Glucosamine is a naturally occurring proteoglycan produced by the body and essential for proper joint function. Evidence suggests that not only does glucosamine sulfate help relieve joint pain in arthritis, it may actually help repair damaged joints and prevent the need for surgery.

Glucosamine sulfate increases tissue levels of sulfate, a substance which many scientists now believe is important in the creation of new cartilage glycosaminoglycans. Ironically, acetaminophen, a non-steroidal anti-inflammatory drug often taken to treat osteoarthritis pain, actually reduces levels of sulfate in the joints, essentially predisposing patients to more rapid degeneration of joint tissue.

A review performed in 2005 found that the weight of evidence from double-blind, randomized, controlled trials of oral glucosamine treatment of knee osteoarthritis (OA) helped reduce the progression of joint disease by 54% (Poolsup et al., 2005). What’s more, the review also noted a 41% reduction in pain and a 46% improvement in joint function. Such effects are thought to be due to glucosamine’s inhibition of inflammatory cytokines, tumor necrosis factor-alpha, prostaglandin E 2, and interleukin 1-beta (Chan et al., 2005, Chou et al., 2005). Reduced levels of these substances would also be helpful to those recovering from spine surgery and glucosamine may even help prevent the need for joint surgery by improving symptoms and repairing joint damage.

In another study, this time taking place over three years, patients with knee osteoarthritis were given either a placebo or 1500mg of glucosamine daily (Reginster et al., 2001). The 106 patients receiving treatment actually had improvements in symptoms over the three year study, whereas those in the placebo group had significant progression of joint-space stenosis. Although this study was carried out for knee OA it may be surmised that glucosamine supplements could help reduce spinal stenosis progression and delay the need for back surgery while reducing reliance on NSAIDs that actually expedite spine degeneration.

Foerster, et al (2000), provided further evidence of this potential for glucosamine to help in spine conditions in a study investigating the use of glucosamine sulfate in lumbar spine pain. Lower back pain relief was achieved in those patients taking the supplement in comparison to placebo but it is likely that the poor circulation to the spinal joints may reduce the effects of such supplementation. As spinal arthritis is not always an isolated condition it may be that patients experiencing widespread joint pain that adversely affects mobility could benefit from glucosamine sulfate supplements in order to remain active, maintain healthy circulation and enjoy a better quality of life, without the need for back surgery.

If you receive a slipped disc diagnosis, it does not necessarily mean you must resign yourself to a lifetime of back or neck discomfort. In fact, it’s completely reasonable to anticipate a happy, healthful, active lifestyle – if you know the proper steps to take.

Learn As Much As You Can

Educating yourself about a slipped disc diagnosis starts with educating yourself about the condition. To begin with, it is important to know that “slipped disc” is actually a colloquialism used to refer to a variety of medical conditions, including:

• Bulging disc – a protrusion of a portion of the cartilaginous outer wall of an intervertebral disc into the spinal canal
• Herniated disc – a tear in the outer wall of an intervertebral disc that may allow the extrusion of the gel-like nucleus material inside the disc

These conditions also are known as ruptured discs and prolapsed discs. No matter what the condition is called, a slipped disc diagnosis does not automatically call for extreme measures like open back surgery.

In fact, many people have the condition and never realize it, because the worst possible symptoms – traveling pain, tingling, numbness, and muscle weakness – typically don’t arise unless a portion of the damaged disc makes contact with a nearby nerve root or the spinal cord, and this certainly does not occur in 100 percent of the cases.

Treating a Slipped Disc

However, if you do experience severe spinal pain and the other telltale signs of a slipped disc, and your physician confirms a slipped disc diagnosis, your doctor will recommend a treatment plan geared toward alleviating the symptoms and improving your overall health. Conservative treatment methods used to treat disc pain and other symptoms often include analgesics, anti-inflammatory drugs, exercise, stretching, corticosteroid injections, hot/cold therapy, and more. Back surgery typically becomes an option only after conservative treatment proves ineffective after several weeks or months.

The sciatic nerve is the longest and largest nerve in the body. It originates in most people at the lower thoracic or upper lumbar level of the spine, and branches off to innervate a large portion of the lower body.

The location of the sciatic nerve in the lower back makes it particularly susceptible to compression in middle age and after. This is because the anatomical components of the lumbar region are subjected to years of stress and strain related to near-constant movement and bearing the weight of the upper body. When an anatomical abnormality develops and begins to compress the sciatic nerve, it produces the set of symptoms known as sciatica.


What is Sciatica?

The set of symptoms called sciatica is experienced in the lower back, buttocks, legs, feet, and toes and can become debilitating over time. These symptoms vary from individual to individual, but they generally include:

• Localized pain at the site of the sciatic nerve compression
• Pain that feels like an electric shock or a burning sensation that travels the length of the nerve
• Tingling or numbness in the portion of the body innervated by the segment of the nerve that is compressed
• Loss of strength or muscle function in the area of the body innervated by the affected portion of the nerve

Not everyone experiences symptoms in exactly the same way, or with the same intensity, when the sciatic nerve becomes compressed. Because patient indications vary so widely, confirming whether you have sciatica typically requires a physician’s diagnosis.

Diagnosing Sciatica

A physician generally will begin the diagnostic process with a conversation with the patient, listening for the tell-tale signs of sciatic nerve compression – pain in the buttock or back of the leg on one side of the body; tingling, burning, or numbness down the leg; or pain that is worse when sitting and makes it difficult to stand up. Medical imaging, such as an X-ray, MRI, or CT scan can be used to confirm an obvious herniated disc, bulging disc, or bone spur in the lower back that could be pressing on the sciatic nerve.

In most cases, back surgery is not required to manage sciatica. The majority of patients can manage symptoms using a regimen of conservative, nonsurgical treatment methods like cold compresses, lower-body stretching techniques, and over-the-counter pain medicine.

A slipped disc is a colloquial term for a condition that occurs when the outer wall of an intervertebral disc extends beyond its normal boundary into the spinal canal. It is known medically as a herniated disc or a bulging disc. A common misconception about slipped discs is that they always result in back pain and other neuropathic symptoms. In fact, a bulging or herniated disc usually produces severe symptoms only when the misshapen outer disc wall or a portion of the extruded inner material comes into contact with the spinal cord or an adjacent nerve root.

In most cases, slipped discs are asymptomatic or only cause mild local pain in the neck or back that can be blamed on muscle strain. Many people have slipped discs and never even know it.

Anatomy of a Slipped Disc

How does a slipped disc form? In order to answer this question, a rudimentary knowledge of the anatomy of the intervertebral disc is required. Discs are sponge-like cushions located between individual vertebrae. The inner nucleus pulposus is made up of collagen and water. The outer annulus fibrosus is made up of layered cartilage material. The discs prevent the bony vertebrae from grinding against one another, and contribute to the flexibility of the spine.

By the time most people reach middle age, the discs have begun to lose their effectiveness as the spine’s shock absorbers. This is because as the body ages, discs begin to lose water content and become brittle. This degeneration causes the discs to lose height as their ability to support and separate the vertebrae diminishes. The discs’ collective ability to withstand the pressure from adjacent vertebrae can force one or more disc walls past their normal boundaries. The natural effects of aging can be accelerated by a traumatic spine injury, which also can give rise to a slipped disc. The lumbar (lower back) region is the most common site for the development of herniated and bulging discs, but they can occur at any level of the spine.

Treating a Slipped Disc

Back surgery is almost always the last resort for people suffering from back pain and other symptoms produced by nerve compression caused by a slipped disc. Most patients can manage the pain, tingling, numbness, and/or muscle weakness associated with spinal nerve compression by using a regimen of doctor-recommended pain medicine, exercise, stretching, corticosteroid injections, and other conservative treatment methods. Only when all conservative methods have been exhausted after several weeks or months will a doctor typically recommend back surgery as an option for slipped disc patients.

Experiencing muscle spasms after surgery? Try the natural remedies below.

Depending on the kind of surgery performed and the invasiveness of the procedure it may be that muscles were cut, bruised or pushed aside by an endoscope. As the structures and tissues of the spine settle down and inflammation subsides after surgery there may be cramps and spasms of the muscles in the back or down into the arms and legs.

Luckily, there are ways to relieve muscle cramps while recovering from back surgery, including getting pain-relief medications from the physician and taking non-steroidal anti-inflammatories, unless advised otherwise due to spinal fusion being part of the surgical procedure. There are also natural options to relieve muscle spasms after back surgery, such as:

• Gentle exercise, e.g. walking
• Massage
• Acupuncture and/or acupressure
• Avoidance of sedentary position, i.e. make sure to move frequently
• Moist heat, from a warm compress (avoid immersing incisions in water).

Muscles in the back may also go into spasm if they are overtaxed too quickly after surgery so it is wise to incorporate short periods of rest into the day and to avoid over-exertion until given the all-clear by the surgeon or physician. Some movement is good but too much too soon can reduce the chances of surgery being successful and increase pain, muscle cramps and spasms after back surgery.

As symptoms begin to subside patients are advised to begin reducing the dosage of their pain-relief medications and increasing the time between doses. Combining the above alternative therapies for muscle spasms with medications can help to relieve the symptom most effectively and reduce reliance on the drugs. Natural antispasmodic supplements for muscle spasms and cramps can also be helpful for some patients. These include things like:

• Raspberry leaf (used by athletes for muscle cramps and by women for uterine cramps)
• Peppermint (a popular remedy for gastrointestinal cramps and headaches)
• Chamomile (calming to the nervous system and the stomach)
• Cardamom (which can also relieve nausea associated with medications)
• Liquorice (current evidence only supports use for smooth muscle spasms so far and it may raise blood pressure)
• Lemon balm

Other natural remedies (such as valerian, vervain, skullcap and passiflora) may help ease nerve pain and reduce any anxiety, tension and even post-traumatic stress after back surgery as well as aiding sleep. Caution should be applied over all of these remedies as they may interact with existing medications, cause an allergic reaction or have unintended side-effects, such as drowsiness that may impair driving ability and so forth. It is important that patients let their physicians know all of the supplements and medicinal products they are using so as to reduce risk of adverse reactions.

Another option that may help reduce muscle cramps after back surgery is a gentle massage using eucalyptus oil, another natural antispasmodic. Some such massage ointments also contain capsaicin, a hot pepper extract that can offer pain-relief. Using this in the area of incisions may be inadvisable due to the potential for skin irritation and capsaicin cream also stimulates blood flow to an area so may briefly increase swelling before pain relief is achieved.

Where muscle spasms continue after back surgery it is important to undergo a thorough assessment as it may be that a spinal nerve is being irritated, that a secondary back problem has appeared or that hardware used during surgery has slipped out of place or been incorrectly positioned. Pain in the spine can be a result of a degenerated disc pressing on a ligament or nerve that connects to or innervates the back muscles. This pain and compression will sometimes lead to muscle spasms and so it may be that relieving the involuntary muscle activity will only come about by treating the underlying nerve or ligament compression.

Over time, where the muscles contract, cramp and spasm in an attempt to immobilize the spine in reaction to pain these movements can themselves accentuate the spinal degeneration. Muscle relaxants are not always the best course of action as the spine may very well need to be stabilized through this unfortunate muscle activity. Any onset of bladder or bowel incontinence, weakness or numbness in the legs, breathing difficulties or other serious signs should prompt an immediate medical consultation. Determining the cause of the back spasms after spine surgery is paramount in order to provide effective relief and reduce the risk of future spine degeneration.

Gilani AH, Jabeen Q, Khan AU, Shah AJ., Gut modulatory, blood pressure lowering, diuretic and sedative activities of cardamom. J Ethnopharmacol. 2008 Feb 12;115(3):463-72. Epub 2007 Oct 22.

Rojas-Vera J, Patel AV, Dacke CG., Relaxant activity of raspberry (Rubus idaeus) leaf extract in guinea-pig ileum in vitro. Phytother Res. 2002 Nov;16(7):665-8.

A. Abnormal curvature. B. Removal of problematic vertebrae. C. Spinal fusion to stabilize and realign the spine.

Surgeries may involve techniques that remove bone (an osteotomy) and correct problems with the spinal discs, nerves, muscles, ligaments and the lamina. More than a 70 degree curve is usually a trigger for back surgery for kyphosis in the thoracic spine.

The severity of the curve and its location will determine the type of spine surgery required. Osteotomies usually involve a wedge shape being excised from the bones in order to realign the spine. A pedicle subtraction is one such osteotomy and is where parts of the vertebrae are removed at the front and back to correct posture. The Smith-Peterson osteotomy for thoracic kyphosis is a procedure to remove part of the back of the spine and is frequently performed in tandem with a discectomy and instrumented spinal fusion to stabilize the spinal column. Those with existing spinal hardware will normally have to have these rods, screws and metal plates removed before their latest surgery.

Aggressive surgery such as facetectomy (removal of the facet joint) and cantilever corrections can be the preferred option for patients with flexible kyphosis. Where the spinal deformity is long and smooth it may help to perform multiple osteotomies to produce a more subtle change throughout that section of spine.

Unfortunately, a major cause of thoracic kyphosis in adults can hinder the success of surgery for the condition. Osteoporosis, the loss of bone mineral density can make back surgery difficult due to the increased risk of fracture. Osteoporosis can also make it more problematic to use hardware as this requires fixing to the fragile bones, and patients with osteoporosis tend to have more bone pain before and after surgery unless their condition is well managed.

Spinal fusion can restore lost stability to the spinal column by using a bone graft and medical hardware to affix the graft and hold the spine in place while the bone fuses. In cases of thoracic kyphosis this may involve removal of bone from one area of the spine in order to correct alignment. Surgeries may be done from the front of the spine through the chest cavity (a thoracotomy) and posteriorly, or using both approaches where severe deformity exists. Most surgeries used to require both anterior and posterior approaches but refinements of spine surgery techniques now allow surgeons to perform many surgeries using minimally invasive methods from a posterior approach.

After back surgery for thoracic kyphosis it is important to heed medical advice to improve the likely success of the procedure and aid healing. Patients will usually have follow-up appointments scheduled in order to monitor for any further changes in spinal curvature. It is common to have physical therapy in order to support recovery by strengthening the spine, improving mobility and flexibility and to boost general health and confidence after the procedure. Pain relief medications are usually delivered intravenously and controlled by the patient immediately after thoracic kyphosis surgery and then followed by oral pain medications after discharge from the hospital. Risks of surgery, such as deep vein thrombosis, anxiety, post-traumatic stress disorder (PTSD) and depression and nerve adhesion through scarring can all be reduced by following advice to get up and about quickly after back surgery for thoracic kyphosis.

Macagno AE, O’Brien MF., Thoracic and thoracolumbar kyphosis in adult, Spine (Phila Pa 1976). 2006 Sep 1;31(19 Suppl):S161-70.

Osteoporosis is a major cause of thoracic hyperkyphosis and 'dowager's hump.'

In order to stand upright and walk with as little energy expenditure as possible the body is designed to have a gravity line running from the head down to behind the sacrum and to the center of the hips. Unfortunately, there are numerous reasons that this center of balance can be thrown off, including thoracic kyphosis that is in excess of the natural spinal curvature. Where the lumbar spine and cervical spine lose lordosis and the thoracic spine’s kyphosis is excessive it can cause a condition called flatback syndrome with symptoms of spinal stenosis occurring in some patients as spinal nerves begin to be compressed by the altered spinal structure.

Thoracic kyphosis can cause a hunched back or humpback or be sharp enough to cause gibbus deformity. This may be a congenital condition, Scheuermann’s kyphosis, the result of injury or repeated hunched posture, a condition connected to a musculoskeletal or neuromuscular disorder or an issue related to spinal tumors, infection or degenerative condition such as arthritis. Postural kyphosis usually causes a smoother spinal curvature, whereas sharp or angular thoracic kyphosis is often structural in nature.

Postural kyphosis is more easily corrected as the patient can train themselves to adopt an improved posture. This will involve physical therapy to strengthen the paravertebral muscles, along with the possible use of a kyphosis brace to act as both a prompt to adopt good posture and as a support to encourage bones and other spinal structures to grow appropriately in children and adolescents. Braces and corsets will not help correct structural deformity in an older patient as their spine is already fully developed but can help to correct or reduce both kyphotic and scoliotic curves in adolescents when used appropriately.

It is important to get early medical attention if you begin to suspect that thoracic kyphosis is at the root of your back pain or other symptoms. Where your posture has become stooped and it is difficult to stand up straight it may be that abnormal changes are occurring in the spine. Your physician will want to rule out neuromuscular problems such as Parkinson’s disease as well as do tests for osteoporosis and other bone abnormalities. Catching the condition early makes it more likely that conservative treatments will be effective at training the spine and reducing symptoms without the need for back surgery for thoracic kyphosis.

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Neural foraminal stenosis is a specific kind of spinal stenosis that can result in severe radiating pain, weakness, numbness and paralysis. Surgery for neural foraminal stenosis is not always warranted, with some patients able to find relief using conservative therapies. However, there are a number of options for those undergoing back surgery to relieve nerve compression in the foramen and the choice of back surgery depends largely on the cause of the spinal narrowing.

Bilateral and unilateral foraminal stenosis usually occur due to different pathological processes in the body, namely disc herniation, osteoarthritis, rheumatoid arthritis and ligament calcification. Unilateral spinal stenosis is more common and affects just one side of the spine, often because of an uneven gait due to leg length discrepancy or as a result of continued twisting and pressure on one side of the spine over many years. Rheumatoid arthritis and other systemic conditions tend to cause symmetrical symptoms in the body and so neural foraminal stenosis can be a combination of acute, chronic, systemic and isolated conditions.

Treating neural foraminal stenosis effectively requires a proper diagnosis and therapy tailored to the root cause of the spinal changes. This may include non-steroidal anti-inflammatory drugs (NSAIDs), epidural steroid injections to relieve pain, physical therapy and the use of back braces or supports. Where such treatments fail to provide pain relief for pinched nerves surgery is often recommended.

Cases of neural foraminal stenosis caused by disc herniation and the presence of disc fragments in the space where the nerve roots exit the spine will often require a discectomy or partial discectomy to remove the offending material. The inner gel of the intervertebral discs is also irritating to the nerves and so care must be taken to remove all of the material so as to not induce failed back surgery syndrome. A discectomy may be performed endoscopically or as an open back surgery procedure. It can be combined with a foraminotomy where the bone itself is shaved to widen the foramen and allow the nerves more room. Again, this can be done using minimally invasive techniques (microforaminotomy) or as open back surgery.

For some patients with severe compression a foraminotomy for neural foraminal stenosis may be combined with a laminotomy as a microlaminoforaminotomy. This type of back surgery sees a small window cut into the lamina (backbone) to expose the foramen and allow for easier removal of bone to free the nerves. Such a technique can provide more significant spinal decompression than some other types of surgery.

The basic idea behind surgery for neural foraminal stenosis is to remove the material clogging these openings in the spine, be that bone, disc material or soft tissue. Removing such material can then relieve back pain, neck pain, radicular pain such as sciatica or arm pain and help prevent further muscle weakness, spasms, cramps and other symptoms of neural foraminal stenosis. Back surgery for neural foraminal stenosis is often highly successful in relieving such symptoms but there is always a risk that some obstructive material will be missed or that further degeneration will bring about similar symptoms at a later date.

Degenerative disc disease symptoms can occur in several ways. At first, degenerating discs may lead to general feelings of stiffness and discomfort in the neck or back. If a disc weakens to the point that it develops a tear or rupture in its outer wall (annulus fibrosus), some of the inner disc fluid (nucleus pulposus) may leak out and trigger an inflammatory response from tiny nerve fibers that reside in the disc’s wall. This type of pain will usually remain localized in the area of the damaged disc.


Other symptoms that can occur are caused when a herniated or bulging disc comes into contact with a spinal nerve root. Radiculopathic symptoms tend to travel along the entire path of the compressed nerve and all of its branches. A pinched nerve in the neck may lead to symptoms in the upper back, head, shoulders, arms, hands, and fingers, whereas a compressed nerve in the lower back may cause radiculopathy in the hips, buttocks, legs, feet, and toes.

Radiculopathy may take the form of:

• Shooting, burning, or radiating pain
• A pins-and-needles sensation
• Muscle cramping
• Muscle weakness
• Numbness

Yet another way degenerative disc disease can cause symptoms is when a disc or discs lose height. One of the main purposes of intervertebral discs is to support vertebrae and maintain their position in the spine. When a disc loses height or “collapses,” vertebrae move closer together and the nerve roots that reside in between vertebrae can become compressed. This can also cause radiculopathy.

Treatment for degenerative disc disease symptoms will usually start conservatively with nonsurgical approaches like non-steroidal anti-inflammatory drugs, stretching, physical therapy, and behavior modification. Other treatments include temperature therapy, ultrasound therapy, transcutaneous electrical nerve stimulation, and corticosteroid injections.

Most patients will be able to find sufficient relief from their symptoms with nonsurgical treatments, though a small percentage of individuals will require back surgery to address a severely degenerated disc. Before consenting to a surgical procedure, be sure to consult several spine specialists about what type of surgery they are recommending and why. Do your own research about the procedures that are available to you so that you can make an informed decision about how to deal with your neck or back discomfort.

If you have tried a wide variety of conservative treatment methods over the course of several weeks or months to relieve discomfort caused by degenerative disc disease, and have still not been able to mitigate your back or neck pain, you may be considering a surgical degenerative disc disease procedure. Before consenting to any procedure, however, be sure to get several opinions from different spine specialists regarding the necessity of surgery and the different surgical approaches that are available. While disc disease can be a very painful condition, it is generally not considered a medical emergency and surgery, therefore, is elective and should only be undergone once all the risks and benefits have been weighed.


In the event that you do decide to go forward with back surgery, there are generally two different approaches that are available:

• Open spine surgery – This is a highly invasive surgery that requires hospitalization. The surgeon will make a large incision in the abdomen, throat, or near the spine, cut muscles and soft tissues surrounding the spine, perform a discectomy (complete removal of a damaged or degenerated disc), and will likely insert a bone graft into the space formerly occupied by the disc. The bone graft will be secured in place with stabilization hardware like rods and screws. This “spinal fusion” surgery will allow the affected vertebrae to grow together into one piece of bone and stabilize that area of the spine.  Recovery from open spine surgery can be long and arduous, sometimes taking up to a year for patients to return to a full range of activities.

• Endoscopic surgery – This type of back surgery is considered minimally invasive and is performed on an outpatient basis, which means no overnight hospitalization is required. A small incision is made (usually less than one inch in length) and the surgeon funnels a light, an endoscope, and small surgical tools to the site of neural compression. Endoscopic technology allows the surgeon to operate without a large incision or muscle dissection. The surgeon may only remove the part of the damaged disc pressing on a nerve and then close the small incision, or an entire disc may need to be excised. If the entire disc is removed, the surgeon can then perform spinal fusion through the endoscope. The patient is generally able to walk and return home a few hours after surgery. Many patients return to a full range of activities within six weeks.

While a minimally invasive degenerative disc disease procedure offers many benefits over an open spine surgery, not all patients will be candidates for endoscopic surgery. Be sure to research all of your options, weigh the risks and benefits of each, and make an informed decision based on the facts.