Patient Information
About Your Spine
The following information has been adapted from Saskatoon Health Region and University Health Network back and neck surgery guides and will help you familiarize yourself with common terms used around spinal conditions.
Anatomy
The spine is a column of bones called vertebrae, which supports your body, allows movement, and protects the spinal cord.
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In between each bone is an intervertebral disc. Each disc allows for shock absorption and flexibility and works with the spine joints, muscles and ligaments for movement.
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The area of the spine we will focus on is the lower back or lumbar region. The lumbar region is made up of five large vertebrae and normally has an inward curve called a lordosis.
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The lumbar spine sits on top of the sacrum, which is a solid triangular bone in the pelvis. On either side of the sacrum are the large pelvic bones called ilia. Strong ligaments hold this junction called the sacroiliac joints together.
Many other structures act on the bones of the spine to provide stability and allow movement. A series of ligaments run from vertebrae to vertebrae, while others run along the entire length of the spine. These ligaments are designed to prevent extreme movement of one vertebrae on another. The back muscles that help to move the spine can run from one vertebrae to the next, or travel over many vertebrae so you can move many segments at one time. The abdominal muscles affect movement of the lumbar spine, and they provide support in the front of the spine almost like a girdle.
The spinal cord is a series of nerves that branch out to your body, carrying messages to and from your brain.
Your spine supports your body, allows movement, and protects the spinal cord.
What Causes Back Pain?
Back pain is very common. Many factors can contribute, including:
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Poor posture
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Excess body weight
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Lack of physical activity leading to muscle weakness and fatigue
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Emotional stress/tension
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Reaching / lifting beyond safe base of support
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Poor repetitive lower back movement habits
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Trauma (e.g. a fall or a car accident)
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It may help you to realize that you have control of some (or most) of these factors contributing to back pain. Taking care of your back may help reduce your pain before and after surgery.
Other factors that may cause back pain are from age- related changes in your lumbar spine. These include:
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Loss of intervertebral disc height. As a result, the bones in the spine become closer, causing the nerve openings in the spine to become narrower.
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Joint inflammation (arthritis); causing stiffness and pain in the lower back.
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Intervertebral disc ruptures in the lumbar spine. The ruptured material can put pressure on one or more nerve roots or on the spinal cord, causing pain and other symptoms in the back and legs.
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Degenerative Disc Disease: A medical term for wear and tear on the spinal intervertebral discs.
Degenerative Joint Disease: A medical term for wear and tear on the spinal joints.
Disc Herniation: Intervertebral discs are small cushions which separate each spinal vertebrae. They are made up of a tough outer shell (annulus) and a jelly-like centre (nucleus). Due to wear and tear,
the outer shell can weaken, allowing the jelly centre to push through. This protruding material can put pressure on the spinal nerve root and may cause pain, numbness and/or weakness.
Stenosis: A narrowing of the spinal canal where the spinal cord runs, and of the spaces in the bone where the nerve roots exit from the spinal cord. The narrowing can be caused by poor postural positioning, arthritic changes, inflammation or swelling, and loss of height of the vertebrae and the intervertebral discs due to aging or injury.
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Non-Surgical Treatments
Many people with age-related changes in their lumbar spine can respond to a non-surgical approach that includes:
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Physical therapy and exercises to strengthen back and abdominal muscles
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Improved work/home/leisure ergonomics
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Discussions with a mental health therapist to assist in addressing emotional stress
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Anti-inflammatory medication
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Avoidance of repetitive activities
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Ice and
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Control of weight
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Here are some exercise resources to review for non-surgical management:
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Surgical Treatments
When is surgery needed?​
Back surgery may be considered to alleviate pain and prevent nerve damage when conservative measures have failed with the following conditions:
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Compression on the spinal nerves
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If the spine is unstable due to injury (spinal fracture)
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If the spine is unstable due to slippage of one spine bone on another (spondylolisthesis)
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Risks and complications of spine surgery
Your spine surgeon will review the risks and complications of surgery with you, which may include, but are not limited to the following:
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Infection
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Bleeding or blood clots
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Nerve damage
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Spinal fluid leak
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Paralysis
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No improvement of pain or worsened pain
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The need for a second surgery
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Bones not fusing or bone graft shifting out of place after a spinal fusion
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What if you have symptoms from your neck?
When arthritic changes and disc degeneration occur in the neck it may cause a condition called degenerative cervical myelopathy (DCM)
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Degenerative refers to breakdown.
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Cervical refers to the neck.
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Myelopathy refers to pressure on the nerves.
DCM causes the spinal cord and blood vessels around the cord to
become compressed. About 5 to 10% of patients with cervical spondylosis (arthritis of the spine) will develop DCM.
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Over time, these changes cause damage to the nerves that may lead to paralysis in the arms and legs. Each person can experience these symptoms differently.
Age and gender play an important part in the development of DCM. The usual age of someone with DCM is 64 years. This condition affects men more than it affects women. Family history, environment, and your type of workplace can also affect the development of DCM.
DCM is also an important risk factor for a condition called central cord syndrome, a type of spinal cord injury commonly caused by having DCM.
Common symptoms include:
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Weakness in the arms and/or legs
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No feeling (sensation) in the arms and/or hands
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Not being able to handle or use small objects (pens, clips, buttons, zippers)
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Trouble with walking or keeping your balance
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Problems emptying your bladder or passing bowel movements (you may find that you are holding in urine or stool)
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Neck pain
Important
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Pay attention to any activities that may worsen your symptoms. If possible, try to stop those activities.
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It is not recommended that you have any manipulation of the spine involving spinal traction or chiropractic maneuvers. These methods may not be safe for you.
You may have neck pain and weakness in your arms, hands and legs. Your arms, hands and legs may also feel numb. A small number of patients do not have these symptoms right away. They may develop symptoms after a neck injury instead. We do not know the exact cause for many of these symptoms. But, we can still try to prevent more damage to the spine by acting early.
What DCM does to the spinal cord?
Your family history, environment, and where you work affects how DCM can develop. As you get older, the discs and joints in your spinal cord begin to break down. Changes to the spine are normal as we age, but can be made worse by repeated injuries to the cervical spine.
These changes lead to the spinal cord being pressed or squeezed over time. In some people, this creates pressure on the spinal cord which causes nerve damage. Symptoms depend on how badly the spinal cord has been damaged.
We cannot be sure that you have DCM until you have an MRI or CT scan. During magnetic resonance imaging (MRI) and computer tomography (CT) machines take detailed pictures of the organs and tissues inside of your body. These pictures help your doctor and the spine specialist find out if there is a lot of damage to your spinal canal.
Patients are referred to a spine specialist by their family doctor once the doctor notices that you have symptoms of DCM. Based on your MRI and CT results and your symptoms, the spine specialist will order more tests. Finding out early that you have DCM plays an important part in your treatment.
If your symptoms do not bother your everyday life, your doctor may decide to closely watch your condition instead of surgery. If your symptoms are badly affecting you, surgery might be the best way to stop the condition from getting worse.
The goals of surgery include stopping symptoms from getting worse and preserving your ability to move your arms and legs. For every 10 people who have surgery, 8 people will see improvements.
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Things that affect your improvement after surgery:
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How long you were having symptoms before the surgery
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The size of your spinal canal before surgery
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How much of your spinal cord has been pressed
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You and your surgeon will work together to choose the best option for you.
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Surgery
Surgery is used to treat DCM in patients with spinal cord damage. Pictures from an MRI test can show us where the damage is. Surgery can be done on the front or the back of the spinal cord.
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Anterior Cervical Decompression and Fusion (ACDF): The disc or vertebrae is partially removed and replaced with bone or synthetic material from the front of your neck. The surgeon will keep the area steady using titanium plates and screws.
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Posterior Cervical Decompression and Fusion (PCDF): The areas of your spinal cord causing pressure or pain are removed from the back of your neck. The vertebrae are then held together using rods and screws. Muscles and tissues as well as your skin are closed up.
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If you have DCM and you are not having surgery, watch for these signs that your DCM is getting worse:
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Sudden changes with passing urine or stool
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Sudden numbness and/or tingling of your arms, hands and feet
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Changes in your walking or with your balance that were not there before
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Weakness in your arms and legs that you did not have before
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If any of these things happen to you:
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Call 911
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Go to the Emergency Department
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Surgical Terms
Discectomy: Involves removal of a protruding part of a disc to relieve pressure on the nerve. In most cases, a laminotomy must first be done to expose the disc. Then any part of the disc that presses on a nerve can be removed. Disc matter that is loose or may cause problems in the future is also removed. After surgery, there is usually enough disc remaining to cushion the vertebrae.
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Microdiscectomy: The removal of part of the disc is performed through a smaller incision and with the use of a surgical microscope to see the nerve root and disc material.
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Laminotomy: Involves removal of a portion of the lamina – the bone at the back of the spinal canal. The small opening that is created is sometimes enough to take pressure off a nerve. But in most cases, part of a disc or a bone spur that is pressing on a nerve is also removed.
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Laminectomy: Involves removal of part or all of the lamina of the vertebrae,
this is part of the vertebrae that overlies the spinal canal. Removing it
enlarges the spinal canal, thereby relieving pressure on the nerves. A
laminectomy may be done at one level or multiple levels. If needed, your
surgeon can also remove any part of the disc or bone spur that presses on a nerve. He or she may also enlarge the space to decrease pain caused by stenosis. After the procedure, the new opening in the spine is protected by the thick back muscles. A fusion may need to be done at the same time to make the spine more stable.
Spinal Fusion: This is a surgical technique in which one or more of the vertebrae of the spine are joined together (fused) to prevent motion between them, sometimes caused by decreased disc height or slipping of one vertebrae. This may be done to stabilize broken vertebrae, or to decrease excessive movement between vertebrae (also known as spondylolisthesis), or to increase stability following a laminectomy. A spinal fusion inserts material, called bone grafts, between the vertebral bones to encourage the body to grow new bone and fuse the spinal bones together. The donor bone may be taken from your pelvis or from a bone bank. These grafts heal over several months, fusing or welding the vertebrae together, similar to healing a fracture. Other metal hardware may be used to stabilize your spine while the bones fuse and your body heals.
Preparing for Spine Surgery
What to Do While You Wait
Immediately do the following:
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1. Get thinking and feeling your best
Emotional preparation is very important for your surgery. Sometimes it is difficult to deal with pain while waiting for surgery. You can experience problems sleeping and may become anxious or frustrated. It is important to deal with these feelings. Here are some suggestions:
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Practise formal relaxation techniques such as deep breathing, visualization/visual imagery and progressive muscle relaxation. Speak to your doctor about using anti-inflammatory medications and/or ice to help with the pain.
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Be active. Continue your usual daily activities. Use your pain-controlling exercises and prescribed medications to self-manage your pain. (If you have not been regularly active, speak to your family doctor or health care professional before starting a new exercise program).
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Discuss concerns with your coach or other support person.
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Be informed and prepared prior to your surgery. This helps decrease anxiety and makes you more hopeful.
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2. Improve your physical health
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Manage your weight. Eat a well-balanced diet as recommended by Canada’s Food Guide.
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Before your surgery, consult with your family doctor to ensure that health issues are addressed as needed.
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3. Quit smoking. Smoking delays healing and slows your recovery from surgery
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If you cannot quit, ask your physician for help or contact Smokers Helpline 1-877-513-5333.
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The benefits of quitting smoking begin the day you quit.
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4. Stay active! Exercise and do your regular activities
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Research shows that exercise can help decrease pain, increase flexibility, and keep your heart healthy before surgery. Exercising for longer periods of time can benefit your heart, lungs, circulation, and muscles. Good endurance exercises include walking, swimming, or stationary cycling.
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5. Be proactive
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What you do on a daily basis before and after surgery helps your recovery time and the overall success of the surgery. Research shows that well prepared patients participate better in their care, have a better and faster recovery, experience fewer problems with pain, and feel better overall.
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Set up your home and work environments prior to surgery, so that you are ready for discharge after surgery into a safe environment.
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6. Change how you do things
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Stop and take time to analyze how you move. Minor changes in technique can make a drastic difference in the amount of pain the activity causes. Whether it is work, home, or leisure, all activities of daily living need to be looked at and possibly changed.
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How you do things on a daily basis may be the main cause of the continued irritation in your back.
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Changing how you do things does not mean stopping what you are doing but it means to physically changing how you perform the activity.
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