How is chronic low back pain diagnosed?

As mentioned earlier, chronic low back pain is defined as back pain that lasts greater than three months. During the evaluation of chronic back pain, the goal is to rule out any injuries or disease processes that place the patient at risk of further injury if not treated or addressed. In addition, a specialist will consider diagnoses that can be treated in order to reduce the pain. A good patient history and a thorough physical examination by a well-trained physician are the most important aspects of the evaluation. Serious injuries and illnesses can often be diagnosed or ruled out based on the history and physical exam alone. Lack of a definite diagnosis does not necessarily mean more testing is needed. Needless tests do not add anything to what the physician has already discovered in his or her physical examination and review of previously performed studies and treatments. In fact, unnecessary testing is not only expensive to the patient, but can expose the patient to unnecessary risks or radiation.

If the treating physician feels that more testing is needed based on the patient’s history and physical exam findings, he or she will discuss this with the patient. Testing may include blood tests, radiography (X-ray imaging), bone scans, computed tomography (CT) scans, magnetic resonance imaging (MRI), diagnostic injections, electromyography (EMG) and many other specialized tests.

Often, the exact cause of the pain is still not well defined at the end of the evaluation. Nevertheless an evaluation is successful if it has ruled out those processes that place the patient at risk if they are not treated.Reference information: http://www.knowyourback.org , www.ispine.com.hk

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.

What is Chronic Low Back Pain?

Low back pain is considered to be chronic if it has been present for greater than three months. Chronic low back pain may originate from an injury, disease or stresses on different structures of the body. The type of pain may vary greatly and may be felt as bone pain, nerve pain or muscle pain. The sensation of pain may also vary. For instance, pain may be achey, burning, stabbing or tingling, sharp or dull, and well-defined or vague. The intensity may range from mild to severe.

Many times, the source of the pain is not known or cannot be specifically identified. In fact, in many instances, the condition or injury that triggered the pain may be completely healed and undetectable, but the pain may still continue to bother the patient. Nevertheless, even if the original cause of the pain is healed or unclear, the pain felt by the patient is real and the treating physician knows this.

Chronic low back pain may be the result by many different conditions. It may start from diseases, injuries or stresses to a number of different anatomic structures including bones, muscles, ligaments, joints, nerves or the spinal cord. The affected structure sends a signal through nerve endings, up the spinal cord and into the brain where it registers as pain.

A number of different theories have developed to try to explain chronic pain but the exact mechanism is not completely understood. In general, it is believed that the nerve pathways that carry the pain signals from the nerve endings through the spinal cord and to the brain may become sensitized. Sensitization of these pathways may increase the frequency or intensity with which pain is perceived. A stimulus that is usually not painful, such as light touch, can be amplified or changed by these sensitized pathways and experienced as pain. Sometimes, even after the original injury or disease process has healed, sensitized pathways continue to send signals to the brain. These signals feel just as real and sometimes worse than the pain caused by the original injury or disease process

Reference information: http://www.knowyourback.org, www.hongkong-orthopaedics.com

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.

Tumor Removal and Cervical Spine Fusion – successful stories

I was suddenly in severe, constant pain. Simply getting out of bed each day required a heavy dose of hydrocodone. Unable to perform any task that required sustained attention, I had to rest often and was never comfortable. I was even having difficulty urinating. My quality of life was terrible.

At least this time I had an explanation for my symptoms. I learned that a rare and aggressive cancer, hemangiopericytoma, was causing the recurring tumors that were pressing on my nerves.

Since I had a great deal of scar tissue from my previous surgeries, my then-doctor recommended a non-invasive radiation treatment rather than surgery. I was hesitant about this new technology and sought another opinion. I was referred to ordered X-rays, examined me and said he would be able to remove the tumor surgically, even with the extensive scar tissue.

In a 15-hour surgery, the tumor was removed and, because of the previous surgeries, vertebrae in my neck had to be fused and reinforced with pins and plates. I was in a hard body brace for seven weeks. After the removal of the brace, I underwent six weeks of radiation at a hospital near my home.

Unbelievably, I was able to suspend the pain medication immediately after surgery. Each day I became a little stronger and able to do more. Today, I am able to do most activities, including walking three miles a day, volunteering at a local high school and building wooden boats, which is my passion.

 

Reference information: http://www.knowyourback.org

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.

Spine Navigation Surgery – Procedures

Prior to surgery, patients undergo a series of CT scans. Once the images are downloaded into the navigation system, orthopaedic surgeon would perform a calibration process that is critical for the surgical outcome. Then Orthopaedic surgeon can then perform surgeries based on a 3-D anatomical picture of the patient. Orthopaedic surgeon insert a probing instrument through a small incision in the patient, and then the probe transmits signals back to the system. The system software integrates the patient’s CT scan with data from the digital camera probe, and then displays a real-time view on-screen of exactly where the instruments are positioned - throughout the procedure.

Spine Navigation Surgery – Pros & Cons

1.    In the traditional orthopaedic surgeries, screws are placed using a freehand technique or by fluoroscopy, which uses X-rays to capture an image on a television screen of the process of screw placement. Both patients and the staffs of operating room can be exposed to radiation and must use lead clothing for protection. The spine navigation surgery employ a special camera on a computer that uses infrared light to track a surgical instrument in 3D space that can reduce the X-ray exposures.

2.    Spine navigation surgery is performed on a 3D anatomical instead of 2D that can help orthopaedic surgeon to guide their instruments for precise screw placement

3.    The matching / calibration process is critical for surgical outcomes and experienced techniques are necessary.

4.    The benefits of spine navigation surgery must be weighed against potential complications from the surgery. Potential risks and complications include: anesthesia, infection, blood loss, nerve injury, possible re-operation and continued pain. Patients should consult with their orthopaedic surgeon for further details.

Reference information: www.ispine.com.hk

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.

Intervertebral Disc

The ANNULUS FIBROSUS makes up the outer part of the disc. It consists of collagen fibers containing significant amounts of water and proteoglycans. These fibers are arranged in concentric layers called LAMELLAE. The lamellae are thicker and more numerous in the anterior part of the disc.

Within each lamella, the collagen fibres are oriented obliquely about 30º to the horizontal. The orientation is reversed in each contiguous layer, resulting in a 120º change from layer to layer. This interstriation of fibers imparts great tensile strength and allows for multiplanar motion. The structure of the disc is similar to a radial automobile tire, which also has great strength and simultaneous compression and tension capabilities.

The NUCLEUS PULPOSUS is the internal substance of the disc. The inner fibers of the annulus fibrosus gradually blend with the nucleus pulposus.

The nucleus pulposus is more gelatinous than the annulus and has a higher water and proteoglycan content. The water content can be 85% in young people; in older people, the water content of the nucleus pulposus may be less than 25%. The nucleus pulposus acts to resist compression in axial loading forces.

Besides allowing for motion, the discs act as shock absorbers to prevent injury to the vertebral bodies and neurological struc-tures. However, the discs are so strong that in compression, the vertebral body will fail before the discs fail.

Reference information: www.hkoa.org

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.