Tips on How to Keep Your Back Healthy
(10/14/12)- Back pain continues to be the number one disabling condition for older Americans. Spinal epidural injections are one of the treatment protocols practiced by pain management physicians. The news lately has highlighted some deaths and serious illnesses due to fungal meningitis infections that resulted from contaminated serum used in the procedure
The CDC believes the contamination compound used for the spinal steroidal contizone serum has been isolated to a compounding drug company in Massachusettes. They have shut down the company
Another prescribed form of treatment is spinal fusion. This treatment has been shown to have adverse effects also, according to a recent study published in the journal Spine. "Nearly 20 percent of people who underwent low back fusion surgery developed post-traumatic stress disorder symptoms associated with that surgery", according to a recent Oregon Health & Science University study published in the journal Spine.
(3/27/06)- In spite of intensive lobbying by J&J, it looks like the company will not receive approval for its Charite disk surgery to be paid for by Medicare. As we discussed in our item dated 2/24/06 the 30-day period for comment has now passed. A final ruling will be set by the Centers for Medicare and Medicaid Services (CMS) within 60 days.
Up to now some locally administered Medicare plans pay for the spinal surgery procedure, which can cost as much as $50,000, while many private insurers are refusing to cover the procedure. Over 3,000 surgeons have been trained in the procedure to implant Charite since it received approval from the FDA in October 2004.
Part of the problem impeding the approval is the fact that the trials to get Charite evaluated compared the device to a form of spinal surgery that is no longer considered state of the art. The trials for Charite did not provide convincing evidence that the device left patients with substantially more range of motion over time.
A question has also arisen as to whether or not the device harms neighboring disks. J&J said that 60 insurers now cover Charite, but only 2 are nationwide. About 25% of the regional coverage comes from workers' compensation companies, because it seems as if the procedure enables workers to return to their jobs faster than does the usual spinal operation.
A Swiss company Synthis is expected to receive final approval shortly for its ProDisc-1 by September of this year, which will compete, with Charite. Medtronic and Stryker are also expected to enter this market with their own products by early next year.
(2/24/06)- The Centers for Medicare and Medicaid Services (CMS) has concluded that there is inadequate evidence to show that Johnson & Johnson's Charite disk surgery is "reasonable and necessary". This means that Medicare will not pay for J & J's artificial spinal-disk implant under its health insurance program. The agency now opens up for a 30-day period of time public comments on this proposal.
A final decision from the CMS will be due within 60 days after the comment period expires. Charite is designed to replace the natural cushion between vertebrae of the lower back. The list price for Charite is $11,500, and the total cost for the implantation ranges from $35,000 to $50,000.
Private insurance companies usually follow the proposals from the CMS, so there is a good chance that they too will deny coverage for the procedure.
(10/26/05)- In her Personal Health column of October 4, 2005, Jane Brody wrote and excellent article entitled "What You Can Do About That Aching Back". Although the article is entitled to the aching back ailment, it dealt mainly with spinal stenosis. In my own particular case it was not the back that caused me the excruciating pain, but rather the pain in my left leg that was incapacitating me.
I would like to quote from her article because of all the interesting items that she pointed out in the article:
"Arthritis-the wear-and-tear kind- is by far the most common cause of a potentially debilitating disorder called spinal stenosis, a narrowing of the passageways for spinal nerves. The problem is most common in people over 50, though the young are sometimes affected through injury of a birth defect.
Not everyone with spinal stenosis has symptoms, but 250,000 to 500,000 American do, and with age as the leading risk factor, the number afflicted is expected to grow significantly as the population ages .
The spine houses all the nerves that enable the brain to tell the rest of the body what to do. The spine is a column of 26 bones, 24 of them vertebrae-7 in the neck (cervival), 12 in the upper back (thoracic0 and 5 in the lower back (lumbar). The other two are fused vertebrae that form the sacrum in the hip region and the coccyx at the base of the spine.
Vertebrae are linked by facet joints that stabilize the spine and, at the same time, allow it to bend. Ligaments keep the vertebrae in place during movements, and fibrous disks with jellylike centers provide cushioning between them.
Now for the crux of the problem: The spinal cord, a long bundle of nerves from the base of the brain to the second lumbar vertebra, passes through a bony channe called the spinal canal.
On its way, two spinal nerves-one to the left side of the body and the other to the right- emerge between the vetebrae, and another bundle of nerves, the cauda equina, extends from the end of the spinal cord.
If the channel for the spinal cord and its many extensions becomes narrowed, pressure on the nerves can cause pain, cramping, tingling or numbness in the area served by the nerve .
Arthritis is also associated with deterioration of the spinal disks, which flatten, become brittle and may develop tiny rips that allow the jellylike substance to leak and press on the nerves. The ligaments too, degenerate with age, becoming stiff and thick, shortening the spine,narrowing the canal and sometimes compressing nerves.
Other causes of spinal stenosis are tumors, trauma, Paget's disease of the bone, and a genetic disorder called achondroplasia .
Various diagnostic tests are sued to check for spinal stenosis or other problems that cause similar symptoms. Among then are spinal X-rays, CT scans, a CT myellogram, a bone scan and best of all, an M.R.I .
Drug remedies include over-the-counter or prescription painkillers like acetaminophen (Tylenol and the like) and nonsteroidal antiinflammaroty drugs (Nsaaids) like aspirin, ibuprofen, Celebrex or Mobic.
In conclusion I would like to reiterate my personal opinion that the most important therapy available to sufferers from spinal stenosis is the stretching exercises, that are painful to do, but I believe are worth all the pain and suffering that they cause. At the same time I have to admit that there are days that I pass up doing them because of how tough mentally as well as physically they are to do on a daily basis.
Although I have not had to use any heat pads or spinal electrical stimulation in connection with my spinal stenosis it may be helpful to some of you to be aware as to some devices now available to consumers to help you with pain management for back pain. Researchers feel that heat affects certain nerve endings, which send signals to help block the sensation of pain. Heat also relaxes muscles and increases blood flow.
Modern science has come up with several devices to improve on delivering heat to the body by methods better than the old heat pad that confined your mobility. One of the latest heat wrap pads contain gel or beads that are heated in the microwave and can stay warm for between 30 to 60 minutes. It is a moist heat, which some doctors believe is more effective as a pain reliever than other types of heat. Many of these same gel products can be frozen and used to reduce swelling after an acute injury such as a sprained ankle.
Proctor & Gamble has a disposable eight-hour wrap product called ThermaCare that contains iron, which produces continuous, low-level heat when exposed to air. The price for these disposable products is about $3.50 apiece. Heat should not be used if there is bruising or swelling.
Medtronic Inc. has received FDA approval for an implantable rechargeable spine stimulator that can last up to nine years. Advanced Neuromodulation Systems Inc. has also received FDA approval for its implantable rechargeable spine stimulator called Eon Neurostimulation System, and Boston Scientific's product in this medical equipment area is called Precision.
(3/20/05)-Where do you look to for help if you want to avoid back surgery if at all possible? One of the first places to look might be to find a physiatrist. These are medical doctors who focus on rehabilitation and physical exercise to try and regain the functions of your ailing back while at the same time alleviating the intense pain that you may be suffering from. To learn more about this specialty, and how to find a doctor go to www.aapmr.org the Web site for the American Academy of Physical Medicine and Rehabilitation. To find a center near you that offers this type of treatment go to www.medxonline.com and click on "facility locator" at the top of the screen.
(2/27/04)-Back problems are the leading reason for visits to neurologists and orthopedists and the eighth leading reason for visits to doctors overall. The three most frequent causes for visits to the doctors are general checkup, progressive visits and coughs. Researchers at the University of Duke using national data from 1998, estimated that treating back pain costs Americans over $26 billion a year, and that does not include the cost for worker's compensation and lost wages. Dr. Xeumei Luo led the researchers at Duke.
Sadly we report to you that most studies show that in the majority of cases it is impossible to say why a person's back hurts. Most of the time, the pain goes away with or without medical treatment. According to Dr. Richard Deyo, a professor of medicine and health services at the University of Washington "Nearly everyone gets better, nearly everyone improves." But he went on to say, "Getting better doesn't necessarily mean pain-free." Even when a herniated disc causes the pain, the problem was found to go away by itself over time.
A national study is now underway at 11 medical centers to see if active treatment helps in treating back pain. About 1,000 patients with back problems that most often lead to surgery will be randomly assigned to have surgery or not. The problems under study are herniated discs, spinal stenosis, and degenerative spondylolithesis, a slipped vertabra. Dr. James N. Weinstein, a Dartmouth professor of orthopedics and community and family medicine will head the study group. Incidentally, it is estimated that about 10% of back-pain cases are intractable. For those who have their back pain for over three or four months, there is only a 10% to 20% chance of getting better within the next year.
Oh my poor aching back! How often have we made this statement? Believe it or not you have plenty company if you have had an aching back. Over 80% of all Americans will be laid up at one time or another with a serious enough back injury to seek medical attention. Once you have suffered a back injury, in all likelihood it means that you must do something differently in order to be able to prevent it from re-occurring.
To help prevent back injuries it is necessary for us to understand a little bit about our anatomy. The spine is not a perfectly straight line. It has three curves; one at the neck, one at the middle back and one at the lower back. In order to have a healthy back these three curves must stay in their alignment. There are 24 bones called vertebrae in the spine. Each vertebra is cushioned by a disc in between to act as a shock absorber. The disc is soft on the outside, but contains a liquid substance inside of it. The discs allow the joints to move smoothly. If the disc tears and the inner substance flow out, you have what is called a ruptured disc. Repeated incorrect bending or lifting can cause a slipped disc. The muscles and ligaments that keep your back supported can be strained from constant misuse. These are the most common of the back injuries and they can be excruciatingly painful.
Improper lifting causes most back injuries. Here are the steps to follow for correct lifting procedures:
Sometimes you must use your common sense and not be too macho in evaluating whether or not you can lift the load by yourself. Remember that if you must stretch or stand on your tiptoes to lift or bring down the load you may be causing extra tension on your back.
When you are carrying a weight for a distance remember to keep your head, shoulders and hips aligned. Hold the load close to your body, and keep your elbows resting against your side. Try to keep the load as evenly balanced as possible. If you have a dolly or hand-truck available to help you with the load push it, don't pull it. If you are reaching for something on the floor squat down to get it, don't bend. If you are sitting and try to get something near you, move towards the object you want, don't stretch for it. Try to avoid sudden twists as much as possible.
If you have been standing for a long period of time it is a good idea to put one foot on an elevated step for a short rest. Shift your weight from one foot to the other whenever you are standing in one place for a long time.
When lying down try not to sleep on your stomach. Lie on your side with your knees bent. If you are lying on your back you may want to put a pillow under your knees. You may also benefit from having a small towel rolled up and placed under the small of your back. Remember to use a firm mattress rather than a soft and sagging one.
Most of us spend a good portion of our workday sitting. Correct posture can be critical to maintaining a healthy back.
One of the most critical elements involved in maintaining a healthy back is utilizing exercise to help strengthen your spine and back muscles, and at the same time help to keep them flexible. The following are some of the recommended exercises to help accomplish this:
There are some helpful back exercises to do even while you are in a seated position. You can roll your head around for a few seconds, do the same type of roll with your shoulders or even with your elbows. You can stand up and even do a reverse back bend.
The last item that we will discuss in maintaining a healthy back is to watch your weight. The lighter the load that the back has to carry, the less the back has to complain about to you. A potbelly makes good posture more difficult to obtain, and thus should be avoided. It is your body, and unless you take proper care of it, you will suffer the consequences.
Please also see: Low Back Pain-Does
Spinal Stenosis: A Personal Story
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home"
Many thanks to the Bureau of Business Practice for much of the information in this article.
By Allan Rubin
updated October 14, 2012
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