A Patient's Guide to Sacral Insufficiency Fractures

Introduction

There are blood vessels along the nerve root that pulse with each heart beat. For a successful nerve root decompression, the surgeon must be able to see the nerve root pulsing freely. That indicates the decompression has been complete.

Minimally invasive surgery to decompress the nerve pressed by a herniated or protruding disc is state-of-the-art now. The procedure is called a microdiscectomy. The surgeon makes a tiny incision in the skin and places an endoscope through the soft tissues to the affected area.

Patients' belief systems have a lot to do with how they respond (or don't respond) to treatment. If you think your pain is an indication that there's something wrong or that anything that makes it hurt is actually damaging your spine, then exercise and activity won't seem helpful to you.

Cognitive-behavioral therapy or CBT is a way to help patients understand their beliefs about pain and how it is affecting their recovery. Studies have shown that our beliefs about pain are linked with pain intensity, psychologic distress, and even physical disability.

The use of strong pain-relieving medications is often referred to as rescue medication. Usually acetaminophen (Tylenol®) or nonsteroidal antiinflammatory drugs are used first. But if the pain is too intense and doesn't respond well, then more powerful drugs are used for a short time. This is referred to as rescue medication.

Studies show that most back pain does not have a known, direct cause. For most patients with low back pain, an underlying pathologic disorder just doesn't exist. Once the physician has ruled out tumors, infection, or fractures, then it's time to look for a mechnical cause.

In this article, two family medicine physicians offer a prescription for conducting a quick (10-minute) exam of the low back. The target population is adults with acute low back pain (LBP). This information is helpful since the majority of patients with LBP don't have a clear cause of their painful symptoms. And most physicians don't have the luxury of keeping hour-long appointments with their patients.

The author of this article (Dr. T. Hoogland) has been involved for many years in performing lumbar discectomies (disc removal). The surgical technique has improved over the last two decades. Fifteen years ago, Dr. Hoogland developed new surgical tools to enhance the procedure. Special reamers are now available to make more room for an endoscope and other surgical instruments.

Pain beliefs are linked with pain intensity, psychologic distress, and disability. Having the wrong understanding or belief about the cause of your low back pain (LBP) can be more harmful than the problem causing the LBP.