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Lower/Lumbar Back Total Disc Replacement or Fusion Options

Lower/Lumbar Back Total Disc Replacement or Fusion Options

Many doctors/surgeons rely on the widely adopted lumbar spinal fusion. However, experts have asserted that lumbar total disc replacement or TDR should be made available and increased for treating degenerative disc disease and other spinal conditions. Individuals interested in total disc replacement, the ability to have it done, and if insurance will pay? What to know about TDR and fusion before deciding and moving forward.

Lower/Lumbar Back Total Disc Replacement or Fusion Options

Total Disc Replacement

Spinal fusion has been the traditional approach for relieving lower back pain. In this procedure, a bone graft is inserted between two or more vertebrae. This eliminates movement that causes pain or could be dangerous to the individual. Total disc replacement demands more on a technical level than spinal fusion. However, the worn-out, injured, or damaged disc is fully replaced, even a completely degenerated disc, with a metal and/or plastic one. Benefits from lumbar TDR surgery include:

  • Shown to be a safe procedure with minimal complications
  • Significant improvement in health and quality of life
  • High rates of successful outcomes
  • Mobility is preserved

Who Needs Disc Replacement?

Low back problems affect more than a third of the population. This can come from:

  • Personal
  • Work
  • Sports
  • Automobile injuries
  • Aging
  • All are risk factors

Fusion or Total disc replacement

Fusion reduces and eliminates motion around the affected area which also changes with the spine’s mechanics. It can also place increased stress on the surrounding segments. However, the lack of motion is to eliminate the pain. Total disc replacement does increase mobility, but it can’t fully relieve the pain.  It can relieve pain generated from the disc but not from other causes. TDR has been shown to:

  • Provides motion preservation
  • Reduces staying at the hospital
  • Provides long-term durability
  • Lower reoperation rates compared to fusion

Total disc replacement issues:

  • The procedure is more time-consuming
  • A lot of time making decisions
  • A lot of time preparing

An example could be the patient has a narrow disc space. Looking at the X-rays of the discs above and below, the surgeon has to make sure they choose the right size. Next, the narrow space needs to be mobilized back to a normal height that cannot be too high or too short. Finally, the surgeon has to make sure that the disc is anchored and fits properly.

Why Surgeons Still Choose Fusion?

Despite the benefits, there are reasons why surgeons still choose fusion.

  • There are strict rules as to when TDR can be used. This means insurers are prone only to approve fusion procedures.
  • The surgical technique is challenging. TDR surgery is a highly demanding procedure. As a result, many doctors specializing in fusion for 20 years or more can be reluctant to perform the procedure.
  • Complications and revision surgeries. Reoperations are sometimes necessary, but this happens in both fusion and TDR.

Individual Needs

Fortunately, most individuals with lower back problems never need total disc replacement. And those that do have severe pain/conditions are recommended to try non-invasive/surgical treatment. This ranges from:

  • Chiropractic
  • Physical therapy
  • Massage

Imaging and lab tests will be required. However, if an operation is necessary, ask questions about both procedures. For example, if a surgeon insists that fusion is the only option, ask why total disc replacement is not an option?


Body Composition Testing


Protein and Weight Loss

Protein is one of three basic macronutrients found in food. Proteins are made up of smaller units called amino acids. There are 22 amino acids, with 9 of these being essential. This means the body needs them, as the body cannot produce them. These essential amino acids can be obtained by eating protein-rich foods like:

  • Eggs
  • Meat
  • Fish
  • Vegetarian/vegan options include:
  • Nuts
  • Seeds
  • Beans
  • Tofu

Generally, all the essential amino acids cannot be obtained from just one food. Therefore it is recommended to eat a variety of animal and plant-based proteins. Protein is in almost every structure and function of the body.

Antibodies

These proteins fight off any infections, bacteria, etc.

Repair, maintenance, and structural

Proteins are the building blocks of the body’s muscles, bones, skin, and hair.

Hormones

Chemical messenger proteins are how cells and organs communicate. For example, Growth Hormone affects muscle gain and fat loss.

Enzymes

Not all proteins are enzymes; however, all enzymes are proteins. These proteins are catalysts or starters for chemical reactions in the body.

Transportation and storage

Some proteins carry molecules where they are needed. For example, hemoglobin or the red blood cells carry oxygen to cells, then transport carbon dioxide away.

Not getting enough protein in one’s diet can have serious consequences on the body’s health. Without enough protein, the muscles can begin to atrophy or waste away, taking Lean Body Mass, strength, and energy away as well.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. In addition, we provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

phone: 915-850-0900

Licensed in: Texas & New Mexico*

References

Salzmann, Stephan N et al. “Lumbar disc replacement surgery-successes and obstacles to widespread adoption.” Current reviews in musculoskeletal medicine vol. 10,2 (2017): 153-159. doi:10.1007/s12178-017-9397-4

Hopkins overview of Lumbar TDR (for consumers) https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/lumbar-disk-replacement

“Comparison of Lumbar Total Disc Replacement With Surgical Spinal Fusion for the Treatment of Single-Level Degenerative Disc Disease: A Meta-Analysis of 5-Year Outcomes From Randomized Controlled Trials”, Zigler J, et al., Global Spine Journal, June 2018, PMC602295 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6022955/

“Overview of Lumbar TDR” (for consumers); Johns Hopkins Medical Center https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/lumbar-disk-replacement

Spinal Tumors

Spinal Tumors

A spinal tumor is an abnormal mass of tissue either inside the spine or outside. It is also called a neoplasm meaning a new abnormal growth. They can develop in the bone, spread to other parts of the spine, or outside the spine, like the lungs and chest. Tumor cells can multiply slowly or very rapidly. Tumors are either cancerous or non-cancerous. They can develop anywhere in the spine:
  • Cervical – neck
  • Thoracic – mid-back
  • Lumbar – low-back
  • Sacral – sacrum
It is not uncommon for spinal tumors to develop out of a tumor from the individual’s breast, lung, kidney, prostate, or another area of the body that has spread out.  
11860 Vista Del Sol, Ste. 128 Spinal Tumors
 

Symptoms

Whether cancerous or not, spinal tumors can cause a variety of symptoms, including:
  • Pain not related to an injury or physical activity.
  • Pain in the back or neck that presents suddenly, quickly worsens, especially at night. This can be an indicator of a spinal tumor.
  • Pain that radiates to other parts of the body, like the arms, hands, legs, and feet.
  • The pain continues even when resting.
  • Muscle weakness or loss of sensation, especially in the legs, arms, or chest.
  • Difficulty walking
  • Abnormal curvature of the spine not from poor posture
  • Paralysis
  • Loss of bladder or bowel control
  • Lowered sensitivity to heat and cold
An individual could have a dominating symptom/s or a combination.

Causes

As previously mentioned these tumors can originally develop in another part of the body and then metastasize to the spine. These types of tumors are secondary tumors. Research scientists are still trying to figure out what exactly causes primary tumors that originate in the spine. One theory believes genetics plays a role.  
 

Early diagnosis

The most common symptom of a spinal tumor is pain. Examinations and diagnostic tests will be conducted both physical and neurological. A doctor or specialist needs to see and evaluate the spine. This is essential in diagnosing a potential tumor. A doctor could also order:
  • CT scan
  • MRI
  • PET scan – Positron Emission Tomography
  • Myelogram if there are symptoms of spinal cord compression
If the imaging reveals a tumor, a biopsy could be performed. A sample of tissue will be examined under a microscope to see if the tumor is cancerous or not. If the tumor is cancerous, the biopsy will show the type of cancer and determine the stage of the disease. Depending on the tumor type and location, other tests/procedures could be recommended.

Treatment

There are many factors that go into creating an optimal treatment plan. This includes whether the tumor is cancerous or not, size, location, and symptoms. Types of treatment:
  • Observe and wait as small non-cancerous tumors that are not growing or impinging/pinching other spinal structures could only need to be monitored for changes.
  • Surgery
  • Radiation treatment
  • Stereotactic radiosurgery works by delivering a high dose of radiation specifically targeted at the tumor
  • Chemotherapy

Chiropractor Personal Injury Attorney Recommended

 
 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Lumbar Stenosis Surgery for Sciatica

Lumbar Stenosis Surgery for Sciatica

Lumbar stenosis surgery for sciatica, like any type of surgical procedure does not always yield the most successful results. This is why it�s important to carefully and methodically assess all of the personal risk factors.

Sciatica causes severe pain and surgery could be an option and hopefully of last resort. However, it� is important to first attempt non-surgical/non-pharmacological treatment/s for six to twelve weeks before surgery to relieve symptoms and root cause. A full course of conservative treatment could include:

  • Physical therapy
  • Chiropractic
  • Aerobic exercise
  • Pain meds
  • Epidural steroid injection
11860 Vista Del Sol, Ste. 128 Lumbar Stenosis Surgery for Sciatica

Sciatica and Stenosis

Sciatica can be caused by stenosis. This is when the spinal canal narrows, constricting, and pinching the nerves specifically the sciatic. Around ninety percent of cases stem from a herniated disc compressing the nerve roots. The damaged disc extends out and pinches the roots of the sciatic nerve. This pinching causes: �

  • Pain
  • Numbness
  • Tingling
  • Muscle weakness

If it stays like this for a long time an individual can experience incontinence, along with permanent nerve and muscle damage.

BulgingandHerniatedDiscs ElPasoChiropractor

Lumbar Stenosis Surgery Options

  • Lumbar stenosis surgery depends on the cause of sciatica: A single herniated disc could be pressing the nerve, which would only require the removal of just that portion of the disc that�s causing the compression. This procedure is known as a discectomy or microdiscectomy.
  • If the stenosis is caused by a bone problem like an arthritic bone spur, then space has to be made in the canal. This means a portion of the lamina or the back of the spinal column. This is called a hemilaminectomy. Sometimes the whole lamina has to be removed. This is known as a laminectomy.
third and fourth lumbar vertebrae lumbar vertebra lumbar spine vertebral bone
  • If there is the instability of the spinal column, some of the lumbar vertebrae will be fused together to prevent further instability and added nerve compression.

A non-operative treatment course lasting a few weeks to months could reduce swelling in the nerve and improve sciatica symptoms. What happens is sometimes the disc gets reabsorbed over time and does not irritate the sciatic nerve.

Surgical Success

If the non-surgical options yielded minimal positive results or completely failed and surgery is the last resort talk with your surgeon to discuss the risks and benefits. The discussion will focus on factors like:

  • Age
  • Health status – levels of wellness and illness
  • Underlying conditions
  • Bodyweight
  • Smoker
  • Type of work

Individuals sixty-five and older, multiple health problems, being overweight or a smoker will place an individual at a higher risk of post complications from surgery. Studies found individuals who underwent surgery for sciatica from lumbar stenosis, identified added risk factors that could affect the outcome including:

  • Depression: this was because there were patients that continued to have sciatica symptoms after surgery. This means they are more likely to take antidepressants or anticonvulsants.
  • Quality of life from health perspective was low.
  • Previous spine surgery
11860 Vista Del Sol, Ste. 128 Lumbar Stenosis Surgery for Sciatica

Knowing about these factors and the possible success of sciatica surgery is something to keep in mind. The best way to understand what and how the surgery will be beneficial is to understand the risks and to remember that the risks are not the same for everybody.

Optimization

Surgical success depends on making sure patients are optimized before surgery. Increasing the chances of successful surgery after conservative treatment/s a surgeon will ask the patient to take these steps:

  • Weight loss is difficult, but it has been shown to improve surgical outcomes.
  • A healthy but sensible diet with a moderate calorie deficit is essential.
  • Light aerobic exercise, such as stationary or recumbent cycling can help keep the body’s blood flowing properly.
  • Exercising with pain is difficult but it will increase the cardiovascular system along with keeping the heart and lungs healthy enough to undergo surgical stress.
  • If the exercising causes too much pain ask the doctor about anti-inflammatory, muscle relaxants, or steroid medication along with the non-surgical treatment that can provide relief allowing exercise to resume.

Quit smoking

Smoking increases the rate of spinal degeneration and impairs the body�s ability to heal properly and optimally after surgery. If the surgery is elective, meaning it is not a medical emergency, then it is strongly encouraged to quit smoking before surgery. This will increase the chances of eliminating the habit. Don’t be afraid to get support. cancer.org/smokeout.

Pro-activeness

If taking antidepressant/s for depression, do not quit taking the medication thinking it will improve sciatica surgery success. Mental health is extremely important. The same goes for anticonvulsant meds as well. Stopping anticonvulsant medication for spinal surgery will more than likely cause extended damage or pre/post-surgical complications. Pre-existing conditions like depression means bringing the mental health provider and other specialists into the pre-surgical discussion.


 

Chiropractor Sciatica Symptoms

 


 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

Spinal Tap used to Diagnose, Administer Medicine, and Imaging Assistance

Spinal Tap used to Diagnose, Administer Medicine, and Imaging Assistance

Most of us have heard the term spinal tap, or have seen it on a tv medical drama show. It is known as a lumbar puncture, but what does this procedure involve and how is it utilized? What to know. This procedure is performed in the lower part of the back. It can be used for:

A spinal tap is performed by a doctor or nurse trained to do lumbar punctures. A specialized needle is inserted between the vertebrae to collect cerebrospinal fluid. Cerebrospinal fluid is a watery, colorless fluid that cushions the spinal cord and brain, protecting them from injury/damage. Questions may arise as to when an individual would need a spinal tap, how dangerous it is, and what to expect from this procedure? �

 

11860 Vista Del Sol, Ste. 128 Spinal Tap used to Diagnose, Administer Medicine, and Imaging Assistance

Spinal Tap Utilization

Spinal taps are often utilized in helping to diagnose infections of the central nervous system. One of the most common infections is meningitis. A sample of cerebrospinal fluid is taken, tested, and if infectious organisms are growing within, these are clue/s for determining and customizing a treatment plan and antibiotic therapy. The procedure also helps with:

  • Identifying central nervous system disorders, like multiple sclerosis, or epilepsy for example.
  • Diagnosing cancers that affect the brain or spinal cord
  • Administration of chemotherapy or anesthesia

Spinal taps are also used with imaging assistance.

For example, a contrast dye can be injected into the cerebrospinal fluid to get an anatomical view of the spinal cord and coverings. They are quite helpful when an individual cannot have an MRI done. �

Spinal cord coverings from a cross-section of a nerve

Spinal cord rear view

 

  1. spinal cord
  2. arachnoid
  3. dorsal rootlets of the
  4. spinal nerve
  5. the spinal nerve of
  6. the posterior surface of the body of the vertebra
  7. conus medullaris
  8. cauda equina
  9. filum terminale
  10. subarachnoid space

A spinal tap is done in a hospital or outpatient facility, depending on the reason for the tap. It is not an emergency procedure. Emergencies bring to mind situations and events that have to be done within seconds/minutes. A lumbar puncture does not entail that type of action.

Preparation

Listen and follow the provider�s instructions regarding what to eat and drink.

  • An individual could be told to not eat or drink anything for a specific set of hours before.
  • Any prescription/s, over-the-counter meds, and drug allergies need to be disclosed to the medical team that will perform the procedure.
  • Individuals can wear their own clothes but preferably loose-fitting and comfortable should be the objective.
  • Once at the location a hospital gown is given to the patient for the procedure.
  • The day of the appointment, tell the doctor of any unusual symptoms.
  • Have a designated driver for the ride home, as sometimes a patient can feel weak and dizzy after the procedure.

The Procedure

A tap is a simple procedure that usually takes a half-hour or less to complete.

  • The patient sits bent forward or lying down on the side.
  • The knees should be pulled up as far as possible with the chin down into the chest curled into a ball.
  • This arcs the back and spaces out the vertebrae, so there is a wider area for the needle to enter.
  • The skin is cleaned with an antiseptic.
  • A sterile sheet or towel is placed over the patient that has an opening exposing the lower back.
  • Local anesthesia is injected to numb the area.
  • Unless the doctor instructs movement, remaining still is key as the advancement of the needle into the small area is a delicate procedure.
  • There is an initial what feels like a stinging sensation, but the patient does not feel the actual needle as it advances.
  • The needle gets inserted into the spinal space where the cerebrospinal fluid resides.
  • The cerebrospinal fluid pressure is measured.
  • Sometimes an ultrasound or specialized x-ray technique, known as fluoroscopy is used to locate the best place for the needle.
  • This is where the reason for the tap determines what action is taken. Either medicine is administered or a small amount of cerebrospinal fluid is taken.
  • The needle is retracted.
  • A bandage is applied.
  • Spinal tap pain is rare, but sometimes the needle can brush a nerve root when it is inserted. It could feel like an electric shock down the leg.
11860 Vista Del Sol, Ste. 128 Spinal Tap used to Diagnose, Administer Medicine, and Imaging Assistance

Recovery

Once finished, the patient lies on their back for 30 to 60 minutes so the doctor can check for any abnormalities or affects. Being sent home depends on the reason for the tap. If there is unexplained fever, nausea, etc, a patient will not be sent home.

If it was an outpatient procedure the patient can leave and resume some simple activities after having a few hours of relaxation. Temporary pain meds are prescribed to address any discomfort. Results could come a day or a week later. They depend on the reason for the spinal tap.

Risks and Complications

It is considered a safe procedure with rare complications. The most common effect is a headache and usually comes on several hours, to a day or two later. These will not lead to any neurologic problems. Water or tea can help prevent and reduce the headache. Over-the-counter pain relievers can help too. However, if the headache continues after two days, call the doctor. A very small possibility of a more severe complication could happen including:

  • Infection
  • Bleeding
  • Numbness
  • Brain herniation or movement of the brain tissue from the added pressure
  • Nerve or spinal cord damage

This is a very safe procedure with the medical team being highly trained and skilled professionals that are careful and gentle.


Auto Accident Doctors & Chiropractic Treatment

 


 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

Best Office Chairs for Back Pain

Best Office Chairs for Back Pain

While we have this time at home, working, teaching, we might be realizing that the chairs we are using are great for kicking back or sitting only for a short while. It could be time for a proper office chair with back support for those with back pain, as well as to help prevent poor posture conditions that can generate back pain.

Here are a few of the top picks for back pain. Experts offer guidance on how to purchase an ergonomic office chair. Author of the book Wellness by Design�is a consumer guide to optimizing your home for physical and mental health. Hopefully, this will aid you as you navigate chairs for back pain.

11860 Vista Del Sol, Ste. 128 Best Office Chairs for Back and Back Pain El Paso, Texas

Posture Importance

One way proper posture is gained is by walking with a book on your head. That won’t be necessary, as good office chairs that offer back support lend themselves to healthy posture, which helps back pain. Studies confirm that improved ergonomics greatly decreases back pain. Proper posture keeps your body positioned to minimize stress on the muscles, joints, ligaments. Sitting the wrong way for a long time drains you and can cause fatigue, back pain or aching neck after a long day.

 

 

What to Look For

When it comes to chairs for back pain you want the best ergonomic office chair for your home. Keep an eye out for these key elements.

Adjustable

This is important, as our bodies are all different and require different settings for optimal posture. A chair should have adjustments for the seat, arms and back. The more adjustability the chair offers in terms of height and angle, the more it can be customized to your body.

Rolls Easy

A chair that rolls easily is one essential component for back pain support and prevention. Easily rolling allows you to stay close to your work, move around the work area comfortably, and optimal visibility. Be sure the construction of the casters is heavy-duty and that it will roll on your floor’s surfaces.

 

11860 Vista Del Sol, Ste. 128 Best Office Chairs for Back and Back Pain El Paso, Texas

Durability

Durability goes a long way. Established brands with a reputation for high quality shows their confidence in the chair�s ability to serve you long-term. It might be a bit expensive but it�s an investment in health and productivity. The United States Department of Labor offers a how-to guide to create the best ergonomics set up for you. Their guide includes the backrest, seat, armrests and the chair base. Chairs for back pain are focused on the overall comfort of the individual.

The right chair helps position your body so that you don’t activate trigger points and lets you roll smoothly so that you�re consistently working in a more ergonomic fashion.

 

Best Budget

The best chair for a budget was the Zipcode Design Bret Ergonomic Mesh Task Chair, which runs about $159.99 depending on where you shop. This office chair checks off many ergonomic guidelines set by the Department of Labor and is price friendly. The chair has a five-legged sturdybase, casters that move easily and a backrest that follows the natural curve of the spine.

 

11860 Vista Del Sol, Ste. 128 Best Office Chairs for Back and Back Pain El Paso, Texas

 

Best Mid-Range

The best mid-range model is the Tempur-Pedic TP9000 Mesh Task Chair, $318.99. The Tempur-Pedic company that makes mattresses have created an office chair that helps the body. It is created with memory foam has straightforward levers that allow you to adjust the armrests and seat easily. Easy-to-clean material is another benefit when working from home.

 

Best High-end Option

The best high-end model is the Herman Miller Aeron Chair, $1,395. This one is priced pretty high because of its plush ergonomic features. Think of chairs for back pain as an investment for your health and high quality of life. This is a cult-favorite chair that was designed 20 years ago and has sold over 7 million. It is completely customizable, from the chair size, level of back support, preferred tilt and seat angle, custom armrests and custom casters made for your floor type.

 

 

Honorable Mention

An honorable mention is the Humanscale� Freedom Task Swivel Desk Chair, $1,049.

This is a sleek cutting-edge office chair for back pain. The seat relies on body weight and physics for its ergonomic superiority and checks off the Department of Labor�s recommendations for optimal office chairs. It has adjustable arms, independent-adjustable seat and more.

 


 

Low Back Pain Care

 


 

NCBI Resources

 

Anatomy of the Lumbar Spine

Anatomy of the Lumbar Spine

The lumbar spine is the lower back that starts below the last thoracic vertebra T12 and ends at the top of the sacral spine or sacrum S1. Each lumbar spinal level is numbered from top to bottom, L1 to L5, or L6. The low back bodies are larger, and thicker structures of dense bone. From the front or anterior, the vertebral body has a rounded shape.

The posterior bony structure is a different lamina, which is a thin bony plate that shields and protects access to the spinal canal. There are vertebral arches that create the hollow spinal canal for lumbar nerve structures and the cauda equina.

 

11860 Vista Del Sol, Ste. 128 Anatomy of the Lumbar Spine El Paso, Texas

Lumbar Structure Strong Joint Complex

One intervertebral disc together with the facet joints forms a strong joint complex that allows the spine to bend and twist. One pair of facet joints from the top or superior vertebral body connects the lower or inferior set of facet joints. The facet joints are synovial joints, which means they are lined with cartilage and the capsule holds synovial fluid that enables joints to glide during movement. Think of it as hydraulics with smooth fluid motion.

Facet joint syndrome can develop from aging and degenerative spinal changes causing low back pain. The lumbar discs are secured in place by the fibrous endplates of the superior and inferior vertebral bodies.

The jelly/gel center of each disc called the nucleus pulposus is surrounded by the annulus fibrosis, which is a tough layer of fibrocartilage that you can think of as a radial tire.

Discs are integral to the joint complex and function to:

  1. Hold the superior and inferior vertebrae together
  2. Take the weight
  3. Absorb and distribute shock and forces when moving about
  4. Create an open nerve passageway called foramen or neuroforamen

The neuroforaminal spaces on either side of the disc allow nerve roots to exit the spinal canal and leave the column.

Lumbar disc herniation is a common cause of low back pain that can spread out into one or both legs. This is called lumbar radiculopathy. This condition can develop when the nerves are compressed.

 

Low Back Support

  • Lumbar Ligaments
  • Tendons
  • Muscles

Systems of strong fibrous bands of ligaments hold the vertebrae and discs together and stabilize the spine by helping to prevent over/excessive movements.

The 3 major spinal ligaments are the:

  1. Anterior longitudinal ligament
  2. Posterior longitudinal ligament
  3. Ligamentum flavum.

Spinal tendons attach muscles to the vertebrae and together work to limit excessive movement.

11860 Vista Del Sol, Ste. 128 Anatomy of the Lumbar Spine El Paso, Texas

Lumbar Spine Nerves

The spinal cord comes to an end between the first and second lumbar vertebrae (L1-L2). Below this is the remaining nerves that form the cauda equina which is a bundle of nerves that looks like a horse�s tail. These nerves send messages between the brain and the lower body structures, including the:

  • Large intestine
  • Bladder
  • Abdominal muscles
  • Perineum
  • Legs
  • Feet

Protect Your Back

Around 80% of adults will see a doctor for low back pain at some point. Therefore take care of your lumbar spine to help avoid painful, unnecessary wear-and-tear. You can minimize the risk of a low back injury/pain by:

  1. Losing weight. Even a loss of 5 pounds can help reduce back pain.
  2. Strengthening the core/abdominal muscles. The abdominal and low back muscles work together to form a supportive band around the waist and low back. Stronger muscles help stabilize the low back and reduce the risk of injury.
  3. Stopping smoking. Nicotine reduces blood flow to the spine’s structures. This includes the lumbar discs and accelerates age-related degeneration.
  4. Proper posture and proper body mechanics. When lifting objects keep your spine erect and use your legs. Ask for help with heavy objects. The lumbar spine is can bend and twist simultaneously, try to avoid doing this, as it is a perfect setup for a strain or sprain.

 

Get Rid of Low Back Pain with Custom Foot Orthotics

 


 

 

NCBI Resources

 

The Lumbar Spine: What Chiropractic Patients Need To Know

The Lumbar Spine: What Chiropractic Patients Need To Know

The lumbar spine, or lower back, takes a lot of stress and strain throughout the day. The spine provides stabilization for the entire body, and the lumbar spine bears the brunt of much of the movement and activity. This wear and tear show up as lower back pain in many people. The American Chiropractic Association estimates that 31 million Americans have low back pain at some point in their lives. The leading cause of disability is low back pain � not only in the U.S. but worldwide.

What is the Lumbar Spine?

Located in the lower back area, the lumbar region is the portion of the spine that begins below the shoulder blades, about five or six inches, at the lordosis (where it curves in toward the abdomen). Five vertebrae make up the lumbar spine, L1 through L5 � which also happen to be the largest unfused vertebrae in the entire spinal column. The lower vertebrae bear more weight than the upper vertebrae, so they are constructed to be sturdier, but are also more prone to injury and degradation.

The L5 vertebra meets the S1 (the sacrum) at the lumbosacral joint. It is this joint that provides most of the range of motion including rotational flexibility of the hips and pelvis, allowing them to swing during movement such as running and walking.

The spinal cord ends at around the L1 and many nerve roots that originate at the spinal cord form what is called the cauda equine. These nerves travel down the spine, branching out to the legs, buttocks, and feet. The appearance resembles a horse�s tail, hence the name. Because the spinal cord does not extend into the lumbar area, the chance of a problem with the lower back resulting in paralysis or damage to the spinal cord is very rare.

the lumbar spine chiropractic care el paso tx.

Lower Back Pain

The most common causes�of lower back pain are soft tissue injuries and mechanical problems. Either of these can damage the intervertebral discs, compress the nerve roots, and inhibit the�correct function of the spinal joints so that they don�t move properly. Lower back pain is most commonly caused by a pulled or torn muscle or ligament, known as a sprain or strain. These injuries can have some causes, including:

  • Prolonged improper posture
  • Improper lifting of something heavy (without using your legs)
  • Sports injuries, particularly those where the player sustains high impact or where a lot of twisting is involved
  • Lifting while twisting the spine
  • A fall or movement that occurs suddenly and puts a great deal of stress on the lumbar area

Chiropractic Care for the Lumbar Spine

Chiropractic care is a prevalent, effective treatment for lower back pain. A chiropractor can help patients manage their back pain through spinal adjustments and lifestyle advice. They may recommend supplements, exercise, and dietary changes. The whole-body approach to chiropractic makes it an optimal choice for many people, especially those who don�t want to take medications or undergo invasive procedures.

The chiropractic treatment itself usually involves spinal manipulation and mobilization. Spinal manipulation is the technique that most people think of when they think of chiropractic. It of a short lever, high-velocity arm thrust applied directly to the vertebra that is injured or is causing the pain. This technique typically relieves pain, improves the function of the spine, and restores the back�s range of motion. Mobilization is a low-velocity movement performed by the chiropractor to manipulate the area, stretching and moving the joints and muscles.

These techniques typically restore range of motion and flexibility to the spine while reducing pain. For people with chronic lower back pain, chiropractic care can be a game changer.

Lower Back Pain Chiropractic Care

Lumbar Disc Herniation: Micro-Disectomy Surgery Rehab

Lumbar Disc Herniation: Micro-Disectomy Surgery Rehab

In the first part of this 2-part series, chiropractor, Dr. Alexander Jimenez looked at the likely signs and symptoms of disc Herniation, in addition to the selection standards for micro-discectomy surgery in athletes. In this report he discusses the lengthy rehab period following a micro-discectomy procedure, and provides a plethora of strength based exercises.

Surgeries to ease disc herniation, with or without nerve root compromise, comprise traditional open discectomy, micro-discectomy, percutaneous laser discectomy, percutaneous discectomy and micro- endoscopic discectomy (MED). Other surgical conditions are employed in The literature like herniotomy that’s interchangeable with fragmentectomy or sequestrectomy. The saying ‘herniotomy’ is defined as removal of the herniated disc fragment just, and the ‘standard discectomy’ as elimination of the herniated disc along with its degenerative nucleus in the intervertebral disc space.

When surgery is required, minimizing tissue disruption and strict adherence to an aggressive rehabilitation regimen may expedite an athlete’s return to perform(1), that explains why micro discectomy is a favored surgical procedure for athletes. Micro discectomy procedures entails Removing a small part of the vertebral bone over a nerve, or removing the fragmented disc stuff from under the compressed nerve root.

The surgeon can then enter the spine by removing the ligamentum flavum that insures the nerve roots. The nerve roots can be visualized with functioning eyeglasses or with an operating microscope. The surgeon will then move the nerve to your side and to subsequently remove the disc material from beneath the nerve root.

It’s also sometimes required to eliminate A small portion of the related facet joint to permit access into the nerve root, and additionally to relieve pressure on the nerve root resulting in the facet joint. This procedure is minimally invasive since the joints, muscles and ligaments are left intact, and the process doesn’t interfere with the mechanical construction of the spinal column.

Endoscopic Lumbar Discectomy

Local Doctor performs lumbar discectomy using minimally invasive techniques.�From the El Paso, TX. Spine Center.

Surgical Outcomes

In general, athletes with lumbar disc Herniation have a favorable prognosis with traditional therapy; more than 90 percent of athletes using a disc herniation improve with non-operative treatment. Many demonstrate a response to conservative treatment with increased pain and sciatica within 6 weeks of the initial onset(2). This implies that the requirement to function immediately could be considered hasty.

However, in case of failed Conservative therapy, or together with the pressure of a significant upcoming competition, surgery might be needed in some instances. Even though it involves surgical therapy, micro-discectomy has been reported to have a high success rate — over 90 percent in some studies(3,4). Patients generally have hardly any pain, are able to return to preinjury activity levels, and therefore are subjectively happy with their results.

The achievement rate of micro-discectomy is The following studies have been summarised to underline the success rate of micro-discectomy procedures:

1. In a survey on 342 professional athletes Diagnosed with lumbar disc herniation in sports like hockey, football, basketball and baseball, it was discovered that powerful return to perform occurred 82% of this time, and 81 percent of surgically treated athletes returned for an additional average of 3.3 years(5).

2. From a limb paresis which might be associated with a disc herniation following surgical treatment. If the preoperative paresis was mild then they could anticipate an 84% likelihood of full recovery. Patients with more severe paresis have less chance of recovery (55%)(6).

3. Wang et al (1999) in a study on 14 athletes demanding discectomy processes found that in single degree disc procedures, the return to game was 90%. However when the procedure involved 2 levels enjoyed considerably less favorable results(7).

4. In a study of 137 National Football League players with lumbar disc herniation, surgical treatment of lumbar disc herniation led to a significantly more career and greater return to play rate than those treated non-operatively(8).

5. Schroeder et al (2013) reported 85% RTP rates in 87 hockey players, with no substantial difference in outcomes or rates between the surgical and nonsurgical cohorts(9).

6. A study by Watkins et al (2003) coping with professional and Olympic athletes revealed the acceptable outcomes of micro-discectomy concerning return to play, since elite athletes in general were highly encouraged to return to perform(10). Also, athletes who had single-level micro- discectomy were more likely to come back to their original heights of sports activities than were people who’d two-level micro- discectomies.

7. A study by Anakwenze et al (2010) investigating open discectomy at National Basketball Association participants demonstrated that 75% of patients returned to perform again compared with 88 percent in control subjects who did not undergo the operation(11).

8. A recent review found that conservative therapy, or micro-discectomy, in athletes using lumbar disc herniation seemed to be satisfactory concerning returning the injured athletes into their initial levels of sports activities(12).

These studies conclude that though a Analysis of lumbar disc herniation has career-ending potential, most gamers have the ability to return to play and generate excellent performance-based outcomes, even if surgery is required.

What is also apparent from research Studies is the level of this disc herniation can also determine prognosis after surgery. Athletes shower a greater difference in progress between surgical and non-operative treatment for upper amount herniations (L2-L3 and L3-L4) compared to herniations at the L4-L5 and L5-S1 levels. Patients using the upper level herniations needed less progress with non-operative treatment and marginally better operative outcomes than those with lower degree herniations(13).

There are several possible explanations A range of studies have revealed that low spinal canal cross-sectional area is associated with an increased likelihood of symptomatic disc herniation, and increased intensity of herniation symptoms. The spinal cross-sectional region is the smallest (thus contains a larger possibility of nerve compromise) at the most upper posterior section and the cross-sectional region increases further down to the lower lumbar spine(14).

The location of the disc herniation�(foraminal, posterolateral or central) may also contribute to differences.�In this study, upper lumbar herniations were more likely to happen in the much lateral and foraminal positions than were people in the lower two intervertebral degrees(13).

Post-Surgical Rehab

After micro-discectomy surgery, the Small incision and restricted soft tissue injury makes it possible for the patient to be ambulatory reasonably fast, and they’re usually encouraged to start rehabilitation sooner or later during the 2-6 weeks after surgery.

In a review on the efficacy of busy Rehabilitation in patients following lumbar spine discectomy, it may be reasoned that individuals can safely take part in high or low-intensity supervised or home-based exercises initiated at 4 to 6 weeks following first-time lumbar discectomy(15).

Herbert et al (2010) discovered that with Effective post-surgical rehabilitation plans, there was a key accent on lumbar stabilisation exercises(16). Second, positive trials tended to initiate rehabilitation earlier in the postoperative interval compared to negative trials (about 4 vs 7 weeks).

Outcome Measures

The most widely used result Measure following back injury and/or disc surgery is the Oswestry Disability Questionnaire(17). This questionnaire is reported to have good levels of test-retest reliability, responsiveness, and also a minimum clinically important difference estimated as 6 percent(18) Furthermore, treatment success has been defined as a 50 percent decrease in the Modified Oswestry Disability Questionnaire score(19).

Concerning physical performance measures following back disc or pain operation, a commonly used clinical examination is that the Beiring-Sorensen Back Extension examination (see Figure 1)(20). This test is performed in a prone/horizontal body position with the spine and lower extremity joints at neutral position, arms crossed at the chest, lower extremities and pelvis supported with the top back unsupported against gravity.

Rehabilitation Program

Presented below is a five-stage rehabilitation program. The stages involved in rehabilitation are:

1. Optimize tissue healing — protection and regeneration

2. Early loading and foundation

3. Progressive loading

4. Load buildup

5. Maximum load

This program has been designed to get a field hockey player with had a L5/S1 lumbar spine discectomy. Even though the progressions from one point to the next are driven by the exit standards related to that stage, it might be anticipated that the athlete could progress in post-surgery to ‘fit to compete’ in about 12-13 weeks.

The key features in each phase are as follows:

Optimise Tissue Healing — Protection & Regeneration

In this phase it’s anticipated that the athlete will remain relatively quiet for 2-3 weeks post surgery. This allows for full tissue recovery to happen, including scar tissue maturation. The athlete is allowed to completely mobilize in full weight-bearing; however care needs to be taken using any flexion and rotation motions and no lifting will be allowed.

The athlete can begin with the physiotherapist with the objective to manage any gluteal and lumbar muscle trigger points and start�nerve mobilization techniques that show how to engage the TrA and LM muscles (see Figures 2a and 2b).�If the physiotherapist has access to your muscle stimulator (Compex), then this can be utilized in atrophy manner on the lumbar spine multifidus and erector spinae. The key criteria to exit this early phase are curable walking as well as also an Oswestry Disability Score of 41-60%.

Early Loading & Foundation

The primary feature of this phase is that the athlete can start early and low-load strength exercises focusing on muscle activation in a neutral spine position, along with a progressive selection of motion program to improve lumbar spine flexion, extension and rotation. In this stage that the physiotherapist will guide the athlete through safe and gentle stretches to your hip quadrant muscles like the hip flexors, gluteals, hamstrings and adductors. The athlete also lasts gentle neuro-mobilization exercises to advance the freedom of the sciatic nerve — an issue in this condition as neurological tethering is a chance as a result of scar tissue formation caused by the surgical procedure.

The athlete can also be encouraged to start hydrotherapy in the form of walking in water (waist high) along with swimming fitnesscenter. In addition, he/she must start a string of low degree muscle activation drills in this stage (see Figure 3) that can be performed every day. This exercise teaches the athlete to hip flex (fashionable hinge) whilst maintaining a neutral spine. The neutral spine is maintained by using a light broomstick aligned with the back with the touch points being the occiput, the 6th thoracic vertebrae (T6) and the posterior sacrum.

Progressive Loading

In this phase the athlete continues with a variety of movement progression along with the physiotherapist progresses manual therapy to the pelvis and lumbar spine. Neuro-mobilization techniques can also be progressed. The significant change in this phase is that the progression of load on many of the strength and muscle control exercises.�Two exercises here are the �standing twisties� and the �crook lying pelvic rotation� exercise (Figures 4 and 5).�These movements are the introductory spinning based movements. The primary progression about fitness drills is the athlete can begin pool running drills.

Load Accumulation

This is the stage where the athlete begins to advance the load in strength-based exercises. Resistance is used in the form of barbell load and band resistance. Three exceptional exercises performed here are the ‘kneeling hip thruster’, ‘deadbug antirotation press’ and also the ‘quadruped walkout’ (Figures 6-8 — explained in detail in the online database of exercises).

 

The athlete also begins running drills at this phase and it might be expected that as well as building running Amount, the athlete should progress over four weeks to close to full sprint speeds. This is also the stage whereby they would initiate mild to moderate sports special skills drills. Another characteristic of this stage is that the athlete starts the ‘Sorensen test’ exercise (Figure 9) and it will be expected that they can maintain the position for no less than 90 seconds before advancing to the next phase.

Maximum Load

In this final stage, the athlete spreads all core and strength exercises to maximum loads, and they work with the fitness trainer on coming to squat and functional fitness center lift movements. Skill progression can also be advanced alongside sprint and agility drills. The last exit standards prior to advancing to endless strength and training work is they have to keep the ‘Sorensen test’ for 180 seconds and their self documented Oswestry scale ought to be someplace between 0-20%.

References
1. Neurosurgical Focus. 2006;21:E4
2. Phys Sportsmed. 2005;33(4):21�7
3. Spine. 1996;21:1777-86
4. Neurosurgery 1992;30:861-7
5. Spine J. 2011;11(3):180�6
6. European Spine Journal. 2012. 21: 655-659
7. SPINE 1999;24:570-573

8. Spine (Phila Pa 1976). 2010;35(12):1247�51
9. Am J Sports Med. 2013;41(11):2604�8
10. Spine J. 2003;3:100�105
11. Spine. Apr 1 2010;35(7):825-8
12. Open Access Journal of Sports Medicine. 2011:2 25�31
13. J Bone Joint Surg Am. 2008;90:1811-9
14. Eur Spine J. 2002;11:575-81

15. Physical Therapy. 2013. 93: 591- 596
16. Journal of orthopaedic & sports physical therapy. 2010. 40(7). 402-412
17. Physiotherapy. 1980;66:271-273
18. Spine (Phila Pa 1976). 2009;34:2803-2809
19. Phys Ther. 2001;81:776-788
20. Spine 1984, 9:106-119
21. Joint Bone Spine 73 (2006) 43�50

Lumbar Disc Herniation & Micro-Disectomy Surgery

Lumbar Disc Herniation & Micro-Disectomy Surgery

Chiropractor, Dr. Alex Jimenez looks at lumbar spine disc herniation. What are the Likely signs and symptoms associated with disc herniation, and what would be the selection criteria for micro-discectomy operation in athletes? Complaint in the young college age athlete and professional athlete, and it’s been estimated that over 30% of athletes complain of back pain at least once in the profession(1).

Lumbar spinal disc herniation is one kind Of lumbar injury that can’t just cause painful low back pain, but can also compress nerve roots and create radicular referral of pain into the lower leg with related sensation changes and muscle contraction. This injury will not only influence the short-term opponent ability of the athlete, but might also reoccur and eventually become persistent possibly causing a career ending injury.

Managing disc herniation from the athlete Usually begins with conservative therapy and if this fails, surgical solutions are considered. But often elite athletes will request a quicker resolution to their symptoms to minimize time away from competitors. Therefore, providing the criteria for lumbar spine surgery are suggested, the conservative period will often be compressed, and surgery will be sought earlier. The favored surgical process for the athlete with a disc herniation is that the lumbar disc micro-discectomy.

Anatomy & Biomechanics

A significant biomechanical role in the spine, allowing for motion between the spinal segments while spreading compressive, shear, and torsional forces(2). These discs include a thick outer ring of fibrous cartilage termed the annulus fibrosis (akin to the onion rings enclosing the center of the onion), which encompasses a more gelatinous core called the nucleus pulposus, which is included within the cartilage end plates inferiorly and superiorly.
The intervertebral disc consists of Cells and substances such as collagen, proteoglycans, and thin fibrochondrocytic tissues, which enable transmission and absorption of forces arising from body weight and muscle activity. To do so, the disc depends mainly on the structural condition of the nucleus pulposus, annulus fibrosis and the vertebra lend plate. If the disc is normal and is functioning optimally, then forces are spread across the disc evenly(3).

But disc degeneration (mobile Degradation, lack of hydration( disc failure) may decrease the capacity of the disc to withstand extrinsic forces, as forces are no longer distributed and spread evenly. Tears and fissures from the annulus can lead, and with adequate external forces, the disc material may herniate. Alternatively, a sizable biomechanical force set on a healthy, ordinary disc may cause extrusion of disc material as a result of crushing failure of this annular fibers — illustrations include a hefty compression type mechanism because of a fall on the tailbone, or strong muscle contraction such as heavy weight lifting(4).

Herniations represent protrusions of Disc material beyond the confines of this annular lining and in the spinal canal (see Figure 1)(5). If the protrusion does not invade the canal or undermine nerve roots then back pain may be the only symptom.

fig-1-26.png

Endoscopic Discectomy 3D Simulation

The pain associated with lumbar Radiculopathy happens due to a mix of nerve root ischemia (due to compression) and inflammation (because of neurochemical inflammatory mediators released from the disc). Throughout a herniation, the nucleus pulposus puts pressure on weakened regions of the annulus, and proceeds through the diminished websites in the annulus in which it ultimately forms a herniation(6 ft). It follows from this that some kind of disc degeneration may exist prior to the disc may really herniated(7).

In contrast to other respiratory Tissues, discs have a inclination to degenerate earlier in life, with some studies demonstrating adolescents presenting signs of degeneration between the ages of 11 to 16(8). With increasing age, there’s further degeneration of the intervertebral discs.

While the disc might be in danger of harm in All fundamental planes of motion, it’s particularly susceptible during repetitive flexion, or hyper-flexion, combined with lateral bending or rotation(10). Traumatic events such as excessive axial compression may also damage the inner structure of the disc. This can occur as a result of a fall or powerful muscular forces developed during tasks such as heavy lifting.

Athletes are generally exposed to high loading conditions. Examples of this include:

1. World-class power lifters, in which the calculated compressive loads on the backbone are involving 18800 Newtons (N) and also 36400N acting in the L3-4 motion segment(11).

2. Elite level football linesmen who have Been proven to present time-related hypertrophy of this disc and changes in vertebrae endplate in response to this repetitive high loading and axial pressure(12).

3. Long distance runners have been Shown to undergo significant strain into the intervertebral disc, indicated by a reduction in disc height(13).

Herniations could be classified depending on Ultimately, herniations are also identified based on level, with most herniations happening at the L4/5 and L5/S1 intervertebral disc level; these can then in turn affect the L5 and S1 nerve roots resulting in clinical sciatica(15). Upper level herniations are less common, and when they do occur with radiculopathy, they will affect the femoral nerve. Finally, the prevalence of disc injury rises increasingly caudally, with the best numbers at the L5/S1 degrees(16).

Herniation In Athletes

The offending movements implicated in The 20-35 age group are the most common group to herniate a disc, most likely because of the fluid nature of the nucleus pulposis and due to behavior(18). This age group are more likely to participate in sports which need high lots of flexion and spinning or are reckless with their positions and positions during loading.

The sports most at risk of disc herniation are:

  • Hockey
  • Wrestling
  • Soccer
  • Swimming
  • Basketball
  • Golf
  • Tennis
  • Weightlifting
  • Rowing
  • Throwing events

These are the sports that involve either significant Furthermore, those who take part in more and more severe training regimes seem to be at higher risk of spinal pathologies, as do people involved in sports.

Signs & Symptoms Indicating Discectomy

The efficacy of management programs for lumbar spine disc herniation — in terms of the decision to operate or treat conservatively — will be discussed in greater depth in part 2 of this series. However, the decision to operate within an athlete is generally driven by the motivation and approaching goals the athlete has put themselves. They may in fact favor a comparatively simple micro-discectomy instead of waiting for symptoms to abate through an extended period of rehabilitation.

This conservative period of Management may involve medicine therapy, epidural injections, relative back and back muscle recovery, acupuncture, osteo/chiropractic interventions. On the other hand, the normal presenting symptoms and signs that suggest a substantial disc herniation that will require surgical intervention in the athlete comprise:

  • Low back pain with pain radiating down one or both legs
  • Positive straight leg raise test
  • Radicular pain and neurological signs consistent with the nerve root level affected
  • Mild weakness of distal muscles such as extensor hallucis longus, peroneals, tibialis anterior and soleus. These would fit with the myotome relevant for the disc level
  • MRI confirming a disc herniation
  • Possible bladder and bowel symptoms
  • Failed conservative rehabilitation

Time span in which to enable conservative rehabilitation to be effective. In the overall population, medical practitioners will most likely prescribe a minimal 6-week traditional period of treatment with an overview at 6 weeks as to whether to expand the rehabilitation a further 6 weeks or to seek a specialist opinion. The expert may then attempt more medically orientated interventions such as epidural injections.

The athlete nevertheless will have these They might be more inclined to experience an epidural very early in the conservative period to assess the effectiveness of this procedure. If no signs of progress are evident in a couple of weeks then they may choose to get an immediate lumbar spine micro- discectomy.

Endoscopic Lumbar Discectomy

Local Doctor performs lumbar discectomy using minimally invasive techniques. From the El Paso, TX. Spine Center.

Imaging

MRI remains the favored system of Identifying lumbar spine disc herniation, since it’s also very sensitive to detecting nerve root impingements(23). However, abnormal MRI scans can occur in otherwise asymptomatic patients(25); hence, clinical correlation is always essential before any surgical thought. What’s more, patients can present with clinical signs and symptoms which suggest the diagnosis of acute herniated disc, and yet lack evidence of sufficient pathology on MRI to warrant operation.

Therefore it has been proposed that a Volumetric analysis of a herniated disc on MRI may be potentially beneficial in checking the suitability for operation. Several writers have previously mentioned the possible value of volumetric evaluation of herniated disc on MRI as part of their selection criteria for lumbar surgery(26).

In a survey conducted in Michigan State University, it was found that the size and positioning of the herniated disc determined that the likelihood for operation with what researchers called ‘types 2-B’ and ‘types 2-AB’ being the most likely candidates for surgery(27).

The MRI protocol to your lumbar spine consists of (see Figure 2)

1.Sagittal plane echo T1- weighted sequence

2. Sagittal fast spin echo proton density sequence

3. Sagittal fast spin echo inversion recovery sequence

4.Axial spin echo T1- weighted sequence

Summary

Disc herniations are not a common Complaint in athletes, but they do happen in sports which involve high loads or repetitive flexion and rotation movements. Sufferers of a disc herniation will normally feel focused low-back pain, maybe with referral in the lower limb with associated neurological symptoms if the nerve root was compressed.

Managing a disc herniation within an General population as frequently the risk of a Protracted failed rehabilitation period is Bypassed for the protected and low risk Micro-discectomy procedure. In the Discuss the exact surgical alternatives involved Observing a lumbar spine micro-discectomy.

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