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Low back pain is often a common symptom of most spinal conditions which can result from sudden injury to the muscles, ligaments, bones, and nerves in your spine. Common spinal conditions that can cause low back pain include herniated disc, spinal stenosis, scoliosis, kyphosis, muscle strain or spasm and fracture of the spine caused by osteoporosis. Rarely, arthritic conditions of the spine, spine tumors and infections (osteomyelitis, discitis) can also cause low back pain.
This is a condition where the intervertebral discs, the gel-like material between the vertebrae, has begun to wear out due to aging, repetitive stress, smoking, genetics, etc. In most circumstances the cause is multi-factorial, and unless there is compression of the nerves or spinal cord, it will not improve with surgery. It is a very common condition that may not cause symptoms in many people.
A herniated disc is also called a bulging disc, ruptured disc, or slipped disc. It occurs when the inner core of the spinal disc pushes out through the outer layer of the disc. This causes pressure on nearby nerves leading to low back or neck pain depending on where the bulging disc is located.
When the soft nucleus pulposus calcifies, it becomes hard (similar to a bone spur) and is commonly referred to as a “hard disc”.
Neck and back pain are extremely common. In fact, 80% to 90% of the adult population in the United States will experience back pain at some point in their lives. While the majority of these episodes are benign and self limiting, up to 20% of people can develop chronic and recurrent neck and back pain.
Most episodes of neck pain without associated arm/leg pain, numbness, tingling, weakness, etc is not caused by a “pinched nerve”.
Most episodes of back/buttock pain without associated leg pain, numbness, tingling, weakness, etc is not caused by a “pinched nerve”
A “pinched nerve” in the neck can cause arm pain, numbness, tingling, weakness, etc with OR without associated neck pain. A herniated disc in the neck can compress a nerve root and because the nerve roots form nerves that go into the arm, a pinched nerve in the neck can cause symptoms in the arm.
A “pinched nerve” in the back can cause leg pain, numbness, tingling, weakness, etc with OR without any associated low back pain. A herniated disc in the low back can compress a nerve root and because the nerve roots form nerves that go into the legs, a pinched nerve in the neck can cause symptoms in the leg.
In the most basic terms, it is opposite of normal alignment (lordosis) in the neck. This xray demonstrates loss of the normal curvature of the spine due to degenerative (“worn out”) discs. Due to the degeneration, the vertebrae (bones of the spine) start collapsing on each other resulting in a “forward lean” of the head and neck.
Cervical kyphosis can cause neck and shoulder pain as the muscles on the neck have to work harder to hold up the head & prevent it from falling forward. There is also stretching (and pain) of these posterior neck muscles as the alignment worsens.
While the white line represents normal spinal alignment (what the spine should look like), the red line demonstrates cervical kyphosis (the curve of the spine is in the opposite direction of normal).
While MRIs are very important for assessing the soft tissue in the spine (nerves, discs, ligaments, etc.), it does not provide very good information about spinal alignment as most MRI’s are performed while the patient is lying down. Lumbar spine x-rays (aka radiographs) allow for better evaluation of spinal alignment and the bony structures of the spine.
A CT scan is best at assessing the bony structure (vertebrae, bone spurs, assessing bony fusion, etc) while the MRI is best for evaluating the soft tissues (nerves, discs, etc.). For the majority of patients, a spine MRI is the best diagnostic modality.
Again, most patients who experience neck or back pain will not require surgery and will improve with conservative management. Pain that radiates down the arms or legs, and neurological signs such as weakness, numbness, balance difficulty, bowel/bladder problems, are some symptoms that may benefit from surgical decompression, especially if non-operative measures fail to provide relief.
The majority of degenerative conditions that may require or benefit from spinal surgery are those where there is pain that radiates down the arms or legs, have associated numbness or weakness, and have not improved with non-operative care. Spine surgery is considered as a last resort as many patients improve with more conservative treatments first. Your primary care physician or we can begin treatment with these modalities, and if things do not improve it is time to consult with a spine surgeon.
For most patients, surgery becomes necessary if and when they have failed nonoperative treatment and/or their symptoms are severe enough to significantly limit their quality of life and activities of daily living. Sometimes, surgery is necessary in the absence of pain if there is spinal cord/nerve compression that is causing other symptoms such as neurologic dysfunction.
Minimally invasive spinal surgery is based on the principal of minimizing “collateral damage” in treating spinal pathology. This means, minimizing muscle and bone cutting/removal.
Please consult with Dr. Khanna and his team to determine if you are a candidate for minimally invasive surgery.
Minimally invasive surgery is a technique where surgeries can be performed through small incisions with the use of specialized devices and/or instrumentation. The advantages of minimally invasive surgery include:
Many different types of spinal surgeries may be performed using minimally invasive techniques. Some of the spinal surgeries done by minimally invasive technique include:
However, it is important to note that there are many conditions that are not amenable to minimally invasive techniques; in these situations, conventional open surigical procedures may provide the most reliable results.
The fundamentals of spinal surgery can be broken down in two major categories:
Obtaining full range of motion, strength and flexibility back after surgery usually takes time. That’s where pre-operative exercise and education and post-operative physical therapy programs come in – to ensure that you are physically and emotionally prepared for surgery and to maximize your recovery after surgery.
Physical therapy, chiropractic care, aquatic therapy, acupuncture, massage, dry needling, weight loss, activity modifications, lifestyle adjustments (ergonomic work station etc); medications (typically a combination of anti-inflammatories, muscle relaxes, and or pain medications), epidural or selective nerve root injections; trigger point injections.
After the surgery, we may recommend you practice several measures to ensure the best recovery and avoid possible complications. Some of them include:
Getting a full range of motion, strength and flexibility back after surgery usually takes time. That’s where pre-operative exercise and education and post-operative physical therapy programs come in – to ensure you're physically and emotionally prepared for surgery and to maximize your recovery after surgery.
There are 33 bones (aka vertebral bodies) that make up the spinal column. There are 7 bones in the neck (cervical spine), 12 in the trunk (thoracic spine), 5 in the low back (lumbar spine), 5 fused bones that attach the spine to the pelvis (sacrum) and 3 fused bones form the ‘tail bone’ (coccyx).
The bones of the spine (vertebrae) are stacked on top of each other with soft cushioning discs located in between them (intervertebral discs). These discs can be imagined as a jelly doughnut. The outer portion of the disc (called the annulus fibrosus) is like the dough of a jelly doughnut and the inner portion (nucleus pulposus) is similar to the jelly inside the doughnut. In a normal disc, all the nucleus pulposus remains inside the annulus fibrosus, which is shown to the right.
The nerve roots exit the central spinal columns at different levels of the spine; for example, the L4 nerve root is the nerve that most typically exits the spinal column between the L4 (fourth lumbar vertebrae) and L5 (fifth lumbar vertebrae). However, the L5 nerve root is the one that most commonly becomes compressed at this level due to a disc herniation.
These spinal nerve roots wind together after exiting the spinal column to form larger nerves (eg: sciatic nerve, femoral nerve, etc). The nerves run down our legs to supply our muscles with the power to move and allow us to feel different stimuli. Hence, when a nerve is compressed (“pinched”) in the spine (most commonly due to a disc herniation, bone spurs, stenosis etc.), it can also cause pain/numbness/tingling that radiates down the arms or legs. The location of the radiating symptoms helps medical providers to determine at which level the ‘pinched’ nerve is coming from.