What are spine topics?

From the Guidelines

For patients with low back pain, spinal manipulation, and other non-pharmacological interventions such as yoga and transcutaneous electrical nerve stimulation (TENS) should be considered as initial treatment options. The American College of Physicians and the American Pain Society have jointly recommended these approaches in their clinical practice guideline for the diagnosis and treatment of low back pain 1. Key spine topics include common conditions such as herniated discs, spinal stenosis, degenerative disc disease, scoliosis, and spondylolisthesis. Treatment approaches range from conservative management to interventional procedures and surgical options for severe cases.

Some of the key interventions for low back pain include:

• Spinal manipulation: Manual therapy in which loads are applied to the spine by using short- or long-lever methods and high-velocity thrusts are applied to a spinal joint beyond its restricted range of movement.
• Traction: An intervention involving drawing or pulling in order to stretch the lumbar spine.
• Transcutaneous electrical nerve stimulation (TENS): Use of a small, battery-operated device to provide continuous electrical impulses via surface electrodes, with the goal of providing symptomatic relief by modifying pain perception.
• Yoga: An intervention distinguished from traditional exercise therapy by the use of specific body positions, breathing techniques, and an emphasis on mental focus.

Maintaining spine health involves proper posture, regular exercise focusing on core strength, maintaining healthy weight, proper lifting techniques, and ergonomic workspaces. Understanding these topics helps in prevention, early intervention, and appropriate management of spine-related conditions, ultimately reducing morbidity, mortality, and improving quality of life 1.

From the Research

Lumbar Spinal Stenosis

• Lumbar spinal stenosis is a prevalent and disabling cause of low back and leg pain in older persons, affecting an estimated 103 million persons worldwide 2.
• The prevalence of the clinical syndrome of lumbar spinal stenosis in US adults is approximately 11% and increases with age 2.
• Diagnosis can generally be made based on a clinical history of back and lower extremity pain that is provoked by lumbar extension, relieved by lumbar flexion, and confirmed with cross-sectional imaging, such as computed tomography or magnetic resonance imaging (MRI) 2.

Treatment Options

• Nonoperative treatment includes activity modification, oral medications to diminish pain, and physical therapy 2, 3, 4.
• Epidural steroid injections have been shown to be effective in reducing pain and disability in the short term, but long-term benefits have not been demonstrated 2, 3, 4, 5.
• Surgery appears effective in carefully selected patients with back, buttock, and lower extremity pain who do not improve with conservative management 2.
• Physical therapy combined with epidural steroid injection may be effective in improving quality of life factors such as emotional function, emotional well-being, and perception of general health 4.

Effectiveness of Treatment

• A randomized trial of 94 participants with symptomatic and radiographic degenerative lumbar spinal stenosis found that decompressive laminectomy improved symptoms more than nonoperative therapy 2.
• A randomized controlled trial found that epidural steroid injection plus physical therapy was not superior to epidural steroid injection alone for reducing disability in individuals with lumbar spinal stenosis, but significant benefit was found for the addition of physical therapy related to quality of life factors 4.
• A systematic review found that epidural steroid injections probably reduce short-term pain and disability in cervical and lumbar radiculopathies, and possibly decrease long-term disability 5.

Diet and Nutrition

• Individuals with spinal cord injury are at high risk for obesity and several chronic cardiometabolic disorders due to a deterioration in body composition, hypometabolic rate, and endometabolic dysregulation 6.
• A proper diet for individuals with spinal cord injury should distribute carbohydrates, protein, and fat to optimize a lower energy intake requirement and should stress foods with low caloric yet high nutrient density 6.