Conquer Back and Neck Pain - Walk It Off! (31 page)

In the case of the repair of a degenerative disc, the missing cell function must be replaced for the patient’s entire lifetime. This means that the missing or defective genes that ultimately are responsible for disc degeneration must be replaced in the disc cells. First the genes must be identified, then they must be inserted into the disc cells, and the cells must live long enough to repair and maintain a normal functioning disc. So how can all of this be accomplished?

First of all, disc cells are around for a long time — maybe as long as we live. That is, you may be given your full complement of disc cells from the very beginning, and that is all you get. Therefore, genetically altered disc cells would be around long enough to favorably influence the disc.

Second, disc cells are trapped in a matrix where there is no blood circulation to whisk away injected genes.

Third, a number of missing or defective genes responsible for production and maintenance of normal disc tissue have been identified and can be replicated. Finally, there are ways of piggybacking these genes onto harmless viruses that can carry them inside of disc cells where they can be put to work.

Research bench studies and animal studies have shown that you can genetically influence defective disc cells to produce a normal connective-tissue matrix. Test-tube studies are now in progress to determine the safest and most effective ways of transferring genes into human disc cells. I suspect that practical gene therapy to repair degenerated discs is just around the corner. In the meantime, nothing beats taking care of your own discs by exercising and avoiding those things (such as smoking and lack of exercise) that I have mentioned before!

Despite these remarkable new ideas for treating back pain, the best, safest, and most cost-effective cure is under your control. You and you alone can determine how you will take care of that remarkable engine, your body, and in particular your back, so that it will last a lifetime. You and you alone can prevent your suffering from back pain. The biggest breakthrough in treatment and prevention of back pain resides in your understanding of the problem and how you can solve it through good health habits.

I hope this book has helped you understand your problem and to find the best and safest way to “conquer back and neck pain”.

–Dr. Mark Brown, Miami, Florida

Glossary

acupuncture:
An elaborate oriental method that uses needles to stimulate specific anatomical sites under the skin to relieve pain

adjustments:
A form of treatment in which the spine is passively manipulated; chiropractic method

ankylosing spondylitis:
A form of arthritis of the spine that causes it to become stiff, brittle, and bent forward; sometimes referred to as “bamboo spine” because of its appearance on x-ray

annulus fibrosus:
The tough, outer rim of the spinal disc that contains the spongy center (nucleus pulposus)

anterior interbody spinal fusion:
Spinal fusion that is performed from the front of the spine, with a bone graft replacing the entire spinal disc

anti-coagulants:
Medications that interfere with normal blood clotting; aspirin, most anti-inflammatory medications, Coumadin, vitamin E, and Plavix are the most common

aortic aneurysm:
A blowout of the major blood vessel that leads from your heart to your body; depending on where it occurs, it can cause severe spinal pain; it can be a life-threatening condition

asceptic necrosis of the hip:
Death of the ball portion of the hip joint; can occur from taking steroids by mouth as well as a number of other causes

banked bone:
Bone that is taken from cadaver donors and stored in a tissue bank

BMD:
Bone mineral density:
a measurement used to detect osteoporosis

BMP:
Bone morphogenic protein:
a naturally occurring protein in your body that stimulates new bone formation; genetically engineered BMP is used to stimulate spinal fusion

bulging disc:
Narrowed spinal disc that bulges circumferentially like a flat tire on a car

carpal tunnel syndrome:
Pain and numbness in the hand caused by compression of the median nerve in the carpel tunnel of the wrist

CAT scan:
Computer-assisted tomography: a diagnostic X-ray that provides a three-dimensional picture of the body part scanned

cauda equina:
Cauda equina (literally means horse’s tail in Latin) is the term applied to the multiple nerves that extend from the lower part of the spinal cord in the low back to your legs, your bowel, and your urinary bladder

cauda equina syndrome:
Symptoms of severe back and leg pain associated with change in bowel and bladder function, numbness in the pelvic area, and loss of muscle strength in the leg(s) as the result of pressure on the cauda equina in the low back

central pain:
A term coined by the author to describe a state of lowered threshold to pain secondary to altered pain modulation systems in the brain

cervical spine:
That part of the spine that comprises the neck

chiropractic:
Treatment method based upon a concept of joint misalignment (subluxation), particularly of the spine; practiced by chiropractors

chymopapain:
An enzyme extracted from papaya fruit; it was widely used throughout the world to dissolve herniated discs

claudication:
An aching, burning, and/or cramping sensation in the extremities brought on by activity; see neurogenic claudication and vascular claudication

claustrophobia:
Fear of enclosed spaces

coccyx:
The lower tip of the spine, “tail bone”

cosquillitas:
Spanish meaning “little tickles”; a treatment method invented by the author to relieve musculoskeletal pain; works like acupuncture

COX-2 inhibitors:
Anti-inflammatory medications that were designed to give pain relief with less risk of the bleeding and stomach irritation that are seen with other anti-inflammatory medication

disc degeneration:
A condition in which the normal cushioning function of the spinal disc is lost through a process that is genetically determined

disc excision:
Removal of that part of a herniated disc that is causing pain

discogenic pain:
Pain arising from an abnormal spinal disc

discography/discogram:
Diagnostic test in which x-ray contrast dye is injected into a spinal disc to determine the source of spine pain and the degree of disc degeneration

dura:
Membrane that covers the brain, spinal cord, and origin of the spinal nerves; it contains the spinal fluid

electromyogram:
see EMG/NCV

EMG/NCV:
Electromyogram and nerve

conduction velocity:
a diagnostic test performed by placing needles in muscles and stimulating the nerves to the muscles; used to diagnose neuropathy and other neurological disorders

endorphins:
Naturally occurring painkillers in the body

epidural hematoma:
Hemorrhage into the space surrounding the brain or spinal cord; can be a complication of surgery, secondary to anti-coagulants, or from trauma; can result in nerve damage or paralysis

epidural steroid injection:
Treatment method of injecting a small amount of local anesthetic and steroid medication directly into the area of the spine where a nerve is being irritated by a herniated disc

evidence-based medicine:
Process through which the medical community determines the effectiveness and safety of a treatment based upon clinical research data

extruded discs:
A disc herniation that has ruptured completely through the outer rim of the disc

facet joint cyst:
Cyst on the facet joint that results from degenerative arthritis; these cysts are benign but can recur after being removed; they may cause symptoms of spinal stenosis

facet joints:
Finger-sized joints that are located behind and to either side of each spinal disc and form the roof and walls of the spinal canal

facet rhizotomy:
Treatment for back pain in which the sensory nerves to the facet joints are cut, frozen, poisoned, or destroyed with an electrical current

failed back syndrome:
Recurring painful disorder after spinal surgery

femoral-stretch-test:
A physical examination maneuver in which the patient is lying face down on a flat surface and the examiner bends the knee until pain is experienced in front of the thigh; most commonly seen with disc herniations in the low back

flat back:
Loss of the normal concavity of the low back

fluoroscopy:
X-ray technique in which real-time movement of the bony anatomy can be observed

foot drop:
Weakness of the muscles that lift the foot off of the floor; can cause slapping of the foot on the floor while walking

foramenotomy:
Surgical opening of the channels containing the spinal nerves

herniated disc (HNP):
Associated with a tear in the rim of the disc (annulus fibrosus) with the center of the disc (nucleus pulposus) herniating through the tear.

IDET:
Intradiscal electro-thermal therapy:
a treatment for back pain in which the nerves near the spinal discs are cooked with a heating probe

idiopathic low back pain:
Term for common attack of back pain in which the exact cause of the pain cannot be determined

kyphosis:
Rounding of the spine as seen from the side; normally the chest has some kyphosis, but when it becomes abnormal the person looks as if they are hunched forward

L5-S1 disc:
Spine disc between the 5th lumbar vertebra and the sacrum; usually the lowest disc in the low back, although some people have an L6-S1 disc and in some people the lowest disc is the L4-S1 disc

laminectomy:
Removal of part of the roof of the spinal canal in order to view and remove a disc herniation

lordosis:
The normal concavity of the low back when seen from the side

lumbar spine:
That part of the spine that comprises the low back with the belly in front and surrounded behind and to the sides by muscles

Marfan’s Syndrome:
Inherited disorder characterized by tall stature and long thin figures and can cause severe spinal pain from rupture of the aorta (largest artery in the body)

meta-analysis:
A medical research technique that involves a systematic review of a large number of peer-reviewed publications about a treatment

micro-surgery:
Surgery that is performed through a small incision using a microscope at between 5 and 10X magnification

minimally invasive spine surgery:
Description of a variety of surgical techniques of the spine that are performed through a small incision and/or arthroscopic type of devices

MRI:
Magnetic Resonance Imaging: a diagnostic test that produces a picture of the body anatomy without X-ray exposure

myelogram:
A diagnostic test in which X-ray contrast dye is injected into the spinal fluid in the spinal canal

myelopathy:
A disease of the spinal cord that causes loss of balance, stumbling, aches and pains in the arms and legs, and propensity to fall

neurofibroma:
Benign, slow-growing tumors of the nerves; can cause back pain with sleep disturbance

neurogenic claudication:
Aching pain in the legs or arms aggravated by activity and relieved by rest; the result of constriction of the spinal nerves by spinal stenosis

neurogenic pain:
Pain arising from stimulation of a nerve

neurologist:
Medical specialist in diseases of the brain and spinal cord

neuropathy:
Disease of the nerves in the extremities characterized by annoying sensations of numbness and tingling; usually associated with diabetes; affects the lower legs and feet

neurosurgeon:
Surgical specialist in diseases of the brain and spinal cord

nucleus pulposus:
The gelatinous spongy center of the spinal discs that distributes the weight of the spine; contained by the annulus fibrosis

orthopaedic surgeon:
Medical and surgical specialist in bone, joint, and spine disorders

osteoid osteoma:
Pea-sized benign bone lesion that can cause pin-point spine pain relieved dramatically by aspirin

osteophytes:
Commonly called “bone spurs,” bone projections that form on the edge of the vertebrae adjacent to a loose degenerated disc

osteoporosis/osteopenia:
Literally means porous bones; a condition that results from not enough calcium in the bones

pain drawing:
Front-and-back blank silhouette of the body on which patients draw symbols depicting the location and type of pain they are experiencing

pain management specialist:
Medical doctors who treat acute and chronic pain disorders

Parkinson’s disease/syndrome:
Movement disorder that is associated with a tremor, rigid muscles and a shuffling gait

pars interarticularis:
That part of the spine that attaches the facet joint to the pedicle; a defect in this structure is associated with slippage of the spine (spondylolisthesis)

pediatric orthopaedist:
Orthopaedic surgeon who treats bone and joint diseases in children up to the age of 18; they usually treat scoliosis (curvature of the spine)

pediatrician:
Doctor who treats children from birth to age of 18

pedicle:
Bones that come off of the back of the spine vertebra on each side that act as the wall of the spinal canal and the attachment of the facet joints, lamina, spinous and transverse processes of the spine; this is the structure in which pedicle screws are placed

pedicle screws:
Bone screws that are designed to be placed in the pedicles (walls) of the spine; they are attached to rods or plates to aid in spinal fusion

peripheral neuropathy:
see neuropathy

physiatrist:
Physical medicine and rehabilitation specialist who diagnoses and treats neruro-musculoskeletal disorders with special emphasis on rehabilitation

physical therapist:
Health care providers who deal with assessment of neuro-musculoskeletal disabilities and the restoration of function using physical methods such as exercise

placebo:
An inactive medicine or treatment used in controlled clinical research trials to compare to the treatment being tested

posterior interbody spinal fusion:
Spinal fusion performed from behind, with bone graft replaceing the entire disc

posterior lateral spinal fusion:
Spinal fusion that is performed from behind and alongside the spinal canal

prolapsed discs:
A herniated disc that has not ruptured completely though the outer rim of the disc

retrograde ejaculation:
An abnormality of male sexual climax where the semen is projected backward into the urinary bladder rather than forward out of the penis; can be a complication from surgical exposure of the discs in the low back for an artificial disc replacement or fusion

rheumatoid arthritis:
A form of arthritis that causes deformity of the hands and can cause serious instability of the spine in the neck

rheumatologist:
Medical specialist in diagnosis and treatment of arthritis and other painful diseases of the bones, joints, and spine

rhizotomy:
see facet rhizotomy

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