You are in the right place.
Are you tired of Back Pain? Neck Pain? Hip pain? Sciatica?
You are in the right place.
Back Pain is the most common frequent complaint doctors hear. The first step to treat back pain is to diagnose it correctly, as pain can be caused by mechanical injury, degenerative spine disease, autoimmune, inflammatory conditions, cancers, muscle spasm, infections and possibly referred pain from other locations.
Symptoms vary significantly depending on what is causing the pain. Common symptoms are worsening pain with walking or bending, shooting pain in your legs, numbness or tingling and it progress to sensory and motor weakness. Early diagnosis is essential to avoid long term complications.
The entire spinal column consists of individual bones, called vertebrae. It’s divided into 5 regions: (Cervical, Thoracic, Lumbar, Sacrum, Coccyx). A normal vertebral column creates a graceful, double-S curve when viewed from the side of the body.
The vertebrae connect with each other via small joints, called facet joints. Arthritis of these facet joints is often the source of pain. The sacrum connects to the pelvis on the left and right sides by the sacroiliac joints (SI joints). Arthritis of SI joints is also a common cause of low back pain.
The spinal column doesn’t consist only of bones. The spine relies on discs between vertebrae to provide skeletal support. Bulging or slippage of discs can “pinch” your spinal nerve leading to debilitating pain. The spinal cord runs protected inside a canal formed by the vertebrae.
The space between the spinal cord and vertebrae is called epidural space. Small spinal nerves (Nerve Root) branch out of the spinal cord and exit between the vertebrae. This exit is called neuroforamen.
Pain can occur due to an abnormality in any of the structures we just mentioned, such as an abnormal curve of the spine, slipped intervertebral disc, facet or SI joint inflammation and tightness of nerve exists (neuroforamen).
Oftentimes, your pain is due to a combination of these abnormalities. Establishing the correct diagnosis is essential.
What are the common cause of Back Pain?
The intervertebral discs are complex structures that consist of a thick outer ring of fibrous cartilage termed the annulus fibrosus, which surrounds a more gelatinous core known as the nucleus pulposus.
The gelatinous core can breakthrough the outer fibrous layer leading to compression of adjacent nerves. It also causes severe acute irritation and inflammation. Inflammation and compression both contribute to the pain.
Because the walls of the discs are so densely supplied with nerve fibers, a tear in the wall can also result in excruciating pain, weakness, numbness, or alterations in sensation.
Degenerative Disc Disease:
Due to aging process, intervertebral discs start to deteriorate and degenerate. Small fissures and tears develop in the outer layer while inner gelatinous layer hardens. This process leads to discs losing height and elasticity.
Therefore, spaces between the vertebrae become narrow and tight. Combined with spine arthritis, the spine loses its natural healthy shape and nerves become “pinched”.
Spinal stenosis happens when the space inside the backbone is too small. This can occur due to facet joint arthritis and ligamentum Flavum thickening; a ligament that holds the vertebra together.
Some people with spinal stenosis may develop no symptoms. Others may experience pain, tingling, numbness and muscle weakness especially with walking. Hallmark of this condition is pain relief with forward flexion.
It is a degenerative spine disorder that can make everyday activities like walking or bending forward extremely painful and can be associated with stiffness.
The diagnosis is given when an imaging study such as a x-ray or MRI image of the spine from a side view reveals the displacement of one vertebral level compared to the surrounding levels.
If the vertebral level is shifting forward then it may pinch an exiting nerve and cause discomfort in the distribution of that nerve. If the slippage is not severe, there may not be any symptoms except vague chronic low back pain if any.
The most common location for Spondylolisthesis is in the lumbar region of the spine. Other causes include trauma or fractures, in this case the vertebra may begin to move out of position if a stress fracture weakens the bone and prevents it from maintaining the correct alignment.
Initial treatment is conservative and there is evidence to suggest that lumbar epidural cortisone injections may be beneficial if a nerve is pinched due to forward slippage of the vertebra. Come in for a visit to discuss a specific treatment plan.
Skeletal Deformities – such as scoliosis is congenital whereas some like kyphosis or lordosis can be due to poor posture and genetics.
Discomfort in the lower back can result from such deformities as they alter weight distribution and put more stress on soft tissues like muscles, ligaments and nerves.
Trauma – lower back pain secondary to trauma is frequently seen in victims of car accidents, sports injuries, workplace accidents, falls or other traumatic events. Such accidents may cause vertebral or rib fractures, disc displacement and worse injury to nerves.
The initial treatment is generally conservative unless there is nerve compromise. Regardless of the initial traumatic event, it is crucial to seek medical advice from an experienced pain management doctor early on to prevent surgery and appropriately treat the injury.
Fibromyalgia – a condition of generalized muscle pain and fatigue. It requires a complete medical work-up to rule out serious conditions that may resemble fibromyalgia. Fibromyalgia requires a multi-modal treatment plan.
Osteoporosis – a condition of brittle weak bones that are prone to breaking. A combination of poor nutrition, little sun exposure and advanced age cause bones to weaken over time.
The weaker vertebrae is predisposed to stress fractures also known as compression fractures in which the bone loses more than half its height.
Compression fractures are commonly very painful and occur most commonly in older fragile patients but can occur in younger patients who are malnourished and it may be the first sign of an oncologic process.
Sciatica – describes sciatic nerve inflammation which results in nerve pain in the distribution of the sciatic nerve. The sciatic nerve is the largest nerve and travels from the lower back down the buttock to the back of the thigh and foot.
The pain associated may feel like shooting or radiating pain down a leg, it may also be associated with numbness and tingling. The sciatic nerve may become inflamed if there is structural compression such as a slipped disc compressing it or a large arthritic structure such as a disc osteophyte complex pinching it.
It can also get compressed outside of the spine in the cases of piriformis syndrome where the sciatic nerve gets trapped between tight muscles.
Infections or cancer – the least common causes of back pain but the most serious causes. Osteomyelitis is an infection of bone that can affect the spine and cause pain. It requires urgent medical attention in a hospital setting as intravenous antibiotics will be needed for a prolonged period to ensure eradication of the infection and prevention of a blood infection.
Spinal cord tumors are quite rare but metastatic lesions in the spine can be seen more frequently. It may present as severe pain at night and can be quite disruptive to the spine.
How do you make the correct diagnosis?
We always begin with complete and thorough history as every detail is important. When and how did your pain start? What is the area of most tenderness? Does it radiate to your legs or arms? What makes your pain worse or better?
Do you have sensory changes or motor weakness? Have you tried physical therapy? Does it wake you up at night? Is your pain constant or intermittent? …etc. Physical exam is also crucial to differentiate between various conditions.
Which physical maneuver induces pain? What muscle show signs of weakness? Are your reflexes intact? …etc. Combined with thorough medical history and physical exam, spinal MRI is often necessary as well to view the structure of your spine.
Which joints are arthritis? Which disc have slipped? What is the degree of slippage? Is there a tumor? …etc. Sometimes your doctor would also order a Nerve Conduction Test or EMG test.
Electrodiagnostic studies at CURA Centers is a tool we use to diagnose conditions in your muscles or nerves. These tests help narrow down the causes of your back pain, neck pain, numbness, tingling, or motor weakness.
How is back / neck pain treated?
Your doctor can suggest conservative home treatments like rest, ice, and behavior changes once you’ve obtained the correct diagnosis.
While many back issues necessitate particular therapies, your discomfort may occasionally be reduced by using shoe inserts, maintaining good posture, or using an ergonomic work chair. Visit our back pain specialists now for a precise diagnosis and treatment strategy.
Typically, if there are no alarming signs indicating a medical emergency, your doctor will recommend to start a course of physical therapy, home exercise regimen and oral anti-inflammatory medication. Most patients respond to conservative therapy. However, when conservative therapy fails, advanced MRI studies are necessary.
If your symptoms / physical exam are consistent with disc herniation, your doctor will most likely recommend an epidural injection. If your pain is non radiating and MRI shows extensive arthritis, your doctor may recommend a facet or SI joint injection. Please note these are general statements and each patient is different. Your doctor will walk with you through every step to achieve pain relief.
Epidural Steroid Injections (ESI)
Epidural Steroid Injections (ESI) are the gold standard for radiating “radicular or Radiculopathy” low back or neck pain to provide rapid onset of pain relief. Using live X-ray (Fluoroscopy), our interventional spine specialist will target the irritated nerve root in the epidural space. An epidural steroid injection is only used to relieve pain and suffering.
ESI are not intended to be a long-term fix for the underlying cause of the problem. However, an epidural steroid injection might be suggested as an alternative to invasive surgery if they are successful in treating the pain. It may take one to three days after the steroid injection before you notice its effect, and it could even take a week.
Nerve roots can be irritated due multiple reasons such as a herniated disc, a bulging disc, radiculopathy, spinal stenosis or degenerative disc disease.
The procedure can be cervical or thoracic or lumbar depending on the location of the pain and it takes 15-20 minutes. No downtime and you can resume your daily activities on the same day.
Facet Joint Injection (Facet Block)
Facet joints may hurt as a result of spinal arthritis, a back injury, or mechanical strain on the back such as a motor vehicle accident. Difficulty in twisting or bending your spine is the most frequent indication of facet illness.
Common symptoms are tenderness, pain with trunk twisting or neck rotation. Cervical Facet disease can also be associated with headaches. Using live X-ray (Fluoroscopy), our interventional pain specialist will target the facet joints that are causing pain.
Steroids may be injected inside the joint to decrease inflammation. Pain from facet joints is transmitted via small nerves called Medial Branches. The interventionalist can also block these nerves using Lidocaine to stop the transmission of pain. The pain relief from Medial Branch Block is immediate.
Since the procedure is minimally invasive, there is no downtime and you will be able to return to your normal levels of activity immediately.
Radiofrequency Ablation (RFA)
As we just mentioned, one technique to relief pain immediately is to block the nerve that carries the pain signal. Under Fluoroscopy guidance, our pain specialist will locate the targeted nerve and deliver a mild electrical current to destroy the problematic nerve.
Before scheduling RFA, your doctor is likely to recommend a diagnostic procedure, called a Medial Branch Block (MBB). If the diagnostic block is susccefully, your doctor will likely recommend to ablate (destroy) the nerve. Unlike traditional nerve blocks which provide pain relief for few hours, RFA provide long term relief that can last for years.
This procedure can be cervical or thoracic or lumbar. RFA can be used to treat a variety of chronic pain conditions.
Spinal pain disorders include post-traumatic pain (whiplash), spinal arthritis (spondylosis), pain following spine surgery, Complex Regional Pain Syndrome (CRPS or RSD), peripheral nerve entrapment syndromes and others.
Sacroiliac Joint Injection
SI joint is the place where your spine (sacrum) connects to your pelvis (ilium). These joints act as shock absorbers. Oftentimes low back pain is caused by SI joint inflammation which can be missed easily if careful exam is not done. Under Fluoroscopy guidance your doctor will advance the needle into the SI joint and deliver medication to reduce inflammation.
Trigger Point Injection
Trigger points are small tight knots in muscles that fail to relax. It can be extremely painful as it irritates surrounding nerves. Trigger points often affect many muscle groups, especially those in the arms, legs, lower back, and neck.
Our pain specialist will inject a numbing medicine (an anesthetic) or a steroid into the trigger point for immediate pain relief. It also can be used to treat fibromyalgia, tension headaches and myofascial pain as well.
The procedure takes only few minutes and multiple trigger points can be injected at the same time for maximum relief.
If you still have low back pain, you may be a candidate for advanced spine interventions
What are these interventions?
Advanced Spine Interventions
Epidural Lysis of Adhesions
Ultrasound-guided targeted delivery of corticosteroids relieves inflammation and swelling, which reduces pain.
Minimally Invasive Lumbar Decompression
Injecting a concentration of your own platelets can accelerate healing of damaged joint and reducing inflammation.
Injecting hyaluronic acid into the joint. Thick fluid that works a lubricant and shock absorber in your joint.
Spinal Cord Stimulator
Permanently destroy (ablate) the nerve transmitting pain signals from area of inflammation around the joint.
Dorsal Root Ganglion Stimulator
Ultrasound-guided, high-pressure injection of saline into the area of the entrapped nerve to release it, which leads to pain relief.
Reserved for patients who failed other treatments or patients who are not surgical candidates or failed surgery
Epidural Lysis of Adhesions
Lysis of adhesions is a procedure to reduce the compressive effects of scar tissue (adhesions) in the spinal canal. Scarring tissue is common in patient who underwent previous spine surgery.
Using x-ray guidance, Racz Catheter is introduced to the scarred area, special enzyme is injected to dissolve some of the scar tissue from around entrapped nerves in the epidural space of the spine. This allows medications such as cortisone to reach the affected inflamed areas.
Minimally Invasive Lumbar Decompression (MILD)
Minimally invasive lumbar decompression, commonly referred to as the mild® Procedure, is an outpatient procedure that is designed specifically for patients with spinal stenosis. The traditional surgical treatment for lumbar spinal stenosis is an open spinal decompression surgery in which a portion of your vertebra is removed to enlarge the space to relieve the pressure. This procedure is an open surgery that requires a lengthy recovery.
On the other hand, MILD is minimally invasive, done as an out-patient procedure and doesn’t require any suturing or scar formation. Under x-ray guidance our board-certified spine interventionalist will guide a small port along your back to get access to the thickened Ligamentum Flavum.
Small tools are inserted through the port to safely remove the excess thickened ligament tissue. Once the tissue is removed, the port is taken out and a bandage is placed over the small incision site. It is done under light sedation and takes less than hour to complete.
The Vertiflex Procedure is an FDA-approved system that utilizes a small implant (the Superion® Indirect Decompression System). This is an alternative treatment for patients with Spinal Stenosis.
The implant is placed between the vertebrate to improve the spacing in your spinal canal. The implant is the size of a dime and slides in between the spinous process, which are bony projections on the back of each vertebra.
This provides relief by lifting pressure off the nerves to alleviate leg and back pain symptoms that often accompany spinal stenosis. The procedure only takes approximately a half hour. More than one spinal decompression device can be inserted.
Spinal Cord Stimulator (SCS)
Spinal cord stimulators (aka neurostimulators) consist of thin wires (the electrodes) and a small, pacemaker-like device (the generator). The electrodes deliver mild electrical stimulation to the nerves along the spinal column which alters the sensation of pain signals.
Spinal cord stimulation is reserved after all other treatment options have failed to provide sufficient relief. Spinal cord stimulators require two procedures. First procedure is a trial to confirm the efficacy of the stimulator device. If the trial is successful, we proceed with permanent device implantation.
Dorsal Root Ganglion Stimulation (DRGs)
DRG stimulation therapy works by stimulating dorsal root ganglia (DRG), unlike spinal cord stimulator which stimulates cells inside the spinal cord itself. DRG are structures next to the spinal column made up of densely populated sensory nerves.
They act like traffic lights, regulating signals and sensations that travel through a specific nerve root. DRG therapy has the unique ability to inhibit pain in targeted areas of the body, depending on which DRG your doctor will stimulate.
DRG stimulators require two procedures. First procedure is a trial to confirm the efficacy of the stimulator device. If the trial is successful, we proceed with permanent device implantation.
Vertebral body fractures can cause collapse or compression of a vertebra which leads to compression of spinal nerves and causes significant pain. The doctor uses specially designed instruments to inject the fracture cavity with a cement-like material which hardens quickly, stabilizing the bone.
Kyphoplasty can restore a damaged vertebra’s height and may also relieve pain. The procedure is typically performed as an outpatient procedure. You’ll be sent home the same day.
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Following the submission of your information, a member of our front desk will be in touch with you to ask if your insurance will cover the appointment. Then, we’ll schedule your first visit at one of our Pain Centers that are nearby.
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