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Suggest remedies for recurring back pain post an injury

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Posted on Sat, 7 May 2016
Question: Hello,



I am asking this question on behalf of my father who is 63 years of age.

About 2 years back, in an accident where he slipped on the floor he suffered an injury involving his back. The MRI report is attached.

Since then he has to take precaution to prevent excessive jerky motion. Though he can walk and drive, but occasionally it starts paining if the road he is driving is bad. Most times he wears a Lumbar belt on his waist area to prevent any movement or jerks. Surgery was suggested to install plates but he does not want to take the risk.

The question is whether there is any other slow healing process through some physiotherapy or exercise through which his situation can improve.
doctor
Answered by Dr. Olsi Taka (53 minutes later)
Brief Answer:
Surgery to stop further damage, some symptoms may remain, no report uploade

Detailed Answer:
I read your question carefully and I appreciate your concern about your father.

Generally speaking when damage to the spinal cord is partial some improvement is hoped to be achieved through intense physical therapy. The percentage of improvement varies according to the degree and site of damage as well as from individuals, each patient is different in its recovering capabilities.

However what makes me pessimistic in your father's case is the time issue. Improvement takes place during the first year, the period in which it is hoped new connections are formed between nerve cells to compensate. In some individuals this process can go beyond one year. However you speak of two years having already passed and by now that process should be finished. So I am afraid not much improvement can be expected at this point if damage has been done that long ago.

I do not see any MRI report uploaded. I see from past questions you have had the same issue with my colleague Dr Panwar. I don't know what you are doing wrong, other users haven't had issues uploading report, in the interface there should be an upload reports sections where you can upload your report in jpg or pdf (perhaps other formats are processed as well but these seem to be the ones most commonly used by other users).

As for the surgery, I can only assume that it has been proposed because there is instability of the spine which risks to progress and cause even further compression and damage (spondylolisthesis - a slip of the vertebrae perhaps would be my guess in the absence of the MRI). So the plate and screws are used to stop that from happening, stop even more disability, but not necessarily reverse the long standing previous damage.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka (2 hours later)
Dear Dr Olsi

Finally i was able to attach the MRI report today. Please review the same and let me know.

Its not that my father has not had any improvement. He is able to do all normal chores, drive and travel all over the place. Its just that he need to be cautious not to exert himself. If he has a rough movement once in a while he needs to rest again and before it becomes better again.
On the issue of surgery the docs suggested he could avoid it if he can continue to take care of him as the damage is not too severe. Most times he takes care of himself by wearing a lumbar belt. He was not comfortable with the thought of having a mechanical part inserted into the spine and does not believe the case is so extreme that he needs to do it.

What will be interesting is to learn if there are any healing exercises / any other therapy which makes his spine better and less prone to developing occasional pain. Is Chirotherapy an option?

Regards,
XXXX
doctor
Answered by Dr. Olsi Taka (3 hours later)
Brief Answer:
Read below

Detailed Answer:
Finally yes, I can see the MRI report now.

If I was to judge by that MRI I would say that surgery is not necessary as there is no active compression on the spine, so if the situation has not changed since then there is no need for surgery. One other indication apart from spinal cord compression might be nerve root compression due to the described impingement of the foramina, but the report says that leads to no compression.

So situation is not as bad as I initially though, there is no damage to the spinal cord as I assumed, the damage is to the supporting vertebral structures.

Now regarding healing, the healing process of the fractures has ended now. Unfortunately because the balance of the supportive system has changed from the compression of the vertebral bodies other vertebrae suffer as well. Also the vertebral column of each of us undergoes degenerative changes with age due to the wear and tear over the years, even with no trauma, so the trauma accelerates these changes. For that reason I fear as he is not getting younger some pain will likely always bother him, I am sorry.

Whether other measures might help in reducing that....physical therapy is the mainstay of treatment the only means proven by studies.
As for chiropractice it uses techniques which aim to manipulate joints, mobilizing them. As it is not exercised by medical professionals there are not many studies and the few there are have not shown any major benefit. There are some indications it may have a mild benefit in lumbar pain so I do not generally oppose its use for that. However in your father's case where there was a fracture not simply age related degenerative changes, I would be reluctant to do it for fear of joint manipulation causing damage instead of helping.
One alternative medicine method you might try might be acupuncture. Again there are not many studies to have proven benefit, but at least it is considered safe and wouldn't risk causing damage.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Olsi Taka

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Practicing since :2004

Answered : 3669 Questions

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Suggest remedies for recurring back pain post an injury

Brief Answer: Surgery to stop further damage, some symptoms may remain, no report uploade Detailed Answer: I read your question carefully and I appreciate your concern about your father. Generally speaking when damage to the spinal cord is partial some improvement is hoped to be achieved through intense physical therapy. The percentage of improvement varies according to the degree and site of damage as well as from individuals, each patient is different in its recovering capabilities. However what makes me pessimistic in your father's case is the time issue. Improvement takes place during the first year, the period in which it is hoped new connections are formed between nerve cells to compensate. In some individuals this process can go beyond one year. However you speak of two years having already passed and by now that process should be finished. So I am afraid not much improvement can be expected at this point if damage has been done that long ago. I do not see any MRI report uploaded. I see from past questions you have had the same issue with my colleague Dr Panwar. I don't know what you are doing wrong, other users haven't had issues uploading report, in the interface there should be an upload reports sections where you can upload your report in jpg or pdf (perhaps other formats are processed as well but these seem to be the ones most commonly used by other users). As for the surgery, I can only assume that it has been proposed because there is instability of the spine which risks to progress and cause even further compression and damage (spondylolisthesis - a slip of the vertebrae perhaps would be my guess in the absence of the MRI). So the plate and screws are used to stop that from happening, stop even more disability, but not necessarily reverse the long standing previous damage. I remain at your disposal for other questions.