Back Pain

IMPORTANT FACTS

Anyone can experience back problems. However, the major risk factors are age, being overweight, having a sedentary lifestyle, and poor posture. Back pain can be acute or chronic. Acute injuries include sprains and strains. Chronic pain includes spinal stenosis and degenerative disc disease. Surgery is not always the answer. There are many noninvasive treatments to try before considering surgery. The spinal column is complex. It is composed of 33 vertebrae and 2 sets of fused vertebrae, intervertebral discs, ligaments, tendons, muscles and 31 pairs of nerves.

Back pain is a common complaint. Most people in the United States will experience low back pain at least once during their lives, and back pain is one of the most common reasons people go to the doctor or miss work.

Muscle or Ligament Strain

Repeated heavy lifting or a sudden awkward movement may strain back muscles and spinal ligaments. If you’re in poor physical condition, constant strain on your back may cause painful muscle spasms.

Bulging Disc (also called protruding, herniated, or ruptured disc)

The intervertebral discs of your back are under constant pressure. As discs degenerate and weaken over time, cartilage can bulge or be pushed into the space containing the spinal cord or a nerve root, causing pain. Most herniated discs occur in the lower (lumbar) portion of the spinal column.

Cauda Equina Syndrome

Cauda Equina Syndrome is a much more serious complication of a ruptured disc which occurs when disc material is pushed into the spinal canal and compresses the bundle of lumbar and sacral nerve roots. Permanent neurological damage may result if this syndrome is left untreated.

Sciatica

Sciatica is a condition in which a herniated or ruptured disc presses on the sciatic nerve, the large nerve that extends down the spinal column to its exit point in the pelvis and carries nerve fibers to the leg. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg to below the knee, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and an adjacent bone, the symptoms involve not pain but numbness and some loss of motor control over the leg due to interruption of nerve signaling. The condition may also be caused by a tumor, cyst, metastatic disease, or degeneration of the sciatic nerve root.

Degenerative Disc Disease

Spinal degeneration resulting from disc wear and tear can lead to a narrowing of the spinal canal. A person with spinal degeneration may experience stiffness in the back upon awakening or may feel pain after walking or standing for a long time. Similarly, spinal stenosis related to congenital narrowing of the bony canal predisposes some people to pain related to disc disease.

Arthritis and Back Pain

Osteoarthritis can affect the lower back. In some cases, arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.

Musculoskeletal Back Pain

Skeletal irregularities produce strain on the vertebrae and supporting muscles, tendons, ligaments, and tissues supported by spinal column. These irregularities include scoliosis, a curving of the spine to the side; kyphosis, in which the normal curve of the upper back is severely rounded; lordosis, an abnormally accentuated arch in the lower back; back extension, a bending backward of the spine; and back flexion, in which the spine bends forward.

Spondylitis

Spondylitis refers to chronic back pain and stiffness caused by a severe infection to or inflammation of the spinal joints. Other painful inflammations in the lower back include osteomyelitis (infection in the bones of the spine) and sacroiliitis (inflammation in the sacroiliac joints).

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Fluoroscopy Imaging

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Approximately 250,000-500,000 US residents have symptoms of spinal stenosis. This represents about 1 per 1000 persons older than 65 years and about 5 of every 1000 persons older than 50 years.

What are my Treatment Options?

  • Physical Therapy or Exercises 

  • Massage Therapy 

  • Acupuncture 

  • Brace Support 

  • Trigger Point Injections 

  • Medial Branch Blocks/ Radiofrequency Ablation 

  • Selective Nerve Injections 

  • Epidural Injections 

  • Sacroiliac Joint Injections 

  • Spinal Cord Stimulator 

  • Kyphoplasty 

  • Minimally invasive ligament decompression 

Medications Used for Back Pain

  • Steroids
  • Over-the-Counter Painkillers 
  • Anti-Inflammatory Medications
  • Muscle Relaxers
  • Opioids – The most risky. Usually the last resort. The goals of this treatment are to use opioids for a short duration of time.