasty is another minimally invasive procedure that can reduce the pain from compression fractures up to 90 percent. It not only relieves the pain but also stabilizes the fractured area, restores, height, and decreases the chance of deformity. These last two benefits are of particular help to those who have a compression fracture due to osteoporosis.

During the procedure, the surgeon makes two small incisions and using image guidance x-rays places a probe into the space in the vertebrae at the location of the fracture. A hole is drilled into the bone and a balloon called a bone tamp is inserted. A contrast medium is used to inflate the balloon. Once it has expanded to a certain height the balloon is removed. Doing this helps to expand the compressed bone and creates a space in which to insert a cement which binds the fracture and hardens quickly to stabilize the bone.

Compression Fractures – New Options

Another new option for compression fractures is vertebroplasty. This type of surgery was discussed in the chapter called The Latest Advances in Spine Surgery .

Pilates

Something fairly new to the world of relief for back pain caused by degnerative disc disease is Pilates. Pilates exercises have been around for years and thousands of people practice Pilates for slimming down, improving flexibility, and strengthening muscles. Because of all these benefits, Pilates exercises are now being used for physical therapy. Chiropractors recommend Pilates to their patients to relieve their back pain.

Pilates focuses on the structural imbalances of the body that can lead to back pain like:

· Poor posture – Pilates can help correct poor posture that can cause back pain. One of the principals of Pilates is to line the body parts up with one another. When this alignment is not correct this puts stress on the skeleton, especially the spine. Pilates exercises that concentrate on alignment bring about uniform use and development of muscles.
· Lack of core strength – Good posture requires not only body alignment but also core strength. This means that every single muscle in the trunk of the body needs to be strong and flexible so that they can stabilize the spine.

· Lack of flexibility – A spine that is healthy should be able to twist, move from side to side, and curve forward and backward. Pilates strengthens the core and develops support for the spine. The more support the spine has the better the range of motion it will have as well.

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