What Causes A Back Spasm?

A back spasm is a sudden, painful muscle contraction in the back near the spine. It often occurs while lifting, pushing, or pulling a heavy object or performing some other action that would strain the back. The patient’s pain often increases within the next two or three hours after the injury, and any movement of the back usually causes severe pain. Sitting, standing and bending usually cause the patient great pain, and for many lying on one side in a fetal position offers the only relief from pain.

Spasms are more likely to occur if the muscle is already swollen or strained. If force is added, previously damaged muscles and tendons can tear. Any sport or job that requires twisting, pushing or pulling can cause a back spasm. Those with a weakened back from conditions like spondylolysis, spondylolisthesis, disc rupture, spinal stenosis, arthritis, are more likely to have back spasms. Similarly those with anterior pelvic tilt, tight hamstrings, weak muscles along the spine or in the abdomen are also more likely to suffer from back spasms.

The patient should rest as much as possible and treat the site of the injury with ice and compression. Muscle relaxants and anti-inflammatory medication and sometimes even local anesthetic injections can be used to treat the injury during first few days after the injury. Four or five days after injury, these treatments can be supplemented with massage or chiropractic care. As the severe pain of the injury begins to clear, the cause of the injury should be determined by the physician so that further treatment, such as strength training, physical therapy, or even in rare cases surgery, can be considered, depending on the reason behind the muscle spasm.

Why Do I Have Bone Spurs In My Spine?

As people age the spine starts to wear out. The spine undergoes wear and tear from daily living, work, sports and accidents. This damage weakens the discs and facet joints, producing instability or abnormal movements of the spine. If this process continues, the spine may fall apart and one vertebra may slip forward relative to another vertebrae. This process is called spondylolithesis. Instability puts stress on the discs, ligaments, tendons and bones, which stimulates new bone formation to strengthen the spine and hold it together. This new bone formation is called bone spurs or osteophytes.

Bone spurs may pinch nerves inside the spinal canal. The spinal canal may be compressed in the center, outer gutters, exiting hole or just outside of the spine. Central compression is called central spinal stenosis. Gutter compression is referred to as lateral recess stenosis. If the nerve is compressed in the foramen or hole exiting between the vertebrae this is called foraminal stenosis. Lastly, if the nerve is compressed outside of the spine it is called far lateral stenosis. This may cause neck, arm, back and leg pain depending on the location of the bone spur. The pain may be associated with numbness, tingling and weakness.

Bone spurs may be seen on X-rays, CT and MRI. X-rays show irregular white areas in the spine. CT scan shows the size, shape and location of bone spurs best. MRI scan is good at showing if the bone spurs are pinching the nerves. EMG (electromyography) nerve studies can help confirm nerve irritation and injury.

Spinal injections may be used to determine if the bone spur is causing pain. This is called pain mapping. A spinal needle is placed where the bone spur is pinching the nerve under x-ray guidance. Numbing medicine is injected on the bone spur and nerve. If the bone spur is the cause of the pain, the pain will temporarily improve or stop.

Patients who do not benefit from conservative treatment may benefit from surgical treatment. Traditional surgery involved removal of the facet joint to take pressure off the nerve combined with spinal fusion and instrumentation to hold the spine together. Today back and leg pain may be treated with endoscopic foraminotomy.

Endoscopic foraminotomy a micro video camera is inserted through a very small incision onto the bone spur pinching the nerve. The camera projects the images onto a video screen so the surgeon can easily visualize the compression. Tiny instruments are inserted through the camera to decompress the nerve relieving pain and suffering. Advantages of endoscopic spine surgery include twilight sedation (usually avoid general anesthesia), very small incision (size of a finger nail), minimal postoperative pain and much shorter recovery then traditional fusion surgery.

Osteoporosis Spine Fractures: Cause & Treatment

The spine is made up of many bones called vertebrae. The front of each vertebrae is made up of a square shaped vertebral body, disc, and ligaments. The discs act to cushion the vertebrae, but if the vertebral body weakens or is injured by excessive force, it may break and flatten like a pancake, which can cause terrible back pain. Osteoporosis, the condition of having weak thin bones, is the primary cause of vertebral body compression fractures; less common causes include severe trauma, infection or cancer.

Pain is the most common symptom of spine fractures. Even the smallest movement of the patient’s body causes micro-motion in the broken bone, which produces severe pain. The patient’s pain level usually decreases when she is lying down and increases with standing, walking and lifting. Sometimes people have no pain at all. Rarely fractures may cause numbness, weakness, paralysis or bowel and bladder dysfunction from spinal cord or nerve compression. Fortunately, this severe back pain often improves during the first month after injury.

X-ray, CT, bone scan and MRI may diagnose spinal fractures. Besides diagnosing the fracture, MRI scans can determine if the fracture is new, judge its response to treatment, and rule out nerve or spinal cord compression.

How are Osteoporotic Spine Fractures Treated?

Patients who don’t see significant improvement with conservative treatment may benefit from surgical treatment. The key to surgical treatment is stabilizing the fracture. The spine, like a broken arm, must be “cast” to stop abnormal bone movement to prevent pain. Surgical options include vertebroplasty, kyphoplasty and major spine surgery. Major spine surgery is not commonly needed to treat osteoporotic compression fractures.

Vertebroplasty and kyphoplasty are the most common treatments for osteoporotic compression fractures. These procedures involve the placement of a needle into the fractured vertebral body for the injection of liquid cement. Once the liquid cement hardens it stabilizes the vertebral body decreasing painful movements. If there is concern for cancer, then a bone biopsy is sent to pathology for examination.

Vertebroplasty is an outpatient procedure, done under conscious sedation like a colonoscopy, but can be done under local anesthesia in high-risk patients. A needle is placed into the fractured vertebral body under x-ray guidance and then liquid plastic is slowly injected to harden and stabilize the fracture.

Kyphoplasty is similar to vertebroplasty, but kyphoplasty involves the placement of two needles on each side of the spine and balloons into the broken vertebra under x-ray. The balloons are slowly inflated to expand the collapsed “pancake” vertebral body and create cavities to hold the plastic. Plastic is then injected after the balloons are removed to support and stabilize the broken vertebrae.

Some patients report immediate pain relief. The remaining patients generally experience pain relief or a lessening of pain within the next two days. Patients can return to daily life the day after surgery, though they should avoid heavy lifting for at least the first six weeks. Each patient should take their surgeon’s advice about returning to activities, as each patient is different. All patients, but especially women, should speak to their doctor about treating their osteoporosis and preventing further bone loss. Women who develop vertebral body compression fractures are at least 4 times higher risk of developing future spine fractures. Elderly patients with bone fractures should undergo investigation and treatment for osteoporosis.

The Top Benefits of Endoscopic Spine Surgery

Due to the many advantages of endoscopic spine surgery, it should always at least be considered, but currently it is not a replacement for all types of spine surgeries. Fortunately, with the advancement of surgical techniques and equipment, it is being used to treat a wider scope of injuries.

Why might endoscopic surgery be an option when other types of spine surgery are not?
Traditional surgery is limited because the surgeon must see the problem directly, whether with their eyes or a microscope. The endoscopic camera visualizes areas that are not usually visually accessible through holes into the side of the spine and around corners. This greater visualization combined with minimal damage and lowered surgical risk increases the spectrum of pathology that can be treated safely. This allows endoscopic surgeons to treat spinal disorders that traditional surgery may not treat. This happened many years ago in orthopedic surgery, when the endoscope was introduced to knee surgery. Today no one doubts the incredible benefits of endoscopy of the knee, and we are quickly seeing this happen in spine surgery.

Can endoscopic spine surgery help everyone?
Sadly, not everyone can be helped by endoscopic spine surgery. It is still spine surgery, which has inherent risk that is off-putting to some patients. Other conditions simply cannot yet be treated by this technique. Endoscopic spine surgery is the next advance in the treatment of spinal disorders, but it is not a cure-all.

Why isn’t all spine surgery done this way?
These procedures require a unique combination of skills that take time to acquire. There are only a few surgeons who have focused on mastering these advanced techniques. Endoscopic spine surgery is a hybrid procedure that falls in between interventional pain and minimally invasive spine surgery. It is a relatively new, cutting-edge technique. Endoscopic spine surgery is the future.

What are the advantages to endoscopic spine surgery?
▪ No general anesthesia
▪ Very small incisions
▪ Minimal damage to skin, muscle, ligaments and bone
▪ Minimal blood loss
▪ Less post-operative pain
▪ Faster recovery

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