Patients with spinal problems that result from “wear and tear” of the spine may experience back pain, leg pain, or a combination of the two. Many patients experience back pain as their primary symptom. Sometimes this pain is severe and disabling, sometimes dull and constant, and most times it’s aggravated by activity. Less frequently, but still pretty often, patients experience leg pain, a burning or tingling sensation running down the thigh or calf towards the foot, sometimes associated with muscular weakness. Some patients are unlucky enough to have both.
Which of these pain patterns a patient has determines more about their evaluation, treatment, and prognosis for recovery than does any other aspect of care. So, the most important question your doctor will ask you really is, “Where does it hurt?”
The Causes of Back Pain
The type of pain that any individual experiences is determined by the cause of the pain, and the location of the pain generator – the actual structure or tissue that is generating pain signals.
Back pain often results from several things happening at once. Often there is an underlying level of “wear and tear” that has been worsening for years. The disc may have degenerated, or the small facet joints may have become arthritic. Perhaps there was a direct injury to the back resulting in fracture or ligament injury. On top of these issues, the back muscles may have gotten out of shape, and can no longer do their job without going into spasm. And all of these issues are made worse by inflammation.
Now imagine trying to provide one simple treatment that will fix all of those problems at the same time.
There isn’t one. And fusion certainly won’t cover all of these bases. If used for the wrong problem a fusion won’t help and may even hurt. So the first important rule is that fusion will only be really effective if it is used in just the right circumstances.
Which fusion is right for you?
Fusion is the cornerstone to surgical treatment of back pain. Fusion allows us to correct alignment of degenerated segments and stop abnormal motion that can trigger pain and muscle spasm. Fusion is very effective at reducing back pain if that pain is caused by deformity, disc degeneration or instability. However, (second rule), even in cases of instability fusion is never the first thing we try.
In fusion, the surgeon tries to confuse the body’s normal repair process: by removing the outer shell of bone (the cortex) and exposing the inner portion (the cancellous bone) the body is convinced that the spinal elements have been fractured. The normal healing response is triggered as the body seeks to heal the “fractured” parts.
A posterolateral lumbar fusion – an approach from behind - has been used to treat thoracolumbar and lumbar instability caused by fractures, disc degeneration, or spondylolisthesis, and has been used successfully in treating lumbar disc disease and disc-related pain.
An anterior interbody fusion – an approach through the front - involves growing bone from one vertebral body to the next, around or through a cage placed between the two. There are several variations on these themes. So (third rule) not all fusions are the same: the approach selected depends on what your underlying problem is and what your surgeon hopes to accomplish.
The important point is that, if back pain arises from mechanical instability or specific disc-related problems, a carefully planned and performed fusion can be the best solution for you.
Hear more from Dr. Rob McLain and sign up to receive more information from our Spine and Orthopedic Institute at www.stvincentcharity.com/spine-ortho.