Spinal Conditions and How to Treat Them

The spine is a complicated structure of vertebrae, ligaments, and nerves that is prone to a variety of injuries and conditions. Maintaining a healthy, strong spine is crucial in order to prevent further worsening other injuries that may be associated with the vertebral column, and that can include many things. Below are a number of common spinal conditions that can develop overtime, and the proper forms of treatment for each.

Degenerative Disc Disease

Associated with spinal stenosis, degenerative disc disease is a fairly normal part of aging. Minor injuries along with stressors in the back can gradually deteriorate the spinal discs over time. This causes instability within the column and compression of the nerves. The most effective forms of treatment for this disease are typically conservative rehabilitation and pain management courses. Deep tissue massages target spasms muscle tension that tends to build up over time, relieving pain, and stimulating the ligaments.

Herniated Disc

Any type of herniated, ruptured, bulging or slipped disc can be directly caused by an injury, repeated motion, or simply aging. Though physical rehabilitation and pain management are the most commonly chosen options for treatment, extreme cases may require surgery. Determining which form of treatment is best for you depends on the location of the herniated disc, the severity of the pain it’s causing, and any associated symptoms. Medications prescribed by doctors have seen success, along with physical therapy and manipulation like weight training.

Kyphosis

Typically found in older women, kyphosis is an exaggerated rounding of the spine as a result of degeneration or osteoporosis. However, when observed in younger patients, kyphosis is typically found to be a result of poor posture or developmental issues like Scheuermann’s disease. Severe cases of kyphosis may include fractures in the vertebrae, requiring a brace to correct the alignment and allow for proper healing to take place. Physical therapy and surgery are other common forms of treatment. Removing pressure from the nerves and spinal cord is key in treating kyphosis.

Sciatica

Irritation of the sciatic nerve, running from the lower back down each leg, is often caused by a tight piriformis muscle, herniated discs, stenosis, or tumors. Sciatica can be extremely painful in patients suffering from the condition, and surgery may be required in severe cases. Otherwise, anti-inflammatory medications and physical therapy are the most common forms of treatment, like heating and cooling the surrounding muscles, or epidural steroid injections.

Scoliosis
This sideways curvature of the spine normally develops during puberty, over time as a result of arthritis, or as a birth defect during development in the womb. Most cases of scoliosis tend to be mild and easily treatable, but more extreme cases typically require surgery to insert rods, screws, and wires that straighten the spine over time. Physical therapy can stretch and strengthen back muscles to decrease curvature, but back braces and medical intervention of some sort is almost always required.

Neurostimulation Applied to Back Pain

For those suffering from chronic back pain, going about daily activities can be difficult and painful. Depending on the causes and severity, medication and physical therapy may help, but a strategy that tends to see more effectiveness is neurostimulation.

Roughly the size of a stopwatch, a neurostimulator is a surgically implanted device that delivers mild electrical impulses to the epidural area of one’s spine through medical wires, or “leads.” These signals create a tingling sensation in the area of the back that is causing the patient’s back pain. Relief comes due to neurostimulation modulating the signals of pain before they reach the brain, much like rubbing a sore spot after bumping into a table, only no initial pain is felt.

The neurostimulator is placed underneath the skin, most commonly on the abdomen. Special medical wires then extend from the device delivering stimulation. Appearing as just a small bump, neurostimulators make no noise, and are very easy to control.

Controlling the level of stimulation is as easy as pressing a button. Through a handheld programmer, patients are able to adjust the strength and location depending on daily activities. For example, exercise and physical activity may demand stronger stimulation than times in which patients are sleeping, or simply relaxing.

Neurostimulation is an effective way to reduce chronic pain for several areas of the body, depending on the source of one’s pain, which can greatly improve patients’ daily activities and overall quality of life. Those who have seen success experience anywhere from 50% to 70% less pain depending on the provider, and a reduced need for anti-inflammatory medications. Additional bonuses of successful implants include no damage to the spinal cord, easy adjustability, and the option to have the implant turned off.

However, there are risks that come with having a neurostimulator surgically implanted, much like all pain treatments. Common side effects of this procedure include little to no stimulation due to movement of the leads, stimulation in wrong areas of the body (also due to lead movement), pain at the site of the implant, and transmission problems between the implant and the handheld programmer. Some side effects may be more serious though.

Like most surgeries, the risk of infection is present. Hematomas and fluid is also prone to leaking where the stimulator was implanted. Further complications may require additional surgery to relocate, repair, or replace specific parts of the device, and in rare cases, spinal cord injury may occur due to incorrect placement.
As mentioned before, depending on one’s severity and causes of back pain, neurostimulation may be the best option in relieving symptoms. Therapy sessions are available for those that wish to test this strategy before having surgery, so speaking with your physician about whether or not this is the right decision for you is highly suggested.

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The Successes of CBA’s in Arthrodesis

Within the next decade, the number of arthrodesis procedures is expected to continue to increase due to aging populations and complex combinations of diseases in individuals. The goals of arthrodesis procedures are to decrease pain, increase mobility, and improve one’s overall quality of life.

Arthrodesis typically focuses on the reversal of disability associated with arthritis, trauma, diabetes, instability, or misalignment in joints, and successful procedures can depend on numerous risk factors. Considerations you should take into account beforehand include levels of tobacco or alcohol abuse, osteoporosis, use of anti-inflammatory drugs, age, and weight.

The quantity of autograft is sometimes limited, and the bone quality can be poor. This is especially common in older patients and those with a combination of physical difficulties. A second surgery may be required to reduce pain and improve mobility in these individuals, though a variety of bone graft substitutes have since been developed. These new developments range from synthetic matrices, to bone marrow aspirates, though, until recently, none of these substitutes consisted of bone-forming cells.

Breaking down cellular bone allografts (CBA’s), they biologically provide three properties that are necessary for proper bone formation. These include osteoconductive scaffolds, osteoinductive growth factors, and osteogenic cells. Orthofix’s Trinity Elite is a cryopreserved CBA that contains at least 500,000 living cells per CC, the donors of which are strictly screened by MTF based on multiple criteria like age and overall health. In the end, less than 3% of donors are accepted, showing how high the standards are for those that wish donate.

In order to measure CBA’s effects in arthrodesis procedures, a clinical trial was performed for 103 patients undergoing foot and/or ankle arthrodesis, of which were enrolled at 10 institutions and at least 18 years of age. The patients varied for their needs to undergo the procedure, ranging from arthritis, to deformities, to degenerative joint disease. 92 of these individuals successfully completed their 6-month follow-ups after the procedures were done, the primary endpoint being successful fusion after this time, following CT scans that confirmed such findings.

 
To simulate real life scenarios, patients considered high-risk were not excluded from the study. The use of CBA’s did not raise any concerns in terms of safety seeing as there were no adverse effects or infections in those that participated either. Statistically significant improvements in pain and function were noted at the end of the study, which notably improved throughout the entire process, thus showing the success CBA’s have in arthrodesis procedures.

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