By Julie Steenhuysen, Reuters

CHICAGO (Reuters) - Acupuncture brought more relief to people with back pain than standard treatments, whether it was done with a toothpick or a real needle, U.S. researchers said on Monday in a study that raises new questions about how acupuncture works.

For many patients, that benefit lasted for a year, the team reported in the Archives of Internal Medicine.

“Our study shows that you don’t need to stick needles into people to get the same effect,” said Dr. Daniel Cherkin of Group Health Center for Health Studies in Seattle, who led the study.

“Historically, some types of acupuncture have used non-penetrating needles. Such treatments may involve physiological effects that make a clinical difference,” Karen Sherman of Group Health, who worked on the study, said in a statement.

The team, wanted to study the effects of different types of acupuncture in a large, carefully controlled study of 638 patients with chronic low back pain.

They divided patients into several groups. One got seven weeks of standardized acupuncture treatment known to be effective in back pain. Another group got an individually prescribed acupuncture treatment.

A third group was treated using a toothpick in a needle guide tube that did not pierce the skin as regular acupuncture does, but targeting the correct acupuncture “points”.

A fourth group just got standard medical treatment, which included medication and physical therapy.

After eight weeks, 60 percent of the patients who got any type of acupuncture reported significant improvement in their ability to function compared with those who got standard medical care alone.

But there was no significant difference in the pain relief people got from the acupuncture using needles or from toothpicks.

The researchers said there is some evidence that even needles were used 2,000 years ago in acupuncture treatment, and some imaging studies have shown that “superficial and deep needling of an acupuncture point elicited similar blood oxygen level-dependent responses,” the team wrote.

Another study even found that lightly touching the skin can induce some emotional and hormonal reactions, which could explain the benefit, they wrote.

Or, it may simply be the experience of visiting an acupuncturist for treatments that helps.

Regardless of how it worked, they said acupuncture appears to be a relatively safe and painless way of easing an aching back, especially when traditional medicine alone fails.

(Reporting by Julie Steenhuysen; Editing by Maggie Fox and Cynthia Osterman)

source: calgaryherald.com

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Back ache Warning Signs

At some point in our lives, we are likely to experience back ache — 80% of all adults do. Most of the time it is relatively minor but how do we know when it’s time to see a doctor? If you answer yes to any of the following questions, you should consult a spine specialist:

1. Has your low back ache extended down your leg?
If the pain persists and is severe, it is a sign that something is compressing a nerve running from your back to your leg.

2. Does your leg pain increase if you lift your knee to your chest or bend over?
If so, there is a good chance a disc is irritating a nerve.

3. Have you had severe back ache following a recent fall?
A fall may cause damage to your spine. Chances of injury increase if you have osteoporosis.

4. Have you had significant back ache lasting more than 3 weeks?
Often pain will go away with simple treatment. However, if your pain persists you should consult a spine doctor.

5. Have you had back ache that becomes worse when you rest, or wakes you up at night?
If this is accompanied by a fever, it may be a sign that there is an infection or other problem.

6. Do you have persistent bladder or bowel problems?
Bladder and bowel problems may be due to many causes, but some spine problems may cause these symptoms.

7. Do you get numbness or weakness in your legs while walking?
These problems can be caused by a narrowing of the spinal canal. This is called spinal stenosis.

If you don’t know of a spine care specialist in your area, please consult your family doctor or search the Spine Care Provider Search.

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Scoliosis surgery that’s less invasive

Minimally invasive back surgery reduces hospital stays, muscle damage and recovery time. But the long-term benefits are unknown.
By Ford Vox
June 1, 2009
Today’s surgeons can nick out your gallbladder via your belly button and excise your thyroid gland without cutting your neck. Now some doctors have added one of recent history’s most grueling operations to the ranks of minimally invasive surgeries.

These surgeons say there is a safer way to surgically correct scoliosis — curvature of the spine — than the current ordeal, which requires opening an incision that may extend from the shoulders to the pelvis and then stripping back muscles off the vertebrae to reach the bones that must be fused. Multilevel fusions — those that involve shoring up vertebrae all along the spine — are often seven-hour marathons followed by a stay in intensive care.

There is some debate about whether surgery is a wise procedure for scoliosis, and most often the condition is treated with bracing when it begins in childhood or adolescence. Because adults have skeletally mature spines, bracing can improve ache but won’t really correct the problem. In children and adults, surgery usually isn’t considered unless the sideways curve has reached 45 degrees or more, although sometimes surgeons intervene earlier if symptoms such as ache or shortness of breath develop.

Brenda McInnis of Midland, Mich., was diagnosed at a middle-school screening and lived with scoliosis much of her life. Though she was happy that her doctor and parents hadn’t forced her to wear a brace, by age 47, her midback curve had grown to 50 degrees from less than 20. A compensating curve in her lower back sent severe ache into her hips. Most days she could tolerate only two hours at her job as a cashier in a hospital cafeteria. Eventually she had to use an inhaler to breathe.

In November, McInnis became one of fewer than 100 patients at four pioneering centers nationwide to have minimally invasive surgery to correct her scoliosis. Dr. Frank La Marca, a University of Michigan neurosurgeon, inserted dilating tubes through a series of small incisions up and down her spine. The tubes spread apart her muscles rather than ripping through them, providing a path for screws drilled into the sides of every vertebrae composing the curve.

As in the open procedure, metal rods were guided through the heads of the screws along both sides of the spine, straightening it. The screws and rods were placed without direct visualization, using CT and fluoroscopy (real-time X-ray) to guide the surgical team.

The technical demands of this kind of surgery may add an hour or more to operating room times, which can increase the costs. Proponents think it is worth it.

“I see a lot of patients who’ve had big surgeries done,” La Marca said. “The muscle tissue is horrible, de-vascularized, de-nervated, causing back ache, and what little muscle is left is very fatigued and left in spasm. We can’t do anything for these patients and they are miserable.” The new procedure still fuses a curved spine straight, using the same bone graft, and similar screws and rods, but getting to that point, he says, is ultimately less damaging to the patient.

Dr. David Polly, chief of the spine service in the Department of Orthopaedic Surgery at the University of Minnesota, acknowledges the excitement surrounding minimally invasive surgery, but points out that so far, doctors have demonstrated only short-term results, such as shorter hospital stays, less ache, decreased blood loss and quicker recoveries.

Polly, who also serves on the board of the Scoliosis Research Society, wonders whether there will be any long-term benefit to sparing muscle tissue. Once the spine is fixed straight, it won’t bend where the metal rods are in place, he points out, “so we don’t know if it’s important or not” to preserve muscle.

The data are just arriving on longer-term, post-operative effects of minimally invasive scoliosis surgery. Dr. Neel Anand, director of orthopedic spine surgery at Cedars-Sinai Spine Center in L.A., provided The Times with data last week that he will present at the SRS’ international meeting next month showing that a study group of 24 patients who had curves averaging more than 42 degrees maintained deformity correction one year after surgery to an average of 6.5 degrees. Anand says these findings show “we absolutely can maintain good correction and get good correction.” (Anand is a paid consultant for Medtronic and receives royalties for his contributions to the design of the screws used in the minimally invasive surgeries.)

The only published study to date on the technique is also Anand’s, a case series of 12 adult patients with symptomatic lumbar scoliosis who had two to eight levels fused. For those patients, the only significant short-term complication was hip flexor weakness, which resolved within six weeks.

Anand says his patients usually go through a number of treatments before trying surgery, and if they haven’t he will send them to try various options — such as physical therapy, epidural injections or acupuncture — before resorting to surgery.

McInnis tried symptomatic treatment first, including spinal injections and achekillers.

At work full-time since January, McInnis stands 1 3/4 inches taller now and double-takes when passing a mirror. “If people didn’t try new procedures, we’d never go anyplace in life,” she said. “We wouldn’t be doing spinal surgeries at all, because people would be too scared.”

source: latimes.com

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NASCAR’s Gordon has procedure to treat back pain

By Dustin Long
The Virginian-Pilot
© May 20, 2009

Jeff Gordon had a procedure done on his ailing back Monday and reports “it went well.”

Gordon has struggled with back pain in recent years and it has gotten progressively worse.

Gordon said he had a facet block procedure Monday.

A needle is typically inserted into center of the facet joint to inject an anti-inflammatory medication. The facet joints are small stabilizing joints located between and behind adjacent vertebrae.

“I was a little sore after the procedure, but I’ll definitely take that brief bit of soreness if it stops the recurring back pain I’ve had,” Gordon said in a statement issued Tuesday. “I hope that will end the back issues I’ve been having, but it’s too early to tell if that fixed the problem.”

Gordon should find out soon. He’s scheduled to participate in a karting event today for the Jeff Gordon Foundation and the Jeff Gordon Children’s Hospital in Concord, N.C., then practice and qualify Thursday for the Coca-Cola 600. He’ll also have two practice sessions Saturday and the season’s longest race Sunday.

“I’m really looking forward to the event,” Gordon said. “Obviously, I want to see how my back does, but I also think we can challenge for the win.”

LOOKING FOR HELP

Defending Coca-Cola 600 winner Kasey Kahne said he can’t wait until the Dover race May 31 because it’s the first time Richard Petty Motorsports is scheduled to use the new Dodge engine.

Kurt Busch has used the newer version to climb to third in the points for Penske Racing. Busch said the engine has played a key role in his team’s turnaround.

Kahne, 16th in the points, hopes the engine can do the same for him.

“When we get the R-6 (engine) for Dover, I think that’s going to be a big help,” he said. “Hopefully we get that and that will… show how good our cars really are.”

NEW LOOK

Jimmie Johnson will sport a new ‘do this weekend at Lowe’s Motor Speedway.

“I was at a friend’s house for a barbecue on Sunday,” Johnson said. “And his kids thought - there were a bunch of neighborhood kids - they thought it would be a great idea to shave our heads. And one of the fathers agreed to do it.

“Then once he pulled it off, he started harassing me and the kids were there and they wanted to do it so bad. It was funny. Got some great photos and the kids all had a great laugh. And what the heck, it will grow back. My wife, she couldn’t look at me for like 10 minutes.”

GOOD EATING

Lowe’s Motor Speedway will host an invitation-only barbecue contest this weekend. Among the entrants will be Chesapeake’s Wood Chicks BBQ. Competitors will begin selling their fare Thursday.

PIT STOPS

Kurt Busch will drive the same car this weekend he won with at Atlanta earlier this season…. Tony Stewart turns 38 today…. Joey Logano turns 19 Sunday, the day of the Coca-Cola 600…. Penske Racing hired Sean Powell as its head strength and conditioning coach. He worked the past eight years with the Carolina Panthers…. USARacing announced the Hampton Convention & Visitor Bureau has been named the title sponsor of the Pro Cup Series’ third event of the season. The Hampton Virginia 250 is scheduled for a 7 p.m. start Saturday at Langley Speedway.

- Dustin Long

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What is a disc

The spine is made up of the vertebrae (the bones making up the spine), which have cartilage discs between them.

The discs consist of a circle of connective tissue with a central gel-like core. This makes the spine flexible and at the same time acts as a protective buffer.

In the centre of this column of vertebrae and discs is the spinal canal, which contains the spinal cord stretching from the brain-stem down to the first or second lumbar vertebra. It continues as a bundle of nerve fibres called the cauda equina stretching down towards the sacrum, which is the extension of the spine. Between each vertebra, the spinal cord has nerve root connections to other parts of the body.

The spine is divided into three parts:

neck (cervical vertebrae)

chest (thoracic vertebrae)

the lower back (lumbar vertebrae).

The spine is connected to the ribs at the chest.

What is a slipped disc?

A slipped disc is when the soft part of the disc bulges through the circle of connective tissue. This prolapse may push on the spinal cord or on the nerve roots. However, it is worth noting that 20 per cent of the population have slipped discs without experiencing any noticeable symptoms.

The term ’slipped disc’ does not really describe the process properly - the disc does not actually slip out of place, but bulges out towards the spinal cord.

What is the cause of a slipped disc?

A slipped disc occurs due to the breaking down of the circle of connective tissue with advancing age. This causes a weakness allowing the soft part to swell.

Slipped discs most often affect the lower back and are relatively rare in the chest part of the spine.

It is possible that hard physical labour can increase the likelihood of a slipped disc. They are also occasionally seen following trauma such as an injury from a fall or a road traffic accident.

At what age can a slipped disc occur?

A slipped disc in the lower back is most often seen between the ages of 30 and 50. In the cervical vertebrae around the neck, slipped discs are most often seen between the ages of 40 and 60.

What are the symptoms of a slipped disc?

A slipped disc can be symptom free. If it causes pain, it is primarily due to the pressure on the nerve roots, the spinal cord or the cauda equina.

Symptoms of nerve root pressure

Paralysis of single muscles, possibly with pain radiating to the arms or legs. There may also be a disturbance of feeling in the limbs.

Symptoms of pressure on the spinal cord

Disturbance of feeling, muscle spasms or paralysis in the part of the body below the spinal cord pressure. For example, pressure on the spinal cord in the chest area will cause spasms in the legs but not in the arms.

Pressure on the spinal cord may cause problems with control of the bladder.

Symptoms of pressure on the cauda equina

The symptoms can include loss of control of the bladder function, disturbance of feeling in the rectum and the inside of the thighs and paralysis of both legs. These are serious symptoms and anyone developing them should contact a doctor immediately. (They are so-called ‘red flag’ symptoms.)

How does the doctor make a diagnosis?

It is possible to make a diagnosis from the patient’s history and the doctor’s physical examination.

In many cases it is possible to determine which disc is affected. This can be confirmed either by a CT scan, MRI scan or a myelography - an injection into the spinal cord canal.

The doctor will decide which examination is necessary.

An ordinary X-ray of the spine is usually taken as well, but is much less use diagnostically than a scan or myelogram.

It is important to make a correct diagnosis because several other diseases have similar symptoms. Any ‘red flag’ symptoms must be acted upon without delay.

How is a slipped disc treated?

It is generally agreed that a slipped disc should be treated conservatively, with surgery being considered only when other approaches to treatment have failed.

The treatment will typically mean a brief period of bed-rest with appropriate painkillers. Physiotherapy or chiropractic treatment should also be explored.

Whether to have an operation or not, is a decision for a specialist.

When there are symptoms of pressure on the spinal cord or on the cauda equina, an operation should be performed as soon as possible.

Cases involving serious or increasing paralysis should be treated as an emergency and admitted to hospital for assessment immediately.

When there are changes in the symptoms, a doctor should be consulted. Significant changes in bladder habits or control, increasing paralysis of the limbs or muscle spasticity should always receive immediate medical assessment.

Based on a text by Dr Per Rochat, Dr Henrik Wulff Christensen, chiropractor and Jan Hartvigsen, chiropractor

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