Spinal Conditions - FUNCTIONAL RESTORATION

FUNCTIONAL RESTORATION

As part of non-operative care, your physician may prescribe a program of physical therapy or exercises. The purpose of such treatments is usually to assist you in restoring muscle tone and muscle strength. The muscular supports of the spine are crucial to maintaining good function and stability of the back. With aging, injury or underlying spinal problem it is very common for the back musculature to become weakened, with diminished tone and easy fatigability. In fact, poor muscle condition can be a significant source of disability and pain itself.

Physical Therapy
The principle to most physical therapy approaches in spinal conditions is twofold: pain modality treatment (as described above) and structured guided strengthening programs for restoring good muscle function. There are many different types of exercise programs and particular focus on isometric strengthening appears to be quite beneficial for many patients. Isometric exercises involve activities that stimulate contraction of a muscle (working the muscle) while maintaining the length of that muscle (ie. no significant motion across the span of the muscle). Vigorous movements or extremes of motion are often avoided in physical therapy approaches to spinal care.

Exercise
Most patients that see benefit with a physical therapy program are advised to maintain some form of regular exercise on a long-term basis. Even patients with mild or intermittent back pain and no severe underlying problem can receive benefits with regular exercise. A number of studies have shown that regular aerobic activity reduces the chance of developing repeated back injuries. Clear advantages of one type of sport over another have not been shown and it therefore may be most important to find some activity that is enjoyable and easy to maintain on a regular schedule (ex. swimming, fast walking, running…).

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Spinal Fusion

Spinal Fusion —Orthospine.com

Fusion is a surgically created solid bone bridge between two or more adjacent, usually freely mobile bones. In a spinal fusion, this is used to create a stability between levels of the spine (vertebrae) that usually have some motion across a disc and the facet joints. In order to achieve a fusion, bone must grow across the desired area in a gradual and solid fashion. A number of techniques can increase the chance of this to occur. The basis principle is to place bone tissue (bone graft) into the area of desired fusion, ensure sufficient immobility across that area (brace, cast, spinal instrumentation…) and then waiting for the spinal fusion to take place (6-9 months or more).

It is important to understand that in the process of preparing an area of the spine for fusion a commitment with little room for error has been made. If a fusion fails to heal (often called a pseudarthrosis or non-union) repeat surgery (revision surgery) must often be done with more bone graft and spinal instrumentation until the fusion area heals solidly.

There are numerous spinal problems for which spinal fusion may be planned. In simple terms there are long spinal fusions (across many levels) and short segmental spinal fusions (one or a few levels).


Long spinal fusions are commonly performed for correction of deformity such as idiopathic scoliosis, adult scoliosis or Scheuermann's kyphosis. The goal is to correct a deformity and to maintain the correction with spinal instrumentation until the spinal fusion is completed and the healed bone takes over the task of the hardware to stabilize the correction.

Short spinal fusions are often performed to stabilize some form of instability ranging from the acute instability caused by a fracture or large disc extrusion to the chronic instability caused by disc, ligament and cartilage wear and tear called degeneration. In many cases spinal instrumentation is placed during the spinal fusion surgery to optimize the chances of successful bone healing. For unclear reasons, in many cases short fusions do not have a better chance of solid healing than long fusion. This fact may be due to the difficulty to achieve solid fixation (blocking all motion) between two or three mobile vertebrae in the spine. The difficulty to obtain successful spinal fusion at the lowest level of the spine (L5-S1) is illustrated by the amount of different techniques which have been proposed to achieve fusion at that level (in some textbooks there are outlines of more than 25 techniques). Despite the many different surgical techniques available to achieve short spinal fusions, they are not all alike and each has advantages and disadvantages. Each patient must be treated in an individual fashion and the optimal surgical fusion technique is dependant upon many factors.

In addition to consideration of the surgical technique applied, and the type of spinal instrumentation used (if it is necessary), there are also several options in the choice of bone graft material. It must be remembered that ultimately for a spinal fusion to be successful, bone must grow across the selected spinal levels. There are a number of possible sources for this necessary bone graft. One option is bone harvested from the patient (autologous bone graft) from the spine itself or an area near the lower spine, from the iliac crest (part of the pelvis). Another option is obtaining bone graft material from a bone bank (harvested from cadavers and sterilized), this is called allograft. A further option is using synthetic bone materials made from demineralized bone matrix (DBM) and calcium phosphates or hydroxyapatites (some are derived from sea corral).


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Scoliosis Correction - Orthospine.com

Scoliosis Correction

There are many different types of scoliosis and with that different types of procedures to correct these spinal deformities. Additionally, scoliosis surgery spans all ages. Each patient must thus be treated in a very individualized manner and there are no simple guidelines or general techniques that can be applied to all. The ideal operative plan in any given case will thus depend upon a number of aspects including patient factors (age, size, type or curve, levels of curve, stiffness of curve…) and surgeon factors (experience, comfort with certain techniques…).


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Spinal Conditions Non Operative Care - Bracing

Bracing
There are a wide variety of collars, binders, belts, braces and other devices designed to offer relief from neck and back pain. Their effectiveness in most cases has not been clearly proven, and yet many patients do feel some relief from their pain with some of these applied devices. Long-term wear of back braces may however lead to gradual weakening of the supportive muscles due to an effect of unloading and may therefore not be desireable.

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Orthospine.com

Orthospine.com

This is an educational site developed for the understanding of spinal problems and back pain. Get top level, unbiased information from leading experts. Get the inside story about conditions such as a degenerative spine conditions like spinal stenosis, or malalignment issues such as flatback or spondylolisthesis and deformities like scoliosis including idiopathic scoliosis and congenital scoliosis and malformed vertebrae resulting in kyphoscoliosis. See the pros and cons of undergoing spine surgery and other procedures such as spinal fusion. Find out how disc surgery on a herniated disc can change the way you live. Discover what treatment may be available for failed back surgery, what to expect from revision spine surgery, and the role of minimally invasive spine surgery. These top New York City doctors have the authoritative answers to your back pain questions right here. Get your questions answered now. It's time to ask the doctors...

Frank J. Schwab, M.D. and
Jean-Pierre C. Farcy, M.D., F.A.C.S.

Visit our main web site at Orthospine.com

Orthospine Non Operative Care - Functional Restoration

FUNCTIONAL RESTORATION

As part of non-operative care, your physician may prescribe a program of physical therapy or exercises. The purpose of such treatments is usually to assist you in restoring muscle tone and muscle strength. The muscular supports of the spine are crucial to maintaining good function and stability of the back. With aging, injury or underlying spinal problem it is very common for the back musculature to become weakened, with diminished tone and easy fatigability. In fact, poor muscle condition can be a significant source of disability and pain itself.

Physical Therapy
The principle to most physical therapy approaches in spinal conditions is twofold: pain modality treatment (as described above) and structured guided strengthening programs for restoring good muscle function. There are many different types of exercise programs and particular focus on isometric strengthening appears to be quite beneficial for many patients. Isometric exercises involve activities that stimulate contraction of a muscle (working the muscle) while maintaining the length of that muscle (ie. no significant motion across the span of the muscle). Vigorous movements or extremes of motion are often avoided in physical therapy approaches to spinal care.

Exercise
Most patients that see benefit with a physical therapy program are advised to maintain some form of regular exercise on a long-term basis. Even patients with mild or intermittent back pain and no severe underlying problem can receive benefits with regular exercise. A number of studies have shown that regular aerobic activity reduces the chance of developing repeated back injuries. Clear advantages of one type of sport over another have not been shown and it therefore may be most important to find some activity that is enjoyable and easy to maintain on a regular schedule (ex. swimming, fast walking, running…).

Visit our main web site for more articles on Non Operative Care

Orthospine - New York, NY Doctors

Jean-Pierre C. Farcy, M.D., F.A.C.S.

Click for bio Jean-Pierre C. Farcy, M.D. is a Clinical Professor of Orthopedic Surgery at New York University and Attending Surgeon at the Hospital for Joint Disease. Dr. Farcy served as director of Orthopedic Surgery at Helen Hayes Hospital, an affiliate of Columbia-Presbyterian Medical Center, for ten years. Dr. Farcy is recognized internationally as one of the leading specialists in the treatment of pediatric and adult spine deformity. His current practice is focused on the treatment of congenital spine deformities in children and revision surgery for spine malalignment and other spine disorders in adults. Dr. Farcy pursued a clinical research program on spine balance in conjunction with the French Institute of Biomedical Engineering in Paris. He is a member of several prestigious spine societies in the United States and abroad including the SRS and NASS and was president of the French Orthopedic Academy in 2001. He is invited regularly as an instructor at international advanced spine courses for surgeons. Dr. Farcy is an editor of several state-of-the-art spinal surgery textbooks.

Frank J. Schwab, M.D.

Click for bioDr. Schwab is Chief of the Spinal Deformity Service at NYU-Hospital for Joint Diseases, and is Clinical Assistant Professor at the New York University School of Medicine. He is fully board certified and recognized for his expertise in complex pediatric and adult spinal surgery. Dr. Schwab's clinical practice is focused on complex revision surgery (failed back, flatback), spinal deformity (scoliosis/kyphosis) and minimally invasive techniques. He is a leading member of the Spinal Deformity Study Group and sits on numerous committees of the Scoliosis Research Society. Dr. Schwab regularly is invited to teach at surgeon's courses and presents original research at international meetings. His publications appear in the prestigious journals and textbooks of spinal surgery.