Low Back Pain

Herniated/Protruded/Bulging Disc

Please read about degenerative disc disease for a brief overview. In some patients, the outer part of the disc called the annulus may become weakened either due to an injury or wear and tear. If it becomes weak enough, the inner part of the disc (called the nucleus) may herniate or rupture through the outer fibers. This will often cause direct pressure on a spinal nerve resulting in neck, back, arm, or leg pain/numbness. An MRI or CT may be necessary to visualize the disc herniation. Nonsurgical treatment options include, but are not limited to, epidural steroid or stem cell injection, intradiscal steroid injections, and physical therapy.

Low Back Pain

Low back or lumbar pain is the second most common reason that patients visit the doctor, only behind the common cold.

The pain may be secondary to a trauma or injury, but frequently is not related to any specific event. Over time there are changes in the discs, facet joints, and supporting musculoskeletal system related to work activities and ergonomics, posture, obesity, repetitive motions, genetics and other systemic diseases.

As with many conditions of the spine, the pain can be significant. Low back pain is also one of the most challenging conditions because there are so many potential sources of pain (pain generators). Common causes are a bad disc irritating a nerve, joint inflammation, arthritis, muscle strain/spasm, sacroiliac joint pain, and stenosis.

The pain may be in the middle of the back, one or both sides. It can also radiate into the buttocks, hip, and groin regions. For some patients, the pain will radiate into the legs and individuals may also experience numbness, tingling, and/or weakness. Some patients report that the pain is worse after walking some distance. The reason for this is that all of the nerves in the legs come from the back. As a result, any issue with the low back can potentially affect the legs.

An MRI, CT, ultrasound evaluation or an NCS/EMG may be necessary to better determine the source of pain. Non-surgical treatment options include, but are not limited to physical therapy, customized home exercise programs, topical treatments, neuromodulation such as TENS, interferential stimulation, Biowave, trigger point injections, protein rich plasma (PrP), epidural steroid or stem cell injections, selective nerve blocks, facet joint injections, sacroiliac joint injections, radiofrequency ablations (nerve burns) intra-discal steroid injections, spinal cord stimulators, and dorsal root ganglion stimulation.

Piriformis Syndrome/Buttock Pain

The piriformis muscle is an under-diagnosed cause of buttock pain that frequently has a sciatic component as well. In some cases, patient’s sciatic nerve may exit through the middle of this muscle, making nerve pain in the leg worse. Pain in the gluteal region is frequently due to the piriformis muscle dysfunction, possibly a strain, muscle spasm, tightening of the muscle or swelling in the muscle. The sciatic nerve exits the spine under the piriformis muscle, which can then cause symptoms in the leg. Sometimes the sacroiliac joint is the source of buttock pain as well. Non-surgical treatment options include, but are not limited to, ultrasound guided injections of the piriformis muscle with steroids and/or regenerative medicine treatments, sacroiliac joint injections, physical therapy and a dedicated home stretch program. An x-ray, MRI, or ultrasound evaluation may be necessary to help determine the source of pain.

Sacroiliac Joint Pain

A large joint that is found in the gluteal/buttocks region that connects the pelvis to the sacrum. It is called the sacroiliac joint or ‘SI joint’. It can be aggravated from trauma such as falls, altered gait, or ‘wear and tear’ in which the joint becomes inflamed or degenerated over time. Unfortunately, many patients suffer with SI joint dysfunction/pain in addition to a low back issue. Fortunately, we have many treatment options available including diagnostic injections, corticosteroid injections for acute inflammation, stem cell / growth factor / PRP injections for regenerative changes.

Degenerative Disc Disease

Degenerative disc disease is not really a disease but a term used to describe the normal changes in your spinal discs  as you age. Spinal discs are soft, compressible discs that separate the interlocking bones vertebrae that make up the spine. The discs act as shock absorbers for the spine, allowing it to flex, bend, and twist. Degenerative disc disease can take place throughout the spine, but it most often occurs in the discs in the lower back (lumbar region) and the neck (cervical region).

The changes in the discs can result in back or neck pain and/or:

Osteoarthritis, the breakdown of the tissue cartilage that protects and cushions joints.
Herniated disc, an abnormal bulge or breaking open of a spinal disc.
Spinal stenosis, the narrowing of the spinal canal , the open space in the spine that holds the spinal cord

Failed Back Syndrome

Many patients will present to our spine center with continued pain despite having already undergone surgery. In these cases, the pain may be related to chronic nerve inflammation, facet joint inflammation, scar tissue related to the surgery, degenerative disc disease, or stenosis. Unfortunately, many patients have more than one ‘pain generator’, and there is another painful structure that was not corrected with surgery.

An MRI, CT, or NCS/EMG may be necessary to better determine the source of pain. Nonsurgical treatment options include, but are not limited to, selective nerve blocks, facet injections, intradiscal steroid injections, and spinal cord stimulators. The most exciting development for failed back patients is regenerative medicine. Injection of stem cells and growth factors can provide significant relief. Many of our patients experience significant improvement despite minimal relief with previous treatments.