It’s back to school time again, and each year many children get a new backpack to carry supplies, books, and homework. These carry-all backpacks often reflect the personality of the child, with many adorned with super heroes, princesses and more than a few Angry Birds.

back-to-school2While this efficient carrying case has been around for many years and has been used by millions of students both old and young, back experts such as Texas Back Institute physician Dr. Rey Bosita have noticed a problem with backpacks. They’re too heavy for some kids, and can cause long-term serious back problems.

We spent a few minutes with Dr. Bosita to get some guidelines on the proper size and use of backpacks. More on this later.

Backpacks Have a Colorful History

Backpacks, in one form or another, have been around since early humans used animal skins to carry meat from hunting trips. Just as with the school kids of today, these packs allowed prehistoric hunters to use the strong muscles in their backs to carry much more game for longer distances than if they were carrying it in their arms alone.

Historians note that the term “backpack” was coined by Americans around 1910; however, before it was known as a backpack, Europeans (specifically the Germans) called this carry-all a “rucksack,” which is a shortened version of the phrase “der Rucken” – German for “the human back.”

Up until the 1950’s, the backpack was primarily used for hunting and military purposes. These early versions were made of rugged materials and very heavy to carry. All of this changed when hiker Dick Kelty realized backpacks could serve a valuable function to the participants of his sport. He began experimenting with creating packs made of lighter materials and more compact designs. He also changed the weight distribution of the backpacks – by putting the skids of the pack in the back pockets of his hiking pants – allowing the hips to carry more of the load.

With this change, anyone who needed to carry several items while they were walking could pack these in a backpack and be on their way. It didn’t take long for parents and students to discover  these same, light-weight backpacks were ideal carrying cases for schoolbooks and homework papers.

The Problem with Backpacks

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For all of its efficiency, the modern backpack has its detractors, some of whom are backspecialists. In an article published in 2012 in the New York Times, it was noted that “heavy backpacks don’t just zap children of energy that might be better used doing schoolwork or playing sports. Lugging them can also lead to chronic back pain, accidents and possibly lifelong orthopedic damage.”

In this article on the dangers of backpacks for kids, the federal Consumer Product Safety Commission calculated that “carrying a 12-pound backpack to and from school and lifting it 10 times a day for an entire school year puts a cumulative load on youngsters’ bodies of 21,600 pounds – the equivalent of six mid-sized cars.”

In a 2012 report in the “Archives of Disease in Childhood,” researchers in Spain assessed the backpacks and back health of 1,403 pupils, ages 12 to 17. More than 60 percent were carrying packs weighing more than 10 percent of their body weight, and nearly one in five had schoolbags that weighed more than 15 percent of their own weight.

This study found that “1 in 4 students said they had suffered back pain for more than 15 days during the previous year; scoliosis – curvature of the spine – accounted for 70 percent of those with pain. The remaining 30 percent had either low back pain or contractures – continuous, involuntary muscle contractions.” Girls faced a greater risk of back pain than boys, and their risk increased with age.

Clearly, there is a potential problem with backpacks and kids. In many cases, they are either too heavy for the size of the child or they are being worn by the child incorrectly. We spoke with Dr. Rey Bosita, a spine specialist with Texas Back Institute, to get an idea on the “dos and don’ts” for backpacks with kids.

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Dr. Bosita noted pain often results when the weight of the pack pulls children backward, prompting them to bend forward or to arch their backs to keep the pack centered. These positions make the back muscles work harder and increase pressure on vertebrae on the discs between them.

If the child has to lean forward or seems unsteady when walking with a loaded pack, it’s too heavy.  This can lead to poor posture and shoulder pain.  Neck pain can also occur when the child is forced to look up from this position.

No parent or teacher wants a child to be injured by a backpack which is too heavy. So, what should be done to correct this situation? Dr. Bosita has some ideas.

Tips You Can Use for Back Safety and Backpacks

“The first thing we should look at is how the backpack fits the child and how he/she is standing while wearing it fully-loaded. The child should be standing straight up – with shoulders back. The backpack should be positioned in a manner that allows it to rest against the child’s back, straps a little tighter, so that the pack doesn’t sag too low,” Dr. Bosita notes.

Another important consideration for back safety is the weight of the backpack. What is the correct weight for a child’s backpack and how does a parent determine the weight of the pack? Dr. Bosita says, “The easiest way to determine the acceptable weight of the pack is to get the family scales out and weigh the child without his/her backpack. The weight of the backpack should be no more than 10 to 15 percent of the child’s weight. Therefore, if the child weighs 50 pounds, the backpack should not weigh more than 5 to 7 pounds.”

“Remember, everything adds weight to the backpack, including the pack itself, Dr. Bosita notes. “It’s a good idea to check the backpack weight with all of the materials connected to the pack (water bottles, knick knacks) and the books and school supplies being carried in the backpack (library books, binders).”

For the complete video of Dr. Bosita’s tips on backpacks, just click here 

Pack Only What’s Needed

When given the chance, younger children will stuff as many things as possible in their backpacks, much of which is not related to school work. Parents should take a minute each morning and afternoon to inventory the items being transported to and from school. If there are toys, games, handheld computer games, pet rocks, frogs and other non-academic items being packed in the bag, remind the child that these things should be left at home.

If he or she disagrees about the contents of the backpack, have a Plan B. Just tell them that you want them to grow up straight and tall and a heavy backpack might keep this from happening. This has the advantage of being the truth.

And if this fails, reward them with a treat  if they keep the back pack light.

Day 4

Today was our first full day at the hospital, although “full” is an understatement. When we opened the clinic at 10am, the open-air waiting room was teeming with patients and their families lining rows of benches or sprawled on mats on the floor.

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The team got right to work; Sherry and Rob left to set up our supply room and prepare equipment for surgery the next day. Izzy, Zvi, Danielle and I were joined by the hospital’s own orthopedic surgeon, Dr. Deo. We parked ourselves in a small room with an examining table and brought in the first patient. Over the next ten and a half hours, we screened 67 patients and selected 16 as candidates for surgery pending results from their imaging. It was a long day, and at times a bit trying; after hours of sitting on a bench in a dark, hot, narrow hallway with minimal food and water, patients began pushing their way into the small examining room. They were understandably anxious; many of them had travelled long distances to Mbarara just to be seen by Dr. Lieberman. We explained sympathetically that we were moving as fast as we could, and they would simply have to wait longer. I was astonished by their patience and resilience. Amina, a thin, frail 85-year old woman with chronic back pain from spinal stenosis shuffled slowly into the examining room with a walking stick. The deep wrinkles in her face folded into themselves each time she winced, emphasizing the extent of her pain. For over 5 hours she had waited quietly and without complaint. After his examination, Dr. Lieberman explained to Amina that he could treat her pain through a surgical procedure called a decompression, though the surgery would carry significant risk given her age. This brave elderly woman became our first surgical patient the following morning.

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As the day dragged on we began to appreciate a specific luxury of North American medical care: the process of waiting. To Canadians like myself and Zvi, waiting a month to see a specialist elicits a groan and some exasperated comment about “the drawbacks of universal healthcare.” Waiting over an hour in an air-conditioned waiting room with cushioned seats and a Starbucks in the lobby prompts a similar reaction. Many of these Ugandan patients had lived for over 20 years with back pain. We saw teenagers and 20-somethings with spine deformities that in North America would have been corrected within the first two decades of their lives.  Here, “waiting” is measured in years rather than weeks or months.

For some patients, their long-awaited visit with Dr. Lieberman brought bittersweet news: they were candidates for surgery, but would have to wait even longer. Kenneth, a short 18-year old with a pockmarked face and a big smile, was born with severe scoliosis and has developed restrictive lung disease as a result of his rigid spine. He walks stooped over to the right because his scoliosis forces his left shoulder upwards. Unable to work with his deformity, Kenneth was hoping that an operation would restore his physical mobility and give him “purpose,” as he put it. But to treat Kenneth’s condition the spine surgery team would need three weeks in Uganda, and we only have six operating days here. Dr. Lieberman explained to Kenneth that he would have to wait until next year when there is the possibility of a longer mission.

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67 patients later, we were done for the day. On the drive back to the hotel, we reflected on some of the cases from that day, including Bernadette, a 45 year-old woman who injured her back while pulling a goat tethered to her waist. When one team member wondered aloud why anyone would tie themselves to a goat, Rob kindly provided an answer, as well as our quote of the day: “If you haven’t mutton-busted, you haven’t lived.”

Day 5

A lot was riding on today: our first day in the OR, our chance to test out the facilities and to work alongside new Ugandan colleagues. Today’s successes and failures would mold our expectations of what we can accomplish in a week and would give us a sense of the challenges we would face. For that reason, Dr. Lieberman deliberately selected a relatively straightforward procedure for our first operation, a posterior decompression in which portions of bone are removed to allow more space around a nerve root. We arrived at the hospital around 8:30am and went straight to the operating room to find the anesthesiologist, Dr. Emanuel already prepping the patient, Amina.

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Sherri and Rob snapped into action and began setting up instrument tables and equipment while Izzy and Zvi scrubbed in. It seemed like we were off to a good start….. until the power shut off. We stood in the window-lit operating room with the patient on the ventilator for about 20 minutes until power returned. The rest of the operation went smoothly and two hours later Amina was on her way to the ICU.

 

 

 

 

 

 

 

 

 

 

 

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With a lunchtime clinic scheduled in between surgeries, we barely had time to scarf down our energy bars before heading out to the corridor of waiting patients. One by one, the patients approached Izzy and Zvi holding their X-rays and CT scans. We were able to add two patients to our list of surgical candidates, and sent several more for imaging and follow-up.

In the meantime, Sherri began setting up the OR for the next case, 56 year-old Muhamoud. Muhamoud had severe vertebral lysis caused by tuberculosis in his spine. I was particularly excited for this case because Dr. Lieberman was planning to approach the spine anteriorly (from the patient’s front), navigating around the peritoneum (the space behind the abdominal organs) to the vertebral column. As Dr. Lieberman went to make his incision, he looked up to find that the anesthesiologist had left the room, leaving his nurse anaesthetist in the pilot’s seat. This wasn’t the only hiccup we would encounter that afternoon. As Dr. Lieberman pulled back the iliac vein to find the vertebral column, the nurse anaesthetist tumbled from his chair, grabbed at the ventilator tubing and crashed into the operating room table causing the patient to move. It was simply luck that the vein between Dr. Lieberman’s forceps did not tear.

That night at dinner, the team discussed some of the lessons of the day. Our first two surgeries in new territory were sobering examples of the importance of thinking on your feet. When things don’t go as planned, improvise. Today’s challenges also highlighted some of the prerequisites of good teamwork. Teams of longstanding colleagues (like the Texas team) work like well-oiled machines. They anticipate each other’s moves, communicate effectively, share expectations and have standard procedures that help things move smoothly. When veteran teams join forces with new colleagues (as the Texas team did with the Ugandan anesthesia team), processes that used to be fluid can suddenly become turbulent. Care must be taken to communicate effectively, lay down expectations and establish roles and responsibilities. Perhaps today’s anesthetic troubles were not from a lack of competence, but rather from miscommunication and incongruent standard practices.

Finally, and on a more personal level, I learned today that surgery is far more multidimensional than I had thought. Spine surgeries don’t necessarily need to be approached from the back, just like heart surgeries aren’t always approached from the anterior chest. Each approach involves different anatomy and with that, different challenges, considerations and risks. The human body is sort of like a labyrinth for the surgeon; sometimes, the best way of reaching a point of interest is not necessarily the most direct route.

All in all, our first surgical day was a great success. As a team, we fell naturally into our own roles and got through our first two surgeries with only a couple nicks along the way. It seemed like we could count on a very productive and rewarding week ahead.

Kentucky derby

Each year, on the first Saturday in May, horse lovers and sports fans turn their rapt attention to Churchill Downs in Louisville, Kentucky for the “fastest two minutes in sports.” Since its beginning in 1875, The Kentucky Derby has run consecutively each year and has become the premier event in thoroughbred horse racing.

Because of this pomp, pageantry and publicity associated with this race, many amateur riders become interested in equestrian sports and some of these will experience injuries from their new sport – especially in the area of the neck and back. This is where the advice of spine specialists at Texas Back Institute such as Dr. Ralph Rashbaum can come in handy. However, before getting some back health tips for equestrians, let’s take a two-minute look at the Run for the Roses.

A New Method for Qualifying This Year

The Kentucky Derby is a 1 and a quarter mile (2 km) race for 3-year old, thoroughbred horses and is the first race of horse racing’s championship series – The Triple Crown. Sports pundits call the race “The Run for the Roses” because the winning horse is draped with a blanket of stunning spring roses when it is in the winner’s circle after the race.

As every horse racing enthusiasts knows, there are hundreds of thoroughbred horses racing at tracks around the world each week. With this many horses, it’s interesting to note how the top 20 horses are chosen to line up at the gate in Louisville on Derby day. The eventual winner of the Kentucky Derby will have gotten there after competing in races around the country to qualify.

As the website of the Kentucky Derby notes, “This year marks the debut of a new way to determine which horses will join this select and storied field: The Road to the Kentucky Derby is a points-based system that replaces the previous selection method (graded stakes earnings) with a series of key races offering escalating points stakes during the course of the Derby year.

The Road to the Kentucky Derby is a long one, starting with the Prep Season races the previous September and building to a crescendo with the Championship Series in the weeks before the Kentucky Derby. Each race awards the top four finishers points that are tallied across all the races to determine the ranking of horses competing to make it into the Derby.”

For a listing of this year’s qualifying horses and their respective rankings, click here

Questions, Rumors and Facts about the 2013 Derby

As with all high-profile sporting events – the NFL’s Super Bowl, MLB’s World Series, and others – even the most minute facts, trends and rumors about the participants (in this case, the horses) entered in the Kentucky Derby are thoroughly scrutinized by experts and casual fans alike. This year’s Derby has a few questions that add to the drama of the race.

  • Highly successful trainer Todd Pelcher has 5 horses in this year’s race and he is teaming up with hall of fame jockey Calvin Borel on one of the favorites in this year’s race – Revolutionary. In 2010, the team of Pelcher and Borel won the Derby with Super Saver. Can they repeat this year?
  • One of the prominent prep races, The Bluegrass Stakes, was run on synthetic surface and since Churchill Downs is good, old fashion dirt, handicappers are trying to determine whether the winners of the race on synthetic surface will translate to the dirt track at the Derby.
  • Well-known and liked jockey, Gary Stevens, is returning to the sport at age 50. Stevens has been an actor and news anchor since retiring from racing a few years ago and will be riding one of the contenders – Oxbow – in this year’s race. Can someone who is old enough to be the father of most of the other jockeys win the race?
  • Highly respected trainer D. Wayne Lukus who is 77 years old and has been enormously successful at the Kentucky Derby will have two thoroughbreds in the race – Oxbox and Will Take Charge. Anytime Lukus has horses in the race, handicappers take notice because of his history.
  • The colt, Lines of Battle, is the only European entry in this year’s race and has won races going longer distances than the other horses in the race. Some feel that Lines of Battle is an excellent choice for a long shot.

Enjoy the Ride and Save Your Back

Just as NCAA’s Final Four tournament has the effect of getting many people out, shooting hoops, the Kentucky Derby energizes those who love horses. Since participating in equestrian sports can result in accidents and even long-term damage to the back, some caution and proper techniques should be considered before saddling up. To help us with this we’ve asked Texas Back Institute spine surgeon Dr. Ralph Rashbaum to give us some insights on back safety when involved in horseback riding.

In addition to diagnosing and treating patients with chronic back pain, herniated discs, back injuries and sacroiliac joint dysruption, Dr. Rashbaum has additional knowledge that most back specialists don’t have. He spent 16 years breeding Arabian horses and his wife and daughter have been involved in the sport of Hunter/Jumper equestrian competitions. With the Kentucky Derby approaching the final turn, we asked Dr. Rashbaum for some tips on back safety and riding.

RashbaumPatientWhat is the most serious health problem casual riders and competitors in equestrian sports should be concerned with? 

The biggest danger to the recreational rider is falling off the horse and injuring his/her spine, long bones (such as legs and arms) and pelvis. After a period of time, the ligaments of the rider get tired or become sore and the muscles become more lax. When this happens, a rider – especially one who does not ride on a regular basis – can be jostled off the horse and take a tumble. This can cause fractures in the vertebra and other injuries we would need to treat.

Are there any dangers to the neck and spine of riders who ride on a regular basis and if so, how can they avoid this? 

Riders who spend a lot of time pursuing this sport can experience a pinpoint injury or tenderness in the area where the sacroiliac joint and buttocks meet. This is not a spine injury but is caused by the repetitive concussion of the buttocks on the saddle when the horse is walking or jogging. This is not as big a problem when the horse is galloping.  Over time, this can result in a sharp pain. The best way to avoid this injury is to learn the proper posture and techniques for cushioning the constant bouncing when riding. This involves using the thighs and leg muscles to cushion the concussive bounces. This is a great argument for young riders to get professional instruction on riding techniques.

What are some physical signs a horse rider should come see a physician at Texas Back Institute? 

Anytime there is a burning pain, particularly if this runs down the leg and lower extremities, these suggest some problems and the rider should come see us. This is sometimes called “sciatica” and can be treated in several ways.

What is your opinion about the athleticism of the professional jockeys that will be riding in the Kentucky Derby Saturday?  

They are amazing athletes! Imagine getting into the posture they must get into in order ride – hips flexed, legs underneath, tremendous extension of the torso and neck all while keep their head up – for the length of time of a race. The jockeys who compete at this level have rigorous stretching exercises and are much more flexible than other athletes.

While their numbers are dwindling, there are still many men and women who raise cattle on large ranches. These folks spend a lot of time on horseback and this is not a sport but rather a job. What are the problems they should be aware of? 

Cowboys, whether they are working on a cattle ranch or competing in rodeos, have the same potential for concussive damage as a hunter/jumper contestant. Most learn, at an early age, how to reduce the concussive blows by using leg muscles to reduce this. However, rodeo contestants – particularly those who are involved in bulldogging where the cowboy ropes the calf, jumps off the horse, lifts the calf and then ties him – have a high risk of spine damage and disc herniation and we’ve seen a few in our examination rooms.

 

Protecting your neck and spine from wear and tear damage as well as injuries is an important part of enjoying equestrian sports. Plus, now that you have the scoop on the horses in this year’s Kentucky Derby, you’re ready for the race. All you need is a mint julep and you’re good to go!    

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Back Pain can affect us all, young and old, no matter how active you may be. In some cases all it takes is incorrect posture while lifting or normal wear and tear over time to trigger pain in your neck and back. Here are some tips from Dr. Shawn Henry that may help you think about the health and safety of your back.

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1)   Don’t lift and twist at the same time.

2)   Maintain good posture while walking. Keep your head high, chin tucked in and toes straight ahead.

3)   Wear comfortable low-heeled shoes (avoid wearing high-heeled or platform shoes).

4)   Don’t bend forward with straight legs, when lifting an object. Instead, bend at the knees and hold the object close to you. Lift steadily by using the power of your leg muscles.

5)   Maintain a healthy body weight (added weight can put extra stress on your back).

6)   Don’t sit or stand for long periods of time, get up and stretch your muscles frequently.

7)   Sit in an ergonomically designed chair that provides proper back support (and makes it difficult for you to slouch). At the very least, get an orthopedic insert or roll up a towel to help support the low back in mid-position.

8)   Quit Smoking: Smoking is known to contribute to advanced degeneration of the spine.

Dr. Henry is now serving in our Ft. Worth, Dallas, and Midland clinics.

Facet Joint Pain

Recently Spine-Health.com featured the blog post below by Dr. Stephen Hochschuler, co-founder and orthopedic spine surgeon at Texas Back Institute.

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Facet Joint Pain after Spine Surgery

The facet joints are two small joints in the back of the spine, on the left and right sides, at each level. These joints work with the discs to provide support and motion to the spine.

There are several ways in which these joints can produce pain:

  • Nerves in the joints can be compressed and/or irritated by inflammatory agents
  • Facet joints can degenerate, become arthritic, and produce pain by forming osteophytes (bone spurs) which compress nerves passing into the legs.

As with many joints, degenerative changes can occur in the facets, which can become painful. Degeneration is likely to occur in the spine as a part of the aging process, regardless if surgery has been performed or not. However, some types of spine surgery may alter load or movement patterns of the spine, which in turn can affect the facet joints.

Causes of Post-operative Facet Joint Pain

Facet joints may be related to pain after spine surgery in several ways:

  • These joints may continue to degenerate after a surgical procedure to treat a herniated disc or compressed nerve roots at the same spinal level
  • Surgery may change the loading or movement patterns of these joints, leading to degeneration and pain.

Following a spine fusion at one spinal level, motion of the level(s) next to it may be altered to compensate for changes the fusion caused. This change in motion pattern may cause facets at the adjacent segment(s) to degenerate and become painful.

Facet joint pain is difficult to identify without injections into these joints. In back pain patients, pain may arise from more than one source within the spine. While surgery may address one problem, existing facet joint pain may not have been recognized prior to the spine surgery, and therefore not addressed.

Treatment Options for Facet Joint Pain

Treatment of facet joint pain may include one or a combination of the following:

  • Physical therapy
  • Medication
  • Chiropractic care/manual manipulation

If these treatments do not provide relief, then more invasive procedures are an option, including:

Treatment Considerations

The most important aspect of pre-operative planning for facet joint pain is the diagnosis. As with real estate investments, where the focus is on “Location, Location, Location,” for spine surgery the name of the game is “Diagnosis, Diagnosis, Diagnosis.”

It is therefore stressed that before any spinal surgical intervention is considered, a thorough diagnostic work up is needed to determine any and ALL causes of the back pain one is addressing.

This is part of the reason that a preoperative discussion and a patient education program is necessary. This process will afford the patient a full understanding as to what is known and unknown in each individual case and what expectations can be set in accordance with all treatment variables.

The EMG Study

As featured on Spine-Health.com. Dr. Patel is a physiatrist and treats patients suffering from neck and back pain.

Contributed by Nayan Patel, MD

For the spine patient with Failed Back Surgery Syndrome, the electrodiagnostic study helps the physician assess for nerve damage coming from the cervical or lumbar spine, as well as evaluate for other nerve-related problems in an extremity (such as peripheral neuropathy).

Because symptoms from a patient withFailed Back Surgery Syndrome can be complicated, additional electrodiagnostic tests can help the physician with accurate diagnosis of the origin(s) of the patient’s pain.

An electrodiagnostic study, commonly called an EMG, is used to evaluate muscle and nerve function of a person who has extremity or facial pain, numbness and/or weakness. The study can be used to assess for cervical or lumbar radiculopathy (nerve damage from spine disease), any co-existing peripheral neuropathy (nerve damage from diseases like diabetes), myopathy (muscle disease) or focal neuropathy.

The test also helps localize the location of spinal nerve damage as well as distinguish if the damage is new or old, and progressive or stable.

There are two parts to an electrodiagnostic evaluation: nerve conduction study (NCS) and electromyography (EMG).

Nerve Conduction Study (NCS)
The NCS is done with a stimulator that generates a mild shock that travels down the nerve; the signal generated is picked up by an electrode placed at a specific distance. The data obtained give the testing physician information regarding the speed and strength of the nerve signal. The NCS picks up signals from two types of nerves: the sensory nerve, which provides sensation signals from the skin, and the motor nerve, which provides power signals to the muscles.

Electromyography (EMG)
The EMG study is done with a sterile, small gauge amplifier needle inserted into the muscles of an affected extremity. Each muscle is powered by specific sets of spinal nerves: for example, the bicep is powered by the C5 and C6 spinal nerves. If an abnormality is seen in the activity of a muscle or group of muscles, the physician can determine which spinal nerve is likely involved. The study can also help assess the age, extent, and possible progression of damage.

The complete EMG test takes 30 minutes to one hour. Although uncomfortable for some patients, the test is well tolerated and there is no persistent discomfort. The ordering physician may use the study in conjunction with other diagnostic studies, such as an MRI or CT scan, especially if the problem is thought to originate in the spine.

Since a patient who has failed spine surgery syndrome can have complicated symptoms, the evaluating surgeon can have difficulty telling if a person’s ongoing pain is coming from a spinal nerve. The EMG study will help evaluate active versus inactive spinal nerve damage as well as localize the spinal level of nerve damage. It will also help assess for any coexisting peripheral nerve damage.

Failed Back Surgery Syndrome

The post below was featured on Spine-Health.com and was contributed by Dr. Stephen Hochschuler, co-founder and orthopedic spine surgeon at Texas Back Institute.

Failed Back Surgery Syndrome (FBSS) refers to chronic back or neck pain, with or without extremity pain, which occurs if spine surgery does not achieve the desired result. Contributing factors include recurrent disc herniation, compressed nerves, altered joint mobility, scar tissue, muscle deconditioning and degeneration of facet or sacroiliac joints.

The problem of failed spine surgery has long been a perplexing and intriguing problem my colleagues and I have tried to accurately analyze and pro-actively prevent. My goal as a spine surgeon is to help treat patients with pain stemming from their spine. Many times I am able to treat patients with nonsurgical treatment options, such as physical therapy or medication, and they do very well. In some instances though, this treatment plan does not provide patients with the pain relief needed so we have to pursue more aggressive treatment options including surgery.

I always consider surgery to be a last option approach to spine care and therefore am very careful to make sure my patients are in the best position to have a successful surgery, in turn minimizing the chances of FBSS. Through experience I know there are several factors that have shown to contribute to failed back surgery syndrome, and therefore I follow the protocol below to make sure my patients are set up for their best outcomes:

  1. Before the surgery:
    • Always treat patients conservatively (non-operatively) first
    • Make sure the patient is correctly diagnosed – meaning that the cause of the patient’s pain has been accurately identified
    • Provide a thorough pre-operative evaluation
    • Make sure the surgery is the right one for the patient
    • Appropriately educate and set expectations for the patient, including pre-operative psychological evaluations.
  2. During the surgery:
    • Take all proper precautions to minimize intra-operative issues.
  3. After the surgery:
    • Keep a close eye on post-operative recovery
    • Work closely with the patients’ interdisciplinary care team.

If you are considering spine surgery, it is important to sit down with your surgeon and determine how he actively attempts to minimize the risk for failed back surgery syndrome. If you have been diagnosed with FBSS, it is not necessarily the end of the road. There exist many alternative treatment approaches to deal with this syndrome, but once again one size does not fit all. It is important to find a surgeon who has experience in treating patients with FBSS and can offer you multiple treatment options.

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