Hello jyoungde-ga,
The simple answer is that the lumbar (spine) fusion places greater
weight/motion/stress on other joints than before the fusion. It seems
the mechanics of this are still not completely understood. Also, the
osteoarthritis may be coincidental, and not necessarily caused by the
fusion. It?s not inevitable that one gets osteoarthritis of the hip
following lumbar fusion, but it?s common that when one has spinal
problems, one often has osteoarthritis in other joints as well.
It?s not my intention to make light of your problem, but remember
the song that goes something like this?: ?The thigh bone?s connected
to the hip bone?? Well, it?s true in this case. Spinal degeneration
and osteoarthritis is connected to hip osteoarthritis, meaning one
often has osteoarthritis in both locations. Weight shifting,
osteophytes, degenerating bone and cartilage, back pain, hip pain,
referred pain ? they?re all connected.
?Fused motion segments are also associated with increased incidence of
osteoarthritis (or degenerative joint disease) in these same levels.
The biomechanical
effects on the facet joint capsules above and below fused motion
segments are unknown.?
http://www.bme.sunysb.edu/bme/people/faculty/docs/pkhalsa/human_capsule_strains_II.pdf
?It's common to have pain in both your back and your hip for a period
of time after surgery. Your doctor will be able to help you manage the
pain with medication. Be sure to talk to your doctor if you are having
pain that is more than you were told to expect.
Most people can return to work and to many of their daily activities
within six weeks of surgery.?
http://www.zimmer.com/ctl?op=global&action=1&id=7755&template=PC
?Hip arthritis is essentially divided in to two categories,
degenerative arthritis (osteoarthritis) and inflammatory arthritis.
Degenerative arthritis may occur generally in the older population
without apparent cause and this is the most common type of arthritis
which may lead to total hip replacement and is often caused by subtle
anatomical variations within the hip. Secondary arthritis is arthritis
which occurs after some form of anatomical abnormality within the hip
such as a developmental disorder of the hip which may have occurred
during childhood or the teenage years.
The presentation of this type of arthritis tends to be earlier,
generally in the fourth and fifth decades of life. The other common
type of arthritis is inflammatory arthritis is inflammatory arthritis,
the most common cause of which is rheumatoid arthritis which can
affect many joints apart from the hip.
The common link in all types of arthritis of the hip is that the
articular cartilage is damaged or destroyed either through mechanical
wear or biological action. The simplest analogy is to imagine a worn
tyre which eventually wears down to the wheel rim.?
?Hip arthritis is caused either by an underlying structural
abnormality within the head of the femur or is else due an
inflammatory arthritis due to the action of enzymes produced by the
inflammatory process. In the degenerative type of arthritis there is
no doubt that weight reduction will reduce the forces going through
the hip joint and may lead to reduction in symptoms from hip
arthritis. There are a variety of preparations available including cod
liver oil, glucosamine and tumeric which patients relate to have
improved their symptoms, although there is no apparent scientific
basis for this.?
http://www.medicdirect.co.uk/diseases/default.ihtml?pid=578&step=4
Other Problems to be Considered with Lumbar Fusion:
Muscle strain
Ligament/tendon injury
Sacroiliac joint syndrome
Lower lumbar zygapophyseal joint syndrome
Hip joint pain
Compression fracture
Stress reaction
Stress fracture
Spondylolysis
Spondyloarthropathy
Marfan syndrome
Fibromyalgia
Myofascial pain syndrome
Discitis
Neoplastic disease
http://www.emedicine.com/pmr/topic67.htm
?Spinal fusion (arthrodesis) has been used to relieve chronic LBP
associated with DDD by the restoration of disc height, the elimination
of abnormal motion and/or the removal of stress on spinal joints.
However, spinal arthrodesis, by its own nature, does not restore the
normal spinal mechanics. It can, therefore, result in transfer of
abnormal load and stress to the adjacent, unfused segments, leading to
degeneration of those segments and recurrent pain.?
http://www.stacommunications.com/journals/cme/2005/May/PDF/059.pdf
Avascular Necrosis of the Femoral Head After Surgery for Lumbar Spinal Stenosis.
?The development of avascular necrosis of the femoral heads following
surgery for spinal stenosis may be due to hypotensive anesthesia,
prone positioning on a Montreal mattress, or a combination of the two.
Careful intraoperative positioning may reduce the risk of this
occurring after spinal surgery. However, close postoperative
surveillance and a high index of suspicion of worsening hip pathology
in patients who appear to mobilize poorly after lumbar spinal surgery
may be the only method of early detection and treatment for this
condition.?
http://www.spinejournal.com/pt/re/spine/abstract.00007632-200309150-00029.htm;jsessionid=CKqnhuWc7m1dQTJ8JIc0baIew8YB2RIE51MaJ54o3qJR2JZ5vRvi!1032589526!-949856031!9001!-1
?The severe loss of motion of the hips indicated that the patient had
articular pathology in the hips. As shown in Figure 1, this was due to
severe osteoarthritis as evidenced by severe loss of joint space
bilaterally (primarily on the superior surfaces), sclerosis, and
hypertrophic bone formation on both the femoral heads and acetabuli.
Undoubtedly, severe osteoarthritis of the hips was contributing
significantly to this patient?s thigh pain and sense of weakness, but
it could not account for his decreased spinal range of motion, nor the
exercise induced fatigue in his buttocks and thighs.
A primary disease of the spine complicated by spinal stenosis was the
most likely explanation for these symptoms and findings. The dramatic
loss of motion of the spine and history of ?spondylosis? suggested two
potential etiologies: 1) inflammatory spondyloarthropathy such as
ankylosing spondylitis; or 2) exaggerated osteoarthritis of the spine
known as ?diffuse idiopathic skeletal hyperostosis? (DISH) or
Forestier?s Disease. Both ankylosing spondylitis and DISH can cause
limitation of lumbar motion, as well as decreased thoracic and
cervical spine motion. Both can be associated with hip disease and
both can cause spinal stenosis.?
?Our patient?s symptoms were thought to be due to his hip disease
because of the severe limitation of movement. However, an
investigation to rule out spinal stenosis was undertaken. X-rays of
the lumbar spine showed only minimal degenerative disc disease but
large, coarse osteophytes that bridged the lower vertebral bodies?
http://www.hopkins-arthritis.som.jhmi.edu/case/case4/4_case.html
?For most people, the cause of osteoarthritis is unknown, but
metabolic, genetic, chemical, and mechanical factors play a role in
its development. It is associated with the aging process and is the
most common form of arthritis.
It may first appear without symptoms between 30 and 40 years of age
and is present in almost everyone by the age of 70. Symptoms generally
appear in middle age. Before the age of 55 it occurs equally in both
sexes. However, after 55 the incidence is higher in women.
The cartilage of the affected joint is roughened and becomes worn
down. As the disease progresses, the cartilage becomes completely worn
down and the bone rubs on bone. Bony spurs usually develop around the
joint.
Systemic symptoms, sometimes associated with other arthritic
conditions, are not associated with osteoarthritis. The joints of the
hands and fingers, hips, knees, big toe, and cervical and lumbar spine
are commonly affected.
The degeneration of the joint may begin as a result of trauma to the
joint, occupational overuse, obesity, or mal-alignment of the joints
(for example being bow-legged or knock-kneed).?
http://www.shands.org/health/information/article/000423.htm
?Pain from facet joint arthritis is usually worse after resting or
sleeping. Also, bending the trunk sideways or backward usually
produces pain on the same side as the arthritic facet joint. For
example, if you lie on your stomach on a flat surface and raise your
upper body, you hyperextend the spine. This increases pressure on the
facet joints and can cause pain if there is facet joint arthritis.
Pain may be felt in the center of the low back and can spread into one
or both buttocks. Sometimes the pain spreads into the thighs, but it
rarely goes below the knee. Symptoms of nerve compression--numbness or
tingling--are usually not felt because facet arthritis generally
causes only mechanical pain. Mechanical pain is pain from abnormal
movement in the spine.
However, symptoms of nerve compression can sometimes occur at the same
time as the facet joint pain. The arthritis can cause bone spurs at
the edges of the facet joint. These bone spurs may form in the opening
where the nerve root leaves the spinal canal. This canal is called the
neural foramen. If the bone spurs rub against the nerve root, the
nerve can become inflamed and irritated. This nerve irritation can
cause symptoms where the nerve travels. These symptoms may include
numbness, tingling, slowed reflexes, and muscle weakness.?
http://www.hipandkneesurgery.com.sg/PatientEdu/Sp_Lum/facet.htm
Has your doctor diagnosed osteoarthritis of the hip? Could it be
referred pain from your surgery? Has your doctor mentioned
ankylosing spondylitis? ?Ankylosing spondylitis, which is a disease
that progresses over many years. AF (Arthritis Fundation)says it
usually starts in the sacroiliac joints which is where the spine
attaches to the pelvis. It can then progress to involve higher areas
of the spine and sometimes major joints including the hips and
shoulders.?
http://www.stayinginshape.com/3osfcorp/libv/r09.shtml
The osteoarthritis may even have begun before surgery.
?"What's causing my hip pain?" This is one of the most common
questions patients ask their doctors. Unfortunately, it's not always
easy to answer. Many conditions can cause hip pain, including some
you'd suspect--arthritis or a fracture--and some you wouldn't--spinal
stenosis, or a previously undiagnosed congenital hip condition.
Whatever the cause, chronic hip pain can force you to cut down on your
activities, and leave you stiff and unable to get around as well as
you once did.?
?The hip joint unites the femur, or thigh bone, and the pelvis. The
bone ends are covered by glistening blue-white caps of "gristle"
called articular cartilage. Articular cartilage is a unique
material--it is more slippery than ice on ice. It is an excellent
shock absorber, and contracts and expands with pressure. Articular
cartilage has no nerve endings or blood supply, so it has little or no
ability to reproduce itself (although researchers are currently
working on changing that). The joint is held in place by a tough,
flexible material called the joint capsule. On the inner capsule is
the synovial lining, which produces the fluid that lubricates and
nourishes the joint. Movement of the joint is dependent upon the
muscles that attach around the joint.?
http://arthritiseducation.com/learn_hippain.htm
?Lower back pain can become more intense when osteoarthritis affects
the hips or the knees. Osteoarthritis also can directly affect the
spine, causing muscles, tendons, or ligaments to become strained,
which can lead to back and/or neck pain.
Ankylosing Spondylitis
This form of arthritis causes the joints in the spine to become stiff
and swollen. In time, stiff joints can fuse. The most common symptoms
are pain and stiffness in the buttocks and lower back (particularly in
the morning).?
http://www.manbir-online.com/htm2/back_pain.htm
?Probably the most common cause of back pain, osteoarthriits usually
affects older people in their fifties of sixties. It seems to affect
women slightly more often then men, and in addition to the joints of
the spine usually also affects the knees, hips, hands and feet. To
start with there is usually only one joint that suffers but as time
goes by osteoarthritis can spread to many parts of the body.
The main symptoms are stiffness and aching which develop as the
cartilage between the bones gradually gets thinner and thinner.
Eventually the bones end up rubbing on one another.
Osteoarthritis can be caused by excess wear and tear (in which case it
is practically indistinguishable from the problems often caused by old
age), but it can be inherited and may affect younger adults.?
http://www.spine-inc.com/glossary/o/osteoarthritis.html
http://www.arthritis-symptom.com/Osteoarthriti-%20Symptoms/osteoarthritis-hip.htm
?Hip osteoarthritis
Hip osteoarthritis, a breakdown of cartilage in the hip joint, can
often cause symptoms of back, hip, and leg pain.
Often patients with arthritis in the back will also have it in other
joints, and it can be difficult to distinguish which area may in fact
be the cause of the patient?s pain. In fact, a missed diagnosis of hip
osteoarthritis as the source of pain is one of the most common causes
of failed low back decompression.
In general, patients with symptomatic hip arthritis will have
significant limitations in their hip motion. Hip replacement surgery
is effective to relieve both the back and hip pain.?
http://www.spine-health.com/topics/cd/overview/lumbar/misc/misc03.html
??Lumbar spinal stenosis may be localized to a single segment of the
spine or may span multiple segments. Each motion segment of the spine
consists of two adjacent vertebrae and the intervening intervertebral
disk, facet joints, and supporting ligaments. Degeneration of this
joint complex commonly begins as disk desiccation. Mechanical failure
of the disk then alters motion segment kinematics with subsequent
facet joint osteoarthritis and hypertrophy.6 Segmental instability
increases, the pedicles and laminae thicken,7 and the supporting
ligamentous structures undergo hypertrophy.?
http://www.physsportsmed.com/issues/2003/0803/chen.htm
?The modifications observed in hip arthritis that concern the load
transmission across the neck of the femur result in changes that can
be radiologically identified and measured. In the first place the
thickness of the calcar is influenced, as it does the distance between
the rotation center of the hip and the trochanteric line. In the
advanced stages of hip arthritis the sedimentation (bone loss) of the
femur head can also be measured.?
http://www.findarticles.com/p/articles/mi_qa3767/is_200301/ai_n9172522
?Stretching can be achieved in a variety of ways, including active and
passive positioning, mobilization, manipulation, proprioceptive
neuromuscular facilitation (contract-relaxation methods), and muscle
energy techniques.99 A stretching program for the neck and trunk
increases soft tissue extensibility, reduces muscular spasm, and
restores functional muscular length. Flexibility of the upper and
lower extremities allows for greater leg motion without compensatory
spinal motion and provides greater absorption of forces directed
toward the spine. 32-35 Mellin65 showed a correlation between greater
hip mobility and lumbar spine mobility with less back pain.?
http://www.simmonsortho.com/literature/spinalfusionandrehab/spinalfusionandrehab.html
?Disc degeneration, the most common producer of spinal pain, results
from repetitive mechanical stress, altered nutrition to the disc, and
ultimate annulus disruption with protrusions of the nucleus pulposus
through the weakened area.
Disc degeneration and loss of disc height shift the weight-bearing
stress posteriorly onto the articular facets, leading to unequal
weight bearing of the facet joints and osteoarthritis of the joints.?
http://www.vivatek.com/doct/aitart.html
?What are the Potential Complications of Lumbar Spine Fusion Surgery?
As with any operation, there are risks involved with spine fusion
surgery. Some patients may develop a distended abdomen and may not be
able to eat. If this happens, a special tube may be inserted to
relieve the distension.
Another complication is a wound infection. Antibiotics are given
before and after the operation to prevent this from occurring.
Urinary problems after spine surgery may include urinary retention and
urinary tract infection. A catheter will be placed into your bladder
at the time of surgery and will be removed as soon as possible when
you are up and around.
Some patients may continue to have pain at the bone graft donor site.
If the fusion does not heal, (a condition known as pseudoarthrosis)
the instrumentation, such as rods, screws, hooks may break, and
further surgery may be required. People who smoke are at a higher risk
for pseudoarthrosis complications.
Other complications include phlebitis in your legs and blood clots in
your lung. To protect against these problems, you will wear
compression boots on your calves during and after surgery.
Rare complications include a failure to improve, worsening
neurological symptoms, paralysis and possibly death. Your doctor will
discuss these potential risks with you before asking you to sign a
consent form.?
http://www.spineuniverse.com/displayarticle.php/article1562.html
?Dr. Cooper: What are the risks of having a lumbar fusion surgery?
Dr. Ullrich: A major risk is that you might actually not get a solid
fusion, which is called pseudoarthrosis (or nonunion) or when the
joint is still there and still moving. With modern instrumentation
systems and modern techniques, pseudoarthrosis rates are going down
quite a bit. But there are still failures more often than not because
we haven?t identified the pain generator even though we are getting
better fusions.
Dr. Cooper: A lot of procedures get a bad rap because they are done on
a patient population that the procedures weren?t designed for in the
first place.
Dr. Ullrich: Yes. If the joint doesn?t hurt the patient, then removing
the joint motion and fusing it isn?t going to help them. I think we?ve
been overly aggressive too. The back is intended to move. There?s a
term that?s been coined ?fusion disease?, where basically too many
levels are fused and now the back no longer moves. If we stick to,
especially in younger patients, fusing L5-S1, it isn?t a motion
segment anyway, it?s deep in the pelvis, and it?s got big ligaments -
so when we fuse it, we don?t change the mechanics of the back very
much. If we cross the L4-L5 level, that?s where we change the
mechanics quite a bit.
Dr. Cooper: After lumbar fusion surgery, are patients required to
limit their activity in any way? If so, what are they allowed to do
and for how long do they have to maintain these restrictions? Does it
depend on the level of the surgery.
Dr. Ullrich: In general, most people feel it takes about three months
for the fusion to take and at least to set, so the biology of the bone
graft is that the more still we keep the fused segment of the spine
for the three months after the fusion surgery the better it sets.
After three months, I encourage my patients to use their spine,
because bone is live tissue and if you stress it, the bone will get
bigger and stronger with time. So, the limitation is just for about
three months. For one-level fusions, patients won?t have any activity
restrictions from then on. For two-level fusions, we might restrict
them vocationally from doing heavy labor. But once the bone fuses,
patients are allowed to use them. When we say we don?t want them to
use it a lot for those three months, we mean we don?t want them to do
repetitive bending, lifting or twisting, and no sporting activities or
labor. But they can bend over to tie their shoes and certainly can
walk, and the more walking the better which helps the fusion process.?
http://www.spine-health.com/backtalk/radio/lumbarfusion.html
?he hip joint is a ball and socket joint. The acetabulum, or socket,
is formed by three areas of the pelvic structure: the ilium, the
ischium, and the pubis. The femoral head is the "ball", which is
located on the upper end of the femur. There is a high degree of fit
and stability within this ball and socket joint. It is stabilized by
strong ligaments in the front of the hip which prevent dislocation.
Both the femoral head and the acetabulum are covered with a layer of
cartilage which provides shock absorption and load distribution within
the hip. This cartilage is also a source of nutrition for the joint.
Numerous muscles play an important role in the stability of the hip,
one of which is the gluteus medius. This is a deep muscle within the
buttock, and its proper function is important in normal walking.?
http://www.dallasortho.com/hip/overview.asp
?Osteoarthritis in the Spine
Incremental microdamage in the lower disks of susceptible patients
ultimately results in venting and loss of pressure in the disk nucleus
(Rowe, 1969). As the disk degenerates, it narrows, decreasing the
distance between vertebrae. The distribution of forces in the joint is
altered. The ligaments connecting the vertebrae become lax,
destabilizing the joint. Instability and altered force distribution
lead to mechanical stress, which in turn can cause osteoarthritic
changes in the articular processes (Fast and Greenbaum, 1995).
Consequently, the vertebral facets become enlarged, the vertebral
pedicles thicken, and the ligamentum flavum thickens. Type II collagen
replaces elastic tissue (Jane, Jane, Helm et al., 1996; Schrader,
Grob, Rahn et al., 1999), and calcium crystals are deposited
(Schrader, Grob, Rahn et al., 1999). Hyalinization of the collagen
fibers and proliferation of chondrocytes also contribute to the
ossification of the ligament. Facet hypertrophy, thickening of the
pedicles, and ossification of the ligamentum flavum lead to narrowing
of the central spinal canal. Traction spurs may develop. These spurs
can also impinge on the spinal canal or the nerve roots.
Eventually, vertebral stability may be regained as scarring occurs
across the nuclear compartment (Rowe, 1969). Osteoarthritic changes
may also lead to increased stability or even fusion between two
vertebrae (Postacchini and Perugia, 1991; Rosenberg, 1975).
In susceptible individuals, the degenerative changes in the facet
joints lead to two overlapping pathological and clinical entities:
central and lateral stenosis. The two conditions may not be
distinguished by their symptoms (Amundsen, Weber, Lilleas et al.,
1995). The extent to which the degree and location of stenosis
correlates with the nature, intensity, and location of symptoms is
unclear. Individuals are frequently observed to have marked stenosis
and no symptoms (LaRocca and Macnab, 1969; Nagler and Bodack, 1993;
Postacchini and Perugia, 1991; Splithoff, 1953). Among patients with
symptoms, long periods of remission are thought, at least by some, to
be common (Rosenberg, 1976). However, the incidence and duration of
these periods of remission are not well studied?
http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1.section.46199
?The main cause of spinal degeneration is osteoarthritis, an arthritic
condition that affects the cartilage that cushions the ends of bones
in your joints. With time, the cartilage begins to deteriorate and its
smooth surface becomes rough. If it wears down completely, bone may
rub painfully on bone. In an attempt to repair the damage, your body
may produce bony growths called bone spurs. When these form on the
facet joints in the spine, they narrow the spinal canal.
Osteoarthritis can also affect the disks in your spine. By the time
you're 30, your disks may start to show signs of deterioration. They
begin to lose their water content, becoming flatter and more brittle.
Eventually, the tough, fibrous outer covering of the disk may develop
tiny tears, causing the jelly-like substance in the disk's center to
seep out (herniation or rupture). The herniated disk presses on the
surrounding nerves, causing pain ? which sometimes may be excruciating
? in your back, leg or both. Sometimes you may also have numbness,
tingling or weakness in the buttock, leg or foot on the affected side.
The ligaments in your back may also undergo degenerative changes,
becoming stiff and thick over time. This loss of elasticity may
shorten the spine, narrowing the spinal canal and compressing the
nerve roots. Sometimes wear and tear on the disks and ligaments causes
one lumbar vertebra to slip over another ? a condition called
spondylolisthesis. This often compresses the spinal nerves, leading to
numbness, tingling and weakness in your legs, especially when you
stand for long periods or when you walk.?
http://www.cnn.com/HEALTH/library/DS/00515.html
?There are innumerable published studies describing the deleterious
effects of smoking on the musculoskeletal system. The authors of a
recent review in the Journal of the American Academy of Orthopedic
Surgeons have summarized the main conclusions from the more important
studies.
Different periods of time for patients to quit smoking before or after
undergoing surgery have been suggested; however, there is no
established standard for this. Proposed time durations vary from 1 day
to 3 weeks pre-operatively, and from 5 days to 4 weeks
post-operatively. Some authors encourage surgeons not to withhold
elective surgery from a smoker when it is needed. Nevertheless, the
weight of evidence suggests that a smoker should stop before and after
surgery.
There was a fair degree of concordance among the studies examined. At
least 44 articles showed smoking to be deleterious to the
musculoskeletal system, while 14 showed no such association, and
several showed weak associations.
Smoking has been determined to adversely affect bone mineral density,
lumbar disk health, the relative risk of sustaining wrist and hip
fractures, low back pain, and the dynamics of bone and wound healing.?
http://www.healthandage.com/PHome/gm=0!gc=8!l=2!gid2=1229
?Osteoarthritis?Osteoarthritis is the most common form of arthritis
and is more likely to occur in middle-aged and older people. It is a
chronic, degenerative process that may involve multiple joints of the
body. It wears away the surface cartilage layer of joints, and is
often accompanied by overgrowth of bone, formation of bone spurs, and
impaired function. If the degenerative process of osteoarthritis
affects the facet joint(s) and the disk, the condition is sometimes
referred to as spondylosis. This condition may be accompanied by disk
degeneration, and an enlargement or overgrowth of bone that narrows
the central and nerve root canals.?
http://www.niams.nih.gov/hi/topics/spinalstenosis/spinal_sten.htm
With or without surgery, our joints are prone to arthritis and pain as
we age. In the following illustration, you can see where osteophytes
(tiny bone spurs) form on the spine, and can cause pain.
http://www.augustaortho.com/images/spine_178.jpg
?In medical terms, the extra bone is called an osteophyte
(os-t-o-fight). Osteophytes may be found in areas affected by
arthritis such as the disc or joint spaces where cartilage has
deteriorated. The body's production of osteophytes is a futile attempt
to stop the motion of the arthritic joint and deal with the
degenerative process. It never completely works. The evidence of bony
deposits can be found on an x-ray. A bone spur may cause nerve
impingement at the neuroforamen (nu-row for-a-men). The neuroforamen
are passageways through which the nerve roots exit the spinal canal.
Sensory symptoms include pain, numbness, burning and pins and needles
in the extremities below the affected spinal nerve root. Motor
symptoms include muscle spasm, cramping, weakness, or loss of muscular
control in a part of the body.?
http://www.spineuniverse.com/displayarticle.php/article198.html
?Spinal degeneration is ubiquitous in the human aging process. The
resulting local inflammatory effects of osteoarthritis are largely
responsible for the high prevalence of low back pain in the
population. Spinal stenosis is not in and of itself responsible for
low back pain. Virtually all individuals in their seventies have at
least some degree of spinal stenosis on imaging studies, yet only a
fraction of those individuals manifest the true symptoms of central
and/or foramenal stenosis. It is important in the evaluation of
patients with symptoms of back or leg pain to determine the
contribution of the various forms of spinal degeneration to that
patient's unique situation, so that an optimal treatment plan can be
formulated.?
http://www.dcmsonline.org/jax-medicine/1999journals/june1999/lumbar.htm
?The most difficult and crucial part of any type of low back surgery
is selecting the patients who will do well with a certain procedure.
It is especially critical to select the right patients for a lumbar
spine fusion surgery for two reasons:
·Healing from a spine fusion procedure takes a long time (about 3 to 6
months, and up to 18 months)
·The spine fusion forever changes the biomechanics of the back by
increasing the stress placed on the other (non-fused) joints in the
lower spine.
Lumbar spine fusion surgery is generally not recommended until a
patient has tried 6 to12 months of adequate conservative care (such as
physical therapy, medications).?
http://www.spine-health.com/topics/surg/lumbdeg/lumbdeg02.html
?Spinal fusion has been used for many years to treat many painful
conditions in the lumbar (lower) spine. Over the past decade, there
has been dramatic improvement in the way that spinal fusion operations
are performed. One major improvement has been the development of
fixation devices. Designed to stabilize and hold the bones together
while the fusion heals, these devices have greatly improved the
success rate of fusion in the lower back.? There is a great
illustration of a lumbar fusion, allowing you to see how other joints
absorb the motion stress after such surgery.
?Each spinal segment is like a well-tuned part of a machine. All of
the parts should work together to allow weight bearing, movement, and
support. Remember that a spinal segment is composed of two vertebrae
attached together by ligaments, with a soft disc separating them. The
facet joints fit between the two vertebrae, allowing for movement, and
the foramen between the vertebrae allows space for the nerve roots to
travel freely from the spinal cord to the body. When all the parts are
functioning properly, the spinal segments join to make up a remarkably
strong structure called the spine. When one segment deteriorates to
the point of instability, it can lead to localized pain and
difficulties.
Segmental instability occurs when there is too much movement between
two vertebrae. The excess movement of the vertebrae can cause pinching
or irritation of nerve roots.
It can also cause too much pressure on the facet joints, leading to
inflammation of facet joints. It also may cause muscle spasms as the
paraspinal muscles try to stop the spinal segment from moving too
much. The instability eventually results in faster degeneration of the
spine in this area.?
http://www.spineuniversity.com/public/spinesub.asp?id=91
Additional information from the same site:
http://www.spineuniversity.com/public/spinesub.asp?id=69
?Between the vertebrae of each spinal segment are two facet joints.
The facet joints are located on the back of the spinal column. There
are two facet joints between each pair of vertebrae, one on each side
of the spine. A facet joint is made of small, bony knobs that line up
along the back of the spine. Where these knobs meet, they form a joint
that connects the two vertebrae. The alignment of the facet joints of
the lumbar spine allows freedom of movement as you bend forward and
back.
The surfaces of the facet joints are covered by articular cartilage.
Articular cartilage is a smooth, rubbery material that covers the ends
of most joints. It allows the bone ends to move against each other
smoothly, without pain.?
?The intervertebral disc changes over time. At first, the disc is
spongy and firm. The nucleus in the center of the disc contains a
great deal of water. This gives the disc its ability to absorb shock
and protect the spine from heavy and repeated forces.
The first change that occurs is that the annulus around the nucleus
weakens and begins to develop small cracks and tears. The body tries
to heal the cracks with scar tissue. But scar tissue is not as strong
as the tissue it replaces. The torn annulus can be a source of pain
for two reasons. First, there are pain sensors in the outer rim of the
annulus. They signal a painful response when the tear reaches the
outer edge of the annulus. Second, like injuries to other tissues in
the body, a tear in the annulus can cause pain due to inflammation.?
?You may need therapy outside of the hospital.
If you had a lumbar fusion, your surgeon may have you wait six weeks
to three months before starting therapy. Once you start in therapy,
you'll usually go for one to three months, depending on your progress
and the type of surgery you had.
At first, your therapist may use treatments such as heat or ice,
electrical stimulation, massage, and ultrasound to help calm pain and
muscle spasm. Pool therapy is often helpful after lumbar surgery.
Exercises are used to improve flexibility in your trunk and lower
limbs. Strengthening for your abdominal and low back muscles is
started. You'll be shown safe ways to sleep, sit, lift, and carry. And
you?ll be given ideas on how to do your work activities safely.
Ideally, you'll be able to go back to your previous activities.
However, you may need to modify your activities to avoid future
problems.
When treatment is well under way, regular visits to the therapist's
office will you're your therapist will continue to be a resource. But
you are in charge of doing your exercises as part of an ongoing home
program.?
Scroll down the page and click on the word ?Facet joints? to see
where this is located on the spine. Then scroll further down and click
on ?Arthirits in the facet joints?
http://www.eorthopod.com/eorthopodV2/index.php/fuseaction/topics.detail/ID/79791a8f7dd9f446b38653cbeab9a955/TopicID/840d34b9d079dd898138d113221c56f3/area/5
?Late postoperative complications occurred after posterior fusion and
posterolateral fusion as a result of biomechanical alterations. The
stress change between the two fusion procedures has not been well
reported. To differentiate the biomechanical alteration that occurs
with posterior fusion and posterolateral fusion of the lumbar spine,
the load sharing of the vertebrae, disc, facet joint, bone graft, and
the range of motion were computed in a finite element model.?
http://www.jspinaldisorders.com/pt/re/jsdt/abstract.00024720-200202000-00010.htm;jsessionid=CKsajmtMjs2RDk55PDje6KddqKhFbz9E0IKW5PKltCyNxtlLouY6!-1679577767!-949856032!9001!-1
?Adjacent segment degeneration following lumbar spine fusion remains a
widely acknowledged problem, but there is insufficient knowledge
regarding the factors that contribute to its occurrence.?
http://www.springerlink.com/app/home/contribution.asp?wasp=01d084d5be494267aed3d3a70be151b7&referrer=parent&backto=issue,8,19;journal,33,59;linkingpublicationresults,1:101557,1
There several types of spine fusion surgeries:
·?Posterior fusion: When the procedure is carried out through an
incision in the back.
·Anterior fusion: When carried out from the front of the patient.
·Interbody fusion: First the disk between two vertebrae is removed and
then bone is laid down in the space created between the two vertebral
bodies (the interspace).
·Instrumented fusion: A fusion is referred to being instrumented when
an appliance is used to accomplish or support the fusion?
http://www.yoursurgery.com/ProcedureDetails.cfm?BR=2&Proc=35
?Recovery after surgery for low back pain or leg pain
After a spine fusion surgery, it takes 3 to 12 months to return to
most normal daily activities, and the success rate in terms of pain
relief is probably between 70% and 90%, depending on the condition the
spine surgery is treating. Soon a total disc replacement?or artificial
disc surgery?may also be available as a treatment option for patients
with certain types of conditions that cause ongoing low back pain.
For patients who are 55 or older, symptoms of back pain and/or leg
pain are much more likely to be due to degenerative arthritis
(osteoarthritis) that might result in a narrowing of the canal (spinal
stenosis) and/or instability of one vertebral segment. Generally, the
low back pain and/or leg pain created by these back conditions will
get worse with walking and will improve with sitting. Often, the
symptoms will have been present for years, and may get worse at a very
slow rate. Once a patient gets to the point that he or she can no
longer adequately function because of the low back pain, lumbar
decompression with or without spine fusion may be recommended to help
increase the individual?s activity tolerance and quality of life.?
http://www.spine-health.com/topics/surg/when/when02.html
?Osteoarthritis: The facet joints on the back of the spine are made up
of two bony processes with cartilage between them, all surrounded by a
capsule which is filled with fluid (Figure 2). The cartilage and fluid
normally permit the joints to move without much friction. In a patient
with osteoarthritis, cartilage within the joints breaks down,
resulting in the creation of greater friction within the joint. This
leads to increased stiffness and back pain.
Surgical Treatment: It is possible to perform fusion surgery for
osteoarthritis to restrict movement in the painful joint. However,
surgery is generally not recommended since several verterbrae are
usually affected and fusion of multiple levels of the spine would be
required.?
?Lumbar facet joint synovial cysts are a recognized cause of back
pain, radiculopathy, and neurogenic claudication. They are most
frequent at the L4-5 level and are associated with osteoarthritis of
the adjacent facet joint.
Although the diagnosis of a synovial cyst of the lumbar facet joint
can be established with computed tomography (CT) these cysts often are
more conspicuous and more easily diagnosed with magnetic resonance
(MR) imaging, because of its increased contrast resolution.?
http://radiology.rsnajnls.org/cgi/content/full/221/1/179
?One of the most common disorders of the lower spine is disc
degeneration, or osteoarthritis of the spine. As the body ages, the
discs in the spine dehydrate or dry out and lose their ability to act
as shock absorbers. The bones and ligaments that make up the spine
also become less flexible and thicken. Degeneration in the discs is
not uncommon. Degeneration in discs is a part of the normal aging
process and is not in itself abnormal. The problem occurs when these
discs become painful or begin to pinch and put pressure on the nearby
nerve roots or spinal cord. Small nerves surrounding the disc may
become irritated and cause low back pain.
Treatment options for patients with degenerative disc disease in the
spine are numerous, with the main focus on diminishing the low back
pain. Neurosurgeons will often prescribe a variety of treatments
including physical therapy, antiinflammatory medications, steroid
injections and a consultation by a physiatrist (a physician who
specializes in rehabilitative medicine). Physical therapy may be
directed by the neurosurgeon or rehabilitation physician.?
http://www.neurosurgerytoday.org/what/patient/lower.asp
?While the merits of good conditioning cannot be overstated, the
wrong type of exercise may actually worsen your low back problem.
Activities that impart excessive stress on the back such, as lifting
heavy weights, squatting, and climbing are not advised. In addition,
high impact exercises such as running, jumping, and step aerobics can
aggravate a low back condition. When walking, wear well-cushioned
shoes with good arch supports and use a treadmill or a track made for
athletics. Cycling on a recumbent stationary bike can relieve stress
on the back.?
http://www.spineuniverse.com/displayarticle.php/article600.html?source=google
?Total recovery usually takes anywhere from six weeks to six months,
depending on how advanced the condition was at the time of surgery, as
well as on your pre-operative neurological condition. Of course, the
healthier you are, the faster you will heal. If you smoke, quit.
Smoking damages the structures and architecture of the spine and slows
down the healing process. Smoking has been shown to decrease the
likelihood of success after surgical fusions. In addition, a brace may
be required after a fusion procedure. After you are discharged from
the hospital it is unlikely that you will be allowed to drive, lift
heavy objects or engage in contact sports or vigorous physical
activity for a while. Unless instructed otherwise, you may take a
shower after surgery.
This should be done with a dressing in place to protect the incision.
Keep your incision clean and dry and report any signs of drainage or
inflammation promptly to your doctor.
Practice good posture and body mechanics even during routine daily
tasks. It is normal to have some pain, especially in the incision
area. Pain in the back or legs is also not unusual and is caused by
inflammation of the previously compressed nerve roots. It will slowly
lessen as healing occurs. Medication may also help. Numbness or
tingling sensations are often the last symptoms to fade away.
Maintaining a healthy weight and a regular exercise program will help
to keep your back healthy.?
http://www.neurosurgerytoday.org/what/patient/lower.asp
I hope this has answered your question! Please request an Answer
Clarification, before rating, if any part of this answer is unclear.
This will allow me to assist you further, if possible.
Sincerely, Crabcakes
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Post-surgical + spine fusion + osteoarthritis
Facet joint osteoarthritis + spine fusion
osteoarthritis + lumbar fusion + post-surgical
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