Spondylolithesis of the Spine: Definition, Causes, & Treatment

/ Thomas Cohn, MD

spinal painSpondylolithesis is a condition in the spine where one vertebral body has slid forward or backward in relation to another.  It is most common in the lumbar area.

As people age, the likeliness of spondylolithesis increases.  The presence of spondylolithesis is not necessarily a problem, however it may lead to the spinal cord or nerve roots being compressed.  The compression of the spine or nerve roots is often gradual, and sometimes leads to numbness, weakness, and pain especially in the legs.  The slippage can also appear without any symptoms; therefore its presence does not necessarily mean that a problem exists. Even very significant spondylolithesis can be present with no or minimal symptoms and can be managed by very minor levels of treatment.

Causes of Spondylolithesis

The slippage in the spine is caused by problems in the posterior elements of the spine – the facets and connecting bony structures.  When these joints are not functioning correctly, slippage can occur.  Joint damage can occur from:

  • Birth defects
  • Physical damage by trauma or stress fractures
  • Arthritis

Spinal slippage can also result from sports injuries and arthritis as people age.

Diagnosis & Treatment

Spondylolithesis can be easily diagnosed with plain X-rays.  Again, the presence of the slippage does not necessarily mean that there needs to be any special treatment.  Many people are completely without symptoms.  However, if painful symptoms do exist, there are several options for treatment.

Treatment starts with using proper body mechanics for movement, and maintaining core muscle strength.  Seeing a physical therapist may help learning the right strengthening and stretching.  If spondylolithesis is irritating nerves, more intense physical therapy may be necessary, and working with a pain physician may be beneficial.  Chiropractic manipulation of the slippage is not advisable.  If significant weakness occurs or bowel and bladder control is lost, then surgical intervention may be necessary.

Does Laughter Really Help Relieve Pain?

/ Thomas Cohn, MD

laughter and painThere’s an old saying that laughter is the best medicine. While most would admit that laughter is good for your emotional health, can it really reduce pain on a physical level?

In short, yes. Laughing can help fight both mental and physical pain.

Physical Benefits of Laughter

There are many ways that the physical act of laughing can decrease pain and improve your overall health. Here are a few examples:

  • Increased Endorphins. When you laugh, your oxygen intake increases. This invigorates your organs and releases endorphins in your brain.
  • Decrease Stress. Laughing helps circulation and results in more relaxed muscles. This can undercut tension caused by stress.
  • Natural Pain Killers. Laughing helps the body create its own natural painkillers.

Additionally, laughter has been found to increase blood flow, lower blood pressure, and boost the immune system.

Laughter & Brain Signals

Laughter is the opposite of being sad and depressed.  Too much sadness stimulates areas of the brain that are next to the centers that translate pain signals in the brain.  The centers that are involved in depression can “talk” to and stimulate the pain centers.  Emotional pain can make physical pain even worse. Therefore, you need to laugh and spend time relaxing and enjoying life.

When you are in pain it’s often difficult to find the funny things in life and laugh.  The old saying that laughter is the best medicine may just help.  It increases the body’s own pain fighting hormones, and decreases the activity areas of emotional pain.  Laughter distracts the brain from bad signals and focuses on the enjoyable ones.

Tips for Comforting Orthopedic Patients This Summer

/ Thomas Cohn, MD

castcoverzNote: This is a guest post by CastCoverz! Connect with them on Twitter.

We know your pain, your frustration, and your inconvenience while being an orthopedic patient, especially during summer!  CastCoverZ! knows how to comfort , add some fun and solve your biggest challenges while casted, booted, splinted, braced or bandaged.

If you’re a mom with an injured child and need to put a smile back on their face while keeping their cast clean, save your furniture from scratching or your wardrobe from snagging, OR you are an adult looking for fashion or a discreet way to cover your cast, brace, splint or boot, we’ve got you covered with CastCoverZ!-branded products, including:

  • Arm and hand cast covers and slings
  • Leg cast covers
  • Orthopedic walking boot covers

If you need to keep your cast dry, we have two solutions:  DryPro for the beach, waterpark or pool and CastShield for showering and bathing, both offering waterproof protection for casts and bandages.  If you want a pair of designer crutches, a bag to hold your incidentals, and beautiful crutch pad covers that are oh-so-comfortable, you need CastCoverZ! Designer Color Crutches and Accessories.

If you want to get rid of the smell and itch of wearing a cast (let’s be honest, wearing a cast is like having a bacteria-loving Petri dish attached to you,) you need the CastCooler, which is a breakthrough in cast comfort and care, designed to concentrate cooling and drying effectiveness on moist areas under your cast.

Wear your personality or cover up.  Stay clean, dry, snag-free, and comfortable with CastCoverZ! products.  Comfort, fun, fashion, and function in the orthopedic world.  It’s a challenge, but we’re up to it.  Because we know if you Feel Better, you Heal Better!

Are X-Rays, MRIs, & CT Scans Helpful in Treating Back Pain?

/ Thomas Cohn, MD

spine x-rayOne of the most common concerns of someone with low back pain is whether they need X-Rays or special scans such as a CT or MRI study.  Usually, the answer is no. Most low back pain will resolve in weeks to a month or two with conservative care.  For normal back conditions, imaging is not necessary to guide care and is needed only in a few circumstances. In this article, we will outline the three major imaging methods (X-Rays, MRIs, CTs) and discuss when each is recommended.

X-Rays

Plain X-rays of the lumbar spine can show all of the following:

  • Alignment and curvature
  • Disc space
  • Bones

X –rays are helpful when there is acute trauma to the spine and fractures are a concern.  In children, where scoliosis is suspected, plain films of the spine are also helpful.  In normal adults without the above 2 conditions, X-rays show very little information that is useful in managing low back pain.  Chiropractic films of curvature do not contribute to management decisions in back pain, and just expose one to unnecessary radiation.

MRI Scans

MRI scans of the lumbar spine can give good detailed information with regards to the following:

  • Bones
  • Discs
  • Ligaments
  • Nerves
  • Other abnormalities in this region

In reality, MRI scans are best for determining surgical or advanced conservative pain intervention.  If you have had a scan in the past, you probably wouldn’t need another one unless your physician suspects significant new changes such as cancer.

CT Scans

CT scans of the lumbar spine are very good at evaluating the bone structures, but are not as good when evaluating discs, muscles, and nerves.  They are used in cases of trauma, since a scan can be done quickly, in minutes.  CT scans are also used after surgery, or when the patient has implants that are not compatible with the magnets of an MRI scan.  These scans are also done only when significant changes are suspected and a surgery type intervention is being considered.

Rarely is imaging absolutely necessary in the management of low back pain.  Most low back pain heals rapidly with conservative treatment.  If the low back pain is not improving, then one should find a Physical Medicine and Rehabilitation specialist.

Low Back Pain – A Common Problem, often Mistreated

/ Thomas Cohn, MD

low back pain minnesotaLow back pain is a very common issue – 85% of the population will experience back pain at some point in their lives. However, back pain is often treated improperly and as a result, it has become a costly problem in American society.  A lack of understanding of back pain, its causes, and usual treatment, leads to costly management.

Acute Low Back Pain

Acute low back pain is pain that has been present less than 3 months.  Most back pain can be treated conservatively.  Only rarely is back pain a serious medical emergency.  There are many structures in the back that cause pain, including:

  • Vertebral discs
  • Bones
  • Joints
  • Nerves
  • Muscles

All of these can cause pain.  Fortunately, most pain is caused by muscle strains and irritation of joints, discs or nerves.  Initially all of these are treated the same, with ice and heat, minimal rest, stretching, and then muscle strengthening of the core.

Medications should be kept simple – use Tylenol or anti-inflammatories like naproxen to manage the pain.  If pain is more severe, see a primary care physician for referral to a Physical therapist.  Very short-term use of narcotic pain medicine is useful if other medications cannot be taken but these are not advised for more than several weeks.

If Back Pain Persists

If back pain persists for more than a month, despite basic management, you should seek out an expert in low back pain.  The best medical doctors to evaluate and treat this type of pain are board certified physicians in Physical Medicine and Rehabilitation.  These physicians are experts in the musculoskeletal and nervous system.  They can guide a person through a detailed exam and diagnosis and more advanced treatments.

Surgery, MRIs, & CT Scans

Back pain is rarely a medical emergency.  If a patient has had cancer and has new onset of back pain, aggressive evaluation is necessary to determine if cancer is affecting the region.  Low back pain with loss of control of the bowels, or loss of muscle function in the legs is the other case when aggressive evaluation is necessary.

Back pain is usually relatively benign.  Most pain will resolve within weeks with conservative treatment.  Only in rare cases (such as cancer) should MRI or CT scans be obtained.

Surgery should only be considered if nerves are compromised, or bowel or bladder control is lost due to the spine being injured.