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Wed, Sep 17, 2014

KESTNER: Spinal disc degeneration can often be prevented

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Last week this column discussed that spinal degeneration is very common and becoming more so in our culture.
The increase in incidence is related largely to our activities and nutritional habits.

As we have become more sedentary as a culture, our bodies have begun to deteriorate faster. Thankfully, medical science has developed some pretty good repair or replacement parts just in time.

For example, replacement hips and knees are incredibly safe and reliable for the most part. Surgeons are well trained to be able to remove an excessively damaged knee or hip and implant a new metal joint. It can be a rough six weeks post surgery in recovery time, but the outcomes are generally quite good.

Unfortunately, the spine is not so easily repaired and certainly not replaceable. Many efforts have been made to create artificial joint components for the spine, but the success seen for hips and knees is not to be found relative to damaged spines.

Your spine is so sophisticated in the way that it works that engineered components have not been able to satisfactorily duplicate the function.

In the case of a severely degenerated spine joint, the best spinal surgery can accomplish is to remove the damaged disk, then brace the two spinal bones above and below the damage by screwing a metal plate in place, then allow the bones to fuse together over time. That joint will never move again.

Unfortunately spinal surgery often fails. In fact, spinal surgeons will discuss with prospective patients that failed back surgery syndrome will occur in up to 40 percent of spinal fusion cases.

In one study reported in the journal Spine in 2011, 1,450 cases of worker’s comp patients with chronic low back pain related to lumbar disc diagnoses were treated with lumbar fusion or without surgery.

The numbers showed an abysmal record for the surgical outcomes. Only 26 percent of those who received surgery were back at work two years later. (That is interpreted to indicate a 74 percent failure rate for lumbar fusion surgery.)

Compared to the 26 percent who returned to work after surgery, 67 percent of the ones that were treated with non-surgical methods were back at work in the same time.

This is no fault of the surgeons. The doctors who operate on the spine are among the most elite of the medical field.

They are very bright, highly trained individuals.

The problem is the spine itself is much more complex in its mechanics than any other joint system in the body. Spinal surgery also carries a higher risk of complications than many other forms of surgery largely due to the proximity of the delicate nerves to the tissues being cut.

Although surgical management of many other types of joints has a greater success rate, for now, spinal surgery remains a serious challenge. There are promising techniques, methods and devices being investigated, but progress is painstakingly slow.

Since replacement parts are not likely to be available soon, it is vitally important to protect the only spine you will ever have.

As discussed in last week’s column, spinal degeneration comes about largely as a result of spinal injuries that are not treated well. Many people are simply medicated after an injury and no attempt to restore spinal function is attempted.

Many people have experienced one or multiple spinal injuries. It is not uncommon for me to hear, “My back goes out on me every once in a while, but I get over it.”

Unfortunately, the person experiencing these episodes is left to believe that if the pain settles down the problem is gone.

This is not the case.

Although the area of injury may be less painful, it is likely that the resulting dysfunction affecting the injured joint continues to be present unless the injured patient has treatment intended to restore that motion.

When a spinal joint becomes injured, there is a profound dysfunction that immediately impairs that joint. That motion dysfunction is a key cause of the degeneration that follows.

If the injury is not treated with manual therapy, manipulation and rehab exercises designed to quickly restore normal function, early degeneration of the joint will be the likely outcome.

But the degeneration will not show up until years later. By the time the degeneration is discovered permanent damage has been done.

Next week a patient story will illustrate what can be accomplished with non-surgical disc decompression to restore normal function to a degenerated spine.

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chiropractic, degeneration, dr., kestner, mark, spinal
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