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Tag: lifestyle

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By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Advanced Practice Registered Nurses (APRN), Chiropractic Care, Sleep Hygiene , , , , , , , , , , , , , , , , ,

Pseudoarthrosis After Spinal Fusion Surgery Explained

What is pseudoarthrosis of the cervical and lumbar spine?

Pseudoarthrosis of the cervical and lumbar spine

Individuals may need a spinal fusion to treat a fractured vertebra, scoliosis, or conditions like spinal stenosis, degenerative disc disease, and spondylolisthesis/slipped vertebrae. A spinal fusion reduces pain and stabilizes the spine by limiting movement between vertebrae. Pseudoarthrosis happens when the bones don’t heal after a fracture or bone surgery. When pseudoarthrosis affects the cervical or lumbar spine, it means that two vertebrae did not heal and grow together after spinal surgery to fuse them (spinal fusion). Reasons for a failed spinal fusion include:

  • Issues with the instruments used to stabilize the bone
  • Lack of bone growth
  • The number of vertebrae being fused.

The patient’s health and lifestyle play a role in failed fusions, which can include

  • Diabetes
  • Inflammatory health conditions increase the risk
  • Smoking
  • Long-term steroid use

In many cases, revision surgery is needed.

Surgery-Related

During a spinal fusion, surgeons insert a bone graft between two vertebrae and then apply spinal fixation hardware (instrumented spinal fusion) that includes:

  • Plates
  • Rods
  • Screws
  1. The bone graft promotes growth between the two bones.
  2. The hardware stabilizes the vertebrae and prevents movement while they fuse and grow together.
  3. The hardware goes inside, or internal fixation.
  4. Although rare, a severe spinal fracture or deformity may need external fixation.
  5. A rigid frame secured outside the body helps to stabilize the bones.

If the fusion fails, it could be caused by one or more of the following surgical issues:

Number of Vertebrae Being Fused

Hardware

  • The surgeon must carefully plan and use the right hardware.
  • The type of hardware used during a spinal fusion may influence bone healing.
  • The instruments can come loose or break, interfering with the fusion process.
  • Spinal osteoporosis, having thin, weak bones, can affect fixation.
  • Even with the optimal surgical preparedness, weak bones significantly increase the chance of the instruments loosening and pseudoarthrosis developing.

Bone Graft

  • The type of bone graft used may affect the fusion.
  • For example, in cervical/neck spinal fusions, an autograft, which uses a small piece of bone from the patient’s body, has a higher success rate. (Verla T. et al., 2021)
  • Other graft options include specialized steel cages that fit between vertebrae and contain bone growth factors.
  • The surgeon recommends the optimal bone graft for the type of surgery, the number of vertebrae involved, and risk factors.

Risk Factors

  • The patient’s overall health and lifestyle impact the results of spinal fusion. Smoking increases the risk. (Berman D. et al., 2017)
  • Nicotine restricts blood circulation, decreases bone density, reduces new bone formation, and delays bone healing. (Hernigou J., & Schuind F., 2019)

The risk of pseudoarthrosis increases if the individual has any of the following: (Scoliosis Research Society, 2023)

  • Previous pseudoarthrosis
  • Obesity
  • Chronic steroid use
  • Malnutrition
  • Inflammatory diseases

Inflammatory conditions that can lead to bone loss and non-optimal bone healing include: (Torres H. M. et al., 2023)

  • Diabetes (Jiao H, Xiao E, & Graves DT, 2015)
  • Inflammatory bowel disease
  • Psoriasis
  • Rheumatoid arthritis
  • Chronic obstructive pulmonary disease/COPD
  • Periodontitis
  • Systemic lupus erythematosus/SLE

Symptoms

  • The primary sign of pseudoarthrosis is pain in the same area as before the fusion surgery.
  • If the bones pinch a spinal nerve, one arm may experience pain, tingling, burning, or numbness.
  • Rarely does a pinched nerve affect both arms.
  • The pain may return shortly after the procedure.
  • The pain may develop gradually or not appear for many months.
  • However, it’s more likely to appear after several months when the individual returns to their usual activities.

Diagnosis

  • The healthcare provider will learn about symptoms and perform a physical exam to evaluate the back.
  • They’ll assess mobility and the type of movement that causes pain.
  • Then, they order diagnostic imaging to see the spine and identify the cause of pain.
  • Individuals may need a CT scan, MRI, and/or X-rays to evaluate the spinal structures and instrumentation fully.

Treatment

Treatment for pseudoarthrosis will likely start with:

  • Physical therapy
  • Pain management – especially in cases where it is important to rule out other sources of back or neck pain.
  • Medication
  • Injections
  • If symptoms don’t improve with conservative care or if there is severe pain, the healthcare provider may recommend revision surgery.
  • Revision surgery is another procedure to treat complications or correct issues that arise after the initial pseudoarthrosis surgery.

Injury Medical Chiropractic and Functional Medicine Clinic

As a Family Practice Nurse Practitioner, Dr. Jimenez combines advanced medical expertise with chiropractic care to address various conditions. Our clinic integrates Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine to create customized care plans that promote natural healing, mobility, and long-term wellness. By focusing on flexibility, agility, and strength, we empower patients to thrive, regardless of age or health challenges. At El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we passionately focus on treating patients after injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility, and agility programs tailored for all age groups and disabilities. We use in-person and virtual health coaching and comprehensive care plans to ensure every patient’s personalized care and wellness outcomes.

Enhancing Health Together

References

Boonsirikamchai, W., Wilartratsami, S., Ruangchainikom, M., Korwutthikulrangsri, E., Tongsai, S., & Luksanapruksa, P. (2024). Pseudarthrosis risk factors in lumbar fusion: a systematic review and meta-analysis. BMC musculoskeletal disorders, 25(1), 433. https://doi.org/10.1186/s12891-024-07531-w

Verla, T., Xu, D. S., Davis, M. J., Reece, E. M., Kelly, M., Nunez, M., Winocour, S. J., & Ropper, A. E. (2021). Failure in Cervical Spinal Fusion and Current Management Modalities. Seminars in plastic surgery, 35(1), 10–13. https://doi.org/10.1055/s-0041-1722853

Berman, D., Oren, J. H., Bendo, J., & Spivak, J. (2017). The Effect of Smoking on Spinal Fusion. International journal of spine surgery, 11(4), 29. https://doi.org/10.14444/4029

Hernigou, J., & Schuind, F. (2019). Tobacco and bone fractures: A review of the facts and issues that every orthopaedic surgeon should know. Bone & joint research, 8(6), 255–265. https://doi.org/10.1302/2046-3758.86.BJR-2018-0344.R1

Scoliosis Research Society. (2023). Pseudoarthrosis. https://www.srs.org/Patients/Conditions/Pseudoarthrosis

Torres, H. M., Arnold, K. M., Oviedo, M., Westendorf, J. J., & Weaver, S. R. (2023). Inflammatory Processes Affecting Bone Health and Repair. Current osteoporosis reports, 21(6), 842–853. https://doi.org/10.1007/s11914-023-00824-4

Jiao, H., Xiao, E., & Graves, D. T. (2015). Diabetes and Its Effect on Bone and Fracture Healing. Current osteoporosis reports, 13(5), 327–335. https://doi.org/10.1007/s11914-015-0286-8

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Sleep Hygiene , , , , , , , , , , , , , , , , ,

Primary Insomnia Explained: Symptoms and Solutions

Could learning to apply healthy sleep hygiene habits help improve sleep and overall health for individuals with sleeping difficulties?

Primary Insomnia

Insomnia affects most adults at some point in their lives. Primary insomnia is a fairly common condition characterized by difficulty sleeping, and sometimes, it can resolve without treatment. A diagnosis of primary insomnia means that there is no need to worry that a medical or psychological issue is causing sleep problems. Secondary insomnia is the result of medication side effects or medical or psychological issues. However, individuals may need a diagnostic evaluation, including blood tests or an overnight sleep study, to determine an underlying cause for persistent insomnia. Managing lifestyle habits is usually effective for the relief of primary insomnia. If that doesn’t work, medical treatment may be recommended.

Symptoms

Primary insomnia means not getting enough sleep. Individuals with primary insomnia average six hours of sleep per night (Flynn-Evans E. E. et al., 2017). They often toss and turn or get out of bed frequently. Typically, primary insomnia makes it hard to fall asleep and/or stay asleep. Individuals can wake up easily by triggers like noises or even without triggers. Sleep deprivation can lead to several health problems when awake. Symptoms of insomnia fatigue include: (Salisbury-Afshar E. 2018)

  • Trouble waking up in the morning
  • Constant yawning
  • Feeling tired and sleepy throughout the day
  • Lack of energy for physical activity
  • Lack of motivation
  • Hunger
  • Difficulty concentrating
  • Irritability
  • Headaches
  • Hypersomnia or falling asleep during the day
  • Sensitivity to noise or lights when awake
  • Bouts of hyperactivity
  • Jumpiness
  • Being easily alarmed or frightened

Individuals can experience these symptoms for a few days in a row and resolve the day after a restful night of sleep or after a nap. There are times when fatigue can help with falling asleep, which helps to resolve insomnia.

Complications

Individuals can develop severe anxiety and distress about the fact that they are not getting enough sleep. This anxiety is usually more severe before going to bed or in the middle of the night, but the worry can continue during the day as well. Persistent insomnia and chronic lack of sleep can lead to depression and predispose the mind and body to health complications. (Sun, Q., & Tan, L. 2019) Insufficient sleep is associated with lowered immune system function, obesity, and heart disease. (Hung C. M. et al., 2018)

Causes

The conundrum of primary insomnia is that it does not have an identifiable cause, but certain risk factors predispose individuals to have primary insomnia. The condition persists throughout a person’s life, often worsening or improving for months or years. Primary insomnia can be more common among those who have family members with insomnia. Research has found that, while primary insomnia isn’t caused by psychiatric issues, tending to stress or a worry-prone personality might be predisposing factors. (Hung C. M. et al., 2018)

Circadian Rhythm

Research has found that primary insomnia is associated with circadian rhythm irregularities. Primary insomnia can result from individuals falling into deeper sleep phases earlier than those who don’t have the condition. (Flynn-Evans E. E. et al., 2017) However, it can be challenging to know whether early deep sleep is a cause or an effect of primary insomnia. This is because sleep deprivation can also lead to deep sleep’s abrupt or rapid onset.

Diagnosis

Getting enough sleep is a common concern throughout life. Diagnosing primary insomnia involves various steps. One of the main components of identifying insomnia is determining whether the individual needs more sleep than they are getting. For individuals who are unable to get the proper amount of sleep, the second aspect of primary insomnia diagnosis is focused on finding the reason for their lack of sleep. Diagnostic tests measure insomnia and its effects and include:

Sleep Study

  • A polysomnogram is an overnight sleep study measuring brain activity, muscle activity, and breathing.
  • The polysomnogram is expected to show decreased sleep and normal breathing patterns if it is primary insomnia. (Sun, Q., & Tan, L. 2019)

Pittsburgh Sleep Quality Index 

  • The PSQI is a questionnaire that includes a self-assessment of sleep.
  • It helps identify sleep patterns and issues like using the bathroom frequently at night.

Multiple Sleep Latency Test

  • An MSLT is a daytime nap study in which participants are monitored to determine how fast they fall asleep.
  • The test results are a reflection of your sleep deprivation.

These studies help assess whether an individual is not getting enough sleep and what type of sleep interruption is experienced. Other tests might include screening questionnaires or other assessments of emotional issues like depression and anxiety. Sometimes, individuals are aware of these problems but may dismiss symptoms of depression and anxiety, and they instead manifest as insomnia.

Ruling Out Underlying Causes

Medical causes of insomnia can include: (Guo H. M. et al., 2017)

  • Thyroid disease
  • Liver disease
  • Dementia
  • Restless leg syndrome
  • Breathing problems. 

Individuals might need to have tests to determine whether any of these underlying issues are contributing to their insomnia. Individual medical symptoms and physical examination would guide the diagnostic testing.

Sleep Hygiene Habits

Individuals can start making small lifestyle adjustments to help regulate their sleep. The key is to avoid things that prevent falling asleep when you want to. Healthy habits include:

  • Avoid caffeine in the afternoon or evening.
  • Avoid alcohol.
  • Avoid napping during the day.
  • Don’t turn on a phone, computer, or television screen in the bedroom before going to bed.
  • Staying away from bright lights for several hours before sleep.
  • Scheduling tasks so you feel caught up before going to sleep.
  • Getting enough to eat so you aren’t hungry before going to bed.
  • Not eating so much that you feel bloated before going to bed.
  • Doing some light exercise several hours before going to bed.

Medical Treatment

If lifestyle habits don’t help alleviate insomnia, talk to a healthcare provider about medical therapy. Some notice a benefit from treatment with non-prescription-based strategies like counseling, cognitive behavioral therapy for insomnia (CBT-I), or acupuncture. These approaches can have a longer-lasting effect without the risk of side effects. (Salisbury-Afshar E. 2018) A healthcare provider might recommend melatonin or may prescribe medication such as antidepressants, antihistamines, or benzodiazepines.

Injury Medical Chiropractic and Functional Medicine Clinic

Navigating insomnia can be challenging, but understanding the treatment process can significantly help the individual. A healthcare provider can determine the most effective treatment strategies. This can include physical therapy, rest, health coaching, and medication. Overcoming these limitations is possible. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

Building a Stronger Body

References

Flynn-Evans, E. E., Shekleton, J. A., Miller, B., Epstein, L. J., Kirsch, D., Brogna, L. A., Burke, L. M., Bremer, E., Murray, J. M., Gehrman, P., Rajaratnam, S. M. W., & Lockley, S. W. (2017). Circadian Phase and Phase Angle Disorders in Primary Insomnia. Sleep, 40(12), 10.1093/sleep/zsx163. https://doi.org/10.1093/sleep/zsx163

Salisbury-Afshar E. (2018). Management of Insomnia Disorder in Adults. American Family Physician, 98(5), 319–322.

Sun, Q., & Tan, L. (2019). Comparing primary insomnia to the insomnia occurring in major depression and general anxiety disorder. Psychiatry Research, 282, 112514. https://doi.org/10.1016/j.psychres.2019.112514

Hung, C. M., Li, Y. C., Chen, H. J., Lu, K., Liang, C. L., Liliang, P. C., Tsai, Y. D., & Wang, K. W. (2018). Risk of dementia in patients with primary insomnia: a nationwide population-based case-control study. BMC psychiatry, 18(1), 38. https://doi.org/10.1186/s12888-018-1623-0

Guo, H. M., Liu, M., Xiang, Y. T., Zhao, J., Ungvari, G. S., Correll, C. U., Ng, C. H., Chiu, H. F., & Duan, Z. P. (2017). Insomnia in Adults With Chronic Hepatitis B, Liver Failure, and Cirrhosis: A Case-Control Study. Perspectives in psychiatric care, 53(1), 67–72. https://doi.org/10.1111/ppc.12138