New England Spine Care

Your spine is divided into four major sections.  Your neck (cervical spine).  Your mid back (thoracic spine).  and your lower back (Lumbar spine) and finally the sacral /coccyx which is part of your pelvis.   Each segment is constructed from bones, discs, supporting muscles, and tendons. Your spinal cord travels through the bony tunnel within the vertebrae and exits on either side from the space in between the vertebrae.

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Back pain is fairly common in almost all age groups but the reason for pain varies from person to person.  In some, it is related to a natural aging process of the discs or the joints (facets or sacroiliac).  In others, it is related to work injury, sports injury, falls, or repetitive stress of certain activities such as sports. In many cases, there is no inciting factor for back pain.

 

Below we discussed some of the common causes of back pain.

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MUSCLE STRAIN-BACK PAIN 
Back or neck pain may be related to muscle strain. You may strained a muscle during an strenuous activity you may develop soft tissue pain..  The area may swell, the muscle may be painful with contraction and you may lose some range of motion in the adjacent joints.  Most muscle strains are self-limiting and the symptoms of ache or pain will go away within several days.  Example of such is overdoing it in the gym or doing a sports activity in which you may strained a muscle and with icing the area, or couple of days worth of ibuprofen/Tylenol/Bengay, coupled with low intensity stretching, the pain often resolves.  Muscle strain is common in those group of muscle that across to joints.  It is often associa in ted with an explosive action such as sprinting or suddenly changing your exercise routine or intensity.  If persistent, physical therapy, trigger point injections and topical medication can help resolve the symptoms.  Older individuals, people with previous muscle strain, weak muscles, and fatigue are risk factors for muscle strain. A good stretching and warm up prior to explosive sports such as weightlifting or sprinting reduces the risk.

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FACET JOIN-BACK PAIN 
Every two adjacent vertebrae will connect with pair of Facet joints.  There is one facet to the left of the center and one facet is to the right of center at each segment of your spine.  When you bend and twist, your facet joint allows for that motion.  Approximately 15 to 20% of all back pain is related to the facet joint.  Either due to trauma or simple aging, the facet joints can become arthritic, and become painful.  As result, you may develop neck pain, mid back pain, lower back pain.  Most individuals report worsening of pain with twisting and turning the spine to the affected side or extending the spine such as looking up to the ceiling or arching her back.  Facet pain is often steady, moderately painful and symptoms may fluctuate during the day and with changes in temperature or humidity.

• In the neck, facet pain could create just neck pain (often one sided), or neck pain with headaches or neck pain with pain inthe shoulder blade area.  

• In the lower back, it may localize to one or the other side of the spine or may radiate to the buttock and the flank and at times to the groin.

• The facet pain in the mid back often stays localized or may gravitate towards the rib.   Facet pain is managed medically and there is no surgical solution.  

Physical therapy and anti-inflammatory medications are the starting point for treatment.  Some patients benefit from chiropractic adjustments and soft tissue massage.  If the pain does not subside, facet joint steroid injection (Cervical or Lumbar) , facet joint medial branch RF ablation  (Cervical or Lumbar​), and facet joint PRP injection can be offered.  Outcome of the facet treatments are often satisfactory with reduced pain and improved function.   

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SPONDYLOLISTHESIS -BACK PAIN 

This is a farily common cause of neck or back pain and seen due to arthritic changes of the spine or a condition called "pars fracture".  Spondylolisthesis is a malalignment of the vertebrae resulting in increased wear and tears on the discs as well as the facet joints which could result neck pain (often radiating to shoulder rate or causing headaches)  , or back pain (often radiating to the buttock and the groin and the flank ).  This could be diagnosed with x-rays and MRI and treated effectively.  It may also result in leg pain/sciatica    

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SACROILIAC -BACK PAIN 
Sacroiliac joint connects the sacrum and the ilium which are part of your pelvic structure.  Painful sacroiliac joint causes back pain.  Approximately 20% of all back pains are related to the sacroiliac joint.  Sacroiliac joint is more common in females than males likely related to hormonal changes. Females may see fluctuation of pain level with menstrual cycle.  It is often the source of pain in the back and leg during pregnancy.
This joint is sensitive to leg length discrepancy, and often becomes symptomatic in individuals with scoliosis.  If you have chronic knee or ankle pain or you have altered gait, it could also affect your sacroiliac joint.  Arthritic sacroiliac joint can be the source of pain and also pain from the sacroiliac region can be emanating from the ligaments across it.
Painful sacroiliac joint resembles other sources of back pain may present with buttock pain, groin pain, radiation to the back of the hamstring.  Patients may experience pain with sitting, standing and transition in between.  Treatment is often conservative but there is a surgical solution to it.  Conservative care includes sacroiliac belt, a course of physical therapy, medications including Tylenol or ibuprofen.  Correction of leg length discrepancy with a insert and a better shoe wear is always helpful.  In cases with persistent sacroiliac pain, sacroiliac joint steroid injection, sacroiliac PRP injection, RF ablation of the nerve to the sacroiliac joint and minimally invasive x-ray guided sacroiliac fusion are treatment options.  Outcome of the sacroiliac joint pain treatment are often satisfactory with reduced pain and improved function.  

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DISCOGENIC -BACK PAIN
Discs separate adjacent vertebral body.  It allows you to move move your spine in every direction particularly bending forward and they function as shock absorbers.  We need healthy disks to be able to move freely.    Over time: Discs become dehydrated, and are more prone to small tears and herniation.  As result, it could be a source of neck pain, mid back pain or lower back pain.  Degenerated or desiccated disc can result in stiffness, pain, and inability to do daily activities..

Back pain from the disc is called "discogenic".  Discogenic back pain is approximately 40% of all the back pains.  First episode of discogenic back pain often is memorable, severe, associated with a bending-lifting injury (example: moving furniture) , and may land the patient in the ER.  Primarily because of pain, you may not be able to move freely, you may feel stuck and simple things like brushing your teeth, coughing and sneezing be significantly aggravate your pain.  It takes several days for this acute phase to subside but it may recur and become episodic.  Improving body mechanic, improving lifting techniques, and improving her biomechanics and ergonomics are the key to prevention and successful treatment.  Physical therapy, core strengthening, and NSAIDs are first-line of treatment.  Sometimes a back brace can help during the acute phase.  An MRI can diagnose the changes within the discs whether is a annular tear or degenerative disc.  Treatments beyond this includes intradiscal PRP injection  (Regenerative Medicine) or surgical replacement/spinal fusion.  

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SPINAL STENOSIS-- BACK PAIN:

Narrowing in your spinal column is called spinal stenosis.  This can happen in your neck, mid back or lower back.Localized neck pain and localized back pain is a fairly common presentation although often associated with either arm pain or leg pain.  Spinal stenosis in the thoracic spine is not common but it can develop in patients with fracture, herniated disc.  Some cases of lumbar spinal stenosis are congenital.  Presentation varies from neck pain with or without arm pain to lower back pain with or without leg pain.  It is often a condition affecting adults in the 6th -8th  decade of life.  Herniated disc can result in spinal stenosis in younger adults. Spinal stenosis can easily be diagnosed based on history, physical examination, and an MRI.  Treatment varies from conservative care which includes physical therapy and over-the-counter medications.  As the treatment progresses, in order of aggressiveness, epidural injection, transforaminal lumbar ESI,, MILD procedure, VERTIFLEX implant, MINUTEMAN implant, lumbar decompression, laminectomy, laminoplasty, laminectomy and fusion may become necessary to improve pain and improve function.  

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FAILED BACK SYNDROME (Post Laminectomy Syndrome).
Unfortunate outcome of back surgery can be failed back syndrome (post laminectomy syndrome).  It means that patient has persistent back pain or leg pain despite excellent surgical care.  Exact reason for this is not very well-known but it can be contributed to scarring in the surgical area.  Patients are often challenged by chronic pain, whether in the back or towards the leg.  It is difficult condition to treat.  This is a clinical diagnosis, and spine specialist may consider physical therapy, and medication management as the primary way of treating this condition.  To improve back pain, some patients may benefit from procedural treatment which includes lumbar RF ablation, and sacroiliac treatment.  In rare cases, epidural injection, and epidural lysis of adhesions may be effective in reducing pain. Neuromodulation such as a spinal cord stimulator is an option for treatment with reasonable success.

To read more about the back pain choose one of the following to explore:
1.  Facet related back pain
2.  Sacroiliac related back pain
3.  Discogenic back pain
4.  Spinal stenosis
5.  Myofascial pain
6.  Mild procedure
7.  Vertiflex implant
8.  Laminectomy
9.  Failed back syndrome
10.Spinal cord stimulator