Between each vertebra is a disc that acts as a cushion. The outside of the disc is made of tough tissue called the annulus. At its center is a gelatin-like substance called the nucleus pulposus. When this center substance breaks through the outer tissue, it causes a herniated disc.

The discs are in front of the spinal cord so when a herniated disc compresses spinal cord nerves, it can cause pain, numbness, or weakness in the arms or legs. Back or neck pain can occur when the outside of the vertebra is stretched or torn.

Symptoms:

The most common symptom is pain that radiates from the lower back into one or both legs. In the cervical spine, pain radiates into the arms.

Screening and Diagnosis:

Your diagnosis process most likely will start with physical and neurological exams to pinpoint the nerve causing the pain and/or numbness. Typically, an MRI will be performed. It’s the preferred form of testing for this condition because it produces images that not only give clear pictures of the disc, it also shows “soft tissues” such as spinal fluid, and neural elements.

Surgery is not your only option when you have a herniated disc. Dr. Radden is a firm believer of first trying non-surgical treatments that can include bed rest; non-steroidal, anti-inflammatory medications; physical therapy; and light physical activity such as walking.

The most common surgical treatment is lumbar discectomy, which relieves compression of the spinal cord or spinal nerves by removing the portion of the disc that is herniated or protruding beyond its normal boundaries.

Spinal stenosis results when the spinal canal—the passageway where the spinal cord and nerve roots are—narrows. This can occur when there are disc protrusions or herniations (the gelatin-like center breaks through the outer side of the disc), thickening of the ligaments within the spinal canal, movement of the vertebrae, or osteophytes (bone spurs) growing into the canal.

There is no definitive answer to the likelihood that you’ll get spinal stenosis. It could be present at birth. But, most commonly, it occurs in people age 60 and over.

Symptoms:

Persistent pain in the buttocks, limping, lack of feeling in the arms and hands or legs and feet, loss of bladder or bowel control, and pain or stiffness in the legs—even when walking short distances.

Screening and Diagnosis:

You’ll be given a physical exam and possibly undergo testing such as MRI, CT scan, or myelogram (an x-ray photograph of the spinal cord). If it looks as though you have nerve damage, you may have an electromyography (EMG), which measures how effectively your nerves are able to send and receive signals.

Treatment:

The first plan of action is non-surgical procedures such as exercise, changes in your activities, and epidural injections in the fibrous membrane forming the outermost of the three coverings of the brain and spinal cord. Surgery is a likely option if pain doesn’t improve with non-surgical treatments. Surgery typically is used to enlarge the spinal canal and relieve the pressure on the spinal cord or nerves

Between each of the discs that help make up your spine each vertebra acts as a shock absorber. The outer part of the disc is the annulus, which is made of rings of tough cartilage-like tissue. In the center of the disc is a gelatin-like substance called the nucleus. As we get older, the center “cushioning” nucleus begins dehydrating making the disc less supportive and more prone to injury. The dehydrated disc can produce chemicals that irritate surrounding tissue, resulting in back or neck pain and/or pain in the arms or legs.

Disc degeneration is very common in older people, but also can occur in younger adults. Factors contributing to disc degeneration are not fully understood, but there appears to be a genetic link.

Almost everyone’s discs dehydrate and degenerate with age. Some people don’t experience any pain from this process. However, others experience acute, chronic pain—something that also can occur after a tear or injury to the disc tissue.

Screening and Diagnosis:

You’ll be asked about your medical history, have a thorough physical exam, and possibly be X-rayed, and/or undergo MRI testing. You might also have a discography, a procedure, in which a special dye is injected into the disc, making it clearly visible on an x-ray film called a discogram.

Treatment:

Typically, treatment begins with physical therapy to strengthen the muscles in the trunk of your body and around your spine in an effort to reduce pain. It’s also possible you’d be prescribed medication to reduce or eliminate your pain. If, after several months of non-surgical treatments, pain persists, you might need surgery.

There are several minimally invasive surgery procedures (surgery using small incisions) most frequently used for early stages of disc degeneration. One possibility is interbody fusion, through which the disc is removed and replaced with a small segment of bone that will, in time, fuse the vertebrae to stabilize the painful spine area.

Total disc replacement or artificial discs may be used as well. The disc tissue is removed, and a mobile disc prosthesis is put into the disc space.

Radicular syndrome results in pain and other symptoms such as numbness, tingling and weakness in the arms or legs. It’s caused by compressed or irritated nerve roots. The nerve roots are branches of the spinal cord that carry signals out to the rest of the body at each level along the spine. This condition is often caused by direct pressure from a herniated disc or degenerative changes in the spine that cause irritation and inflammation of the nerve roots. Sensory symptoms are more common than motor symptoms, and muscle weakness is usually a sign that the nerve compression is more severe. The quality and type of pain can vary, from dull, aching and difficult to localize, to sharp and burning.

Screening and Diagnosis:

You’ll first undergo a physical examination of the neck, back, arms and lower extremities. Dr. Radden will look for any problems with flexibility, muscle strength, sensation and reflexes. X-rays may be taken to show the bony anatomy of the spine. An MRI scan or a CT scan might also be ordered. An MRI scan is useful in showing compression of nerve roots by giving a detailed picture of soft tissue structures. A CT scan is often used to evaluate the bony anatomy in the spine, which can show how much space is available for the nerve roots and spinal cord within the spinal canal.

Treatment:

In most cases, radicular syndrome can be treated with only non-surgical methods such as physical therapy, chiropractic manipulation, and non-steroidal anti-inflammatory drugs. Epidural steroid injections also may be considered for severe cases. Nerve testing (electromyography or EMG) might be necessary to objectively test the condition of the nerve-muscle connection, particularly if strength testing is limited by pain.

If you suffer from actual nerve injury, surgery might be the best solution to relieve the pressure on the nerves. In other situations, surgery may be offered if none of the non-surgical treatment options have failed to improve symptoms.

Spondylosis is typically a degenerative condition of the spinal joints and is also known as spinal osteoarthritis. The discs, joints, and ligaments of the spine are generally affected. The discs lose their cushioning effect between the spinal bones, the ligaments become weaker or thicken, and the bones can develop bony growths or spurs. Aging and repetitive stresses to the spine are the primary causes of this degeneration, but it also can be present in younger adults who have had prior trauma. Not everyone will have symptoms (usually pain) as a result of spondylosis. If severe, spondylosis may cause pressure on nerves with subsequent pain or tingling in the arms or legs.

Screening and Diagnosis:

Your first step in treatment is a physical exam to observe your posture, range of motion and physical condition, noting any movement that causes you pain. A neurological exam may also be performed to test your reflexes and muscle strength. This evaluation also checks out other symptoms, such as numbness, tingling, or bowel and/or bladder problems. As your doctor develops the diagnosis, imaging tests may be performed. These may include x-rays, CT or MRI. An MRI is especially good at showing abnormal discs, ligaments, or nerve roots. CT scans can show inflammation of the facet joints, which could indicate spondylosis. With an x-ray, your doctor will be able to see the bony elements of your spine.

Treatment:

Non-surgical options include epidural injections, chiropractic care, pain management medications, and physical therapy. If the pain continues or there is evidence of a severely compressed nerve, surgery may be considered. Surgery for spondylosis involves two main components: eliminate what is causing pain and then fusing the spine to control movement. Surgery may also include decompression, which is removing the tissue that is pressing on nerves.

Treatment

Treatment varies with severity of the spondylolisthesis. Most patients require only physical therapy combined with activity modification. If pain is caused by nerve irritation, epidural steroid injection may be considered. For cases with severe pain that’s not relieved by physical therapy, surgery to fuse the slipping vertebra to the stable one below.

Failed back surgery syndrome (FBSS) refers to chronic back or neck pain, with or without extremity pain that can occur if a spine surgery does not achieve the desired result. Contributing factors to pain that returns following spine surgery include, but are not limited to, recurrent disc herniation, pressure on a spinal nerve, altered joint mobility, scar tissue, muscle deconditioning, facet joint degeneration, or sacroiliac joint degeneration.

Symptoms:

Common symptoms associated with FBSS include diffuse, dull and aching pain involving the back and/or legs. Patients may also complain of sharp, pricking, burning or stabbing pain in the extremities.

Screening and Diagnosis:

First, your doctor will review your treatment history, particularly the type of surgery done and for what reason. Particular attention is paid to the result of the surgery and how your symptoms have evolved following the surgery. A physical examination also will be done. X-rays, MRI and computed tomography (CT) may be ordered.

Treatment:

Treatment for failed back surgery syndrome may include physical therapy, nerve blocks, medications, injections, or a chronic pain management program. If the pain is coming from the facet or sacroiliac joints, chiropractic care may be recommended. These non-surgical treatments are given, and if not successful, surgery might be the best option for treatment. This might include facet joint or sacroiliac joint rhizotomy (a surgical procedure that relieves chronic back pain and muscle spasms). Sometimes the cause of symptoms can’t be determined. In these cases, spinal cord stimulation (SCS) or narcotic pumps may be used for pain control.

Spine fractures can occur at any segment of the spinal column. Spinal fractures can happen from something as dramatic as a fall or motor vehicle accident, or, in a patient with osteoporosis, from a simple movement like coughing or reaching overhead. Osteoporosis, or loss in bone quality, causes the spine to be prone to compression fractures. The pain from an osteoporotic fracture is not always severe – sometimes it’s mild. Many people mistake spinal fractures for backaches, which they assume are just part of getting older. The primary symptom seen in compression fractures is moderate to severe back pain made worse by movement. When the spinal cord is affected, numbness, tingling, weakness, bowel/bladder dysfunction, or even paralysis might occur.

Screening and Diagnosis:

The first step in evaluating spinal fractures is to get a detailed history about what caused the injury and perform a physical examination. This may include checking for swelling, bruising, tenderness and other signs of injury to the head, abdomen and back as well as evaluating strength, motion and alignment of arms and legs. A neurologic examination may also be done. This may include tests of sensory (temperature, pain and pressure sensitivity), motor (muscle strength), and reflex functions of the nervous system. In addition, x-rays may be necessary to look for fractures or dislocations. Often computed tomography (CT) or magnetic resonance imaging (MRI) scans may be ordered to determine the extent of injury.

Treatment:

Treatment goals include protecting nerve function and restoring alignment and strength of the spine. Treatment options are based upon the type of fracture and other factors. Non-surgical treatment options include wearing a brace for sitting and standing activities for 6 to 12 weeks. Patients should walk and do other exercises while healing and may take medications for pain. Depending on the symptoms and the type of fracture, surgery may be an option. For some fractures, metal screws and rods or plates may be used to realign the spine. For osteoporotic fractures, vertebroplasty or kyphoplasty may be performed. These are minimally invasive procedures in which bone cement is injected into the fractured vertebrae. It is important to discuss treatment options with your doctor in deciding which treatment, if any, may be best for you.

Chronic pain is pain that is ongoing for more than three months. Many chronic pain patients have had symptoms for years. Typically, we associate pain with an injury that will heal over time and the pain goes away. This is a typical characteristic of acute pain. Chronic pain is different. Chronic pain persists and may vary in intensity. It may be caused by an ongoing mechanism such as arthritis, persistent nerve root compression, nerve root injury or other ongoing processes. In some cases, the exact cause of the pain cannot be identified and can be associated with changes that have taken place within the nervous system itself.

Screening and Diagnosis:

The diagnostic evaluation of chronic pain patients often needs to be fairly extensive. A thorough medical history will be reviewed, including when the pain started, treatments received and their effectiveness, any surgery performed, changes in the type, severity and location of pain, and review of previous diagnostic tests. A physical exam will be performed. Imaging may be done including x-rays, MRI or CT. Other tests such as myelography, discography, EMG, or injections also might be done.

Treatments:

The treatment plan for chronic pain patients is typically based on the results of the diagnostic workup. Considering the variation in treatments from one center to another, some treatments may be attempted again using a different delivery technique. This may include the way an injection is performed or the components of a physical therapy program. Chronic pain in patients is managed with medications, injections, chiropractic care, physical therapy, psychological intervention, education, chronic pain management program, and/or surgery. Chronic pain programs generally require the patient to participate in care for several hours a day for a period of usually 4-6 weeks. Surgery, such as fusion or decompression, also might be considered.

Acute pain is not a particular type of pain, but is based on how long it has lasted. Generally, acute pain follows a course that is typical or expected for a particular type of injury. The pain is usually more severe initially and gradually goes away. The timeframe considered for acute pain varies by injury type, but is typically three weeks to three months.

Screening and Diagnosis:

The doctor will review your history and perform a physical exam. X-rays or other images are not usually ordered unless the pain has lasted at least four weeks. In certain situations, imaging may be done to rule out fracture or other potentially more serious problems. A more extensive evaluation will be performed if there are symptoms of nerve injury, such as loss of bowel/bladder control or weakness in the extremities.

Treatment:

Treatment for most acute back/neck pain includes activity modification, education, physical therapy and/or medication.

Myelopathy is the loss of spinal cord function caused by degenerative changes to the spine or by trauma. It is often first detected as difficulty walking because of weakness or problems with balance and coordination. This process occurs more commonly in the elderly, who can have many reasons for having problems with walking and balance. Myelopathy may be caused by bone spurs or disc herniations in the cervical or thoracic spine that squeeze the spinal cord. Trauma or instability may also play a role in myelopathy. This compression can cause irreversible injury to the spinal cord with serious disability to the patient. Patients showing signs of myelopathy often are considered urgent surgical candidates.

Screening and Diagnosis:

Myelopathy usually develops gradually, making it difficult to detect. Many people with myelopathy will begin to have difficulty with things that require coordination. Examples include walking up or down stairs, buttoning shirts, or tying shoes.

Treatment:

If pain is present, the source of pain should be identified. Surgery is usually offered as an early option for people with myelopathy who have evidence of muscle weakness that is being caused by nerve or spinal cord compression. This is because muscle weakness is an indicator that the spinal cord and nerves are being injured. Relieving the pressure on the nerves and spinal cord may give the best chance for recovery. Surgery is not for everyone. Mild myelopathy or pain related to myelopathy may be treated early with physical therapy and/or medication. However, these will not usually address the structural problem creating the myelopathy.

Excessive motion of vertebrae in relation to one another is considered spinal instability. Some motion is, of course, normal. Motion can be described as instability when the motion is significantly greater than that at adjacent levels. Spinal instability can be the result of an injury, degenerative process, tumor, previous surgery, or congenital condition (present at birth). Symptoms of spinal instability may include neck or back pain, nerve pain, and muscle spasms.

Screening and Diagnosis:

Once a complete physical examination is performed, the diagnosis of spinal instability should be confirmed using x-rays to assess the alignment of the spine. Other tests include an MRI or CT scan to evaluate nerve compression and bony or ligament insufficiency.

Treatment:

Non-surgical treatments include pain management using non-steroidal anti-inflammatory medication and physical therapy. If significant pain persists, surgery may be considered to stabilize the spine. Surgical options generally include dynamic stabilization (best be described as an internal brace – allowing controlled movement of the affected segment of the spine), and posterior lumbar fusion (when a vertebra is fused with the one below it).

Spinal deformity generally is an abnormal curvature of the spine. Scoliosis and kyphosis are types of spinal deformity. The curves may result from degenerative changes, fractures, infection, malignancy, or structural changes following spine surgery. Some types of deformity are due to the spine being misshapen as the person grows from childhood. Spinal deformity may or may not cause pain. Pain in patients with spinal deformity may arise from the curved spine compressing or irritating nerves, or from the facet or sacroiliac joints.

Screening and Diagnosis:

You’ll be given a physical exam to evaluate the curve and to begin addressing symptoms that may be present. The most common means of evaluating spinal deformity is through imaging such as X-ray, MRI, or CT. It’s important to rule out possible causes such a fractured vertebra, infection, or malignancy. In patients with pain, diagnostic testing might include evaluations for nerve root compression, facet joint pain, and/or pain arising from the sacroiliac joint.

Treatment:

The treatment for spinal deformity depends on the type of the problem, your age, and pain severity. Pain is treated in much the same manner as nerve root compression, stenosis, facet joint pain or sacroiliac joint pain, depending on the results of the diagnostic evaluation. If there are significant structural problems, surgery might be an option to re-align the spine or stop progression of a worsening deformity.

Osteoporosis is the thinning of bone and by itself is not painful. While it’s generally associated with aging, metabolic imbalance, genetics, and medications also can be factors. Osteopenia is a lesser form of this condition and, if not treated, may progress to the more serious osteoporosis. In the spine, the thoracic and lumbar segments are the most commonly affected. Vertebral compression fractures occur when the bone weakens and can no longer support the load imposed upon it. Spinal symptoms related to osteoporosis include back pain and deformity that can lead to a hunched back and/or decreased height.

Screening and Diagnosis:

After an examination, your physician may take x-rays of the spine to check for fractures. There are several quick-and-easy screening evaluations for osteoporosis that scan the wrist or heel. However, one of the more reliable tests is called dual-energy x-ray absorptiometry (DEXA). A DEXA scan is generally painless, convenient and emits very little radiation. Generally, the lower spine and hip are scanned. Your bone quality is reported by comparing you to others of the same age and gender as well as to a young adult population. The results are usually considered in terms of your bone being of normal density, somewhat reduced density (called osteopenia) or significantly reduced density (osteoporosis).

Treatment:

Treatments include supplementation with calcium and Vitamin D. Weight-bearing exercise—including walking—is extremely important to build stronger bones. Certain medications such as bisphosphonates, estrogen, reloxifene, calcitonin, and parathyroid hormone are available to prevent, reduce, or treat osteoporosis. Other medications may be used if the osteoporosis is determined to be related to a more general medical condition.

Any pressure placed on the spinal nerves as they branch off the spinal cord can cause compression, resulting in pain or numbness radiating into the arms or legs. This is sometimes called radicular pain and in the low back/leg may sometimes be called “sciatica.” Nerve compression can occur at any level of the spine. This pressure can result from disc protrusions or herniations, bone spurs, scar tissue, spinal instrumentation, tumors, infection or cysts. Severe nerve compression may result in loss of bowel or bladder control, or the weakness of an extremity. If these symptoms occur, you should see a doctor immediately.

Screening and Diagnosis:

The doctor will review your symptoms and perform a physical examination. X-rays may be made and an MRI may be ordered if symptoms persist. Electromyography (EMG) may be performed to check if nerves are working as expected.

Treatment:

The first line of treatment is usually physical therapy, patient education, and possibly medication. If these don’t provide relief, injections are usually the next option. Surgery, such as discectomy or decompression, may be considered if severe pain persists. During these procedures, the tissue pressing on the nerves is removed.

Whiplash is a sprain or strain of the muscles and ligaments in the neck (cervical spine) caused by sudden and forceful movement of one’s head in a backward-then-forward motion. This occurs most commonly from a deceleration injury, as seen in automobile accidents. Whiplash can occur whether the force is directed from the front or from behind. Symptoms accompanying whiplash include neck pain and swelling, decreased motion, tenderness along the upper portion of the back and neck, muscle spasms and possibly headache. In severe cases, “neurologic-like” symptoms may develop even without injury to neural structures. Symptoms can include dizziness or other balance complaints, vision changes, nausea and referred symptoms into the extremities.

Screening and Diagnosis:

Once you are stabilized, the doctor will take a complete medical history and physical examination to assess the degree of injury. In addition to examining your head and neck, the doctor will test your muscle strength, sensation of your extremities and reflexes. X-rays may be used to rule out fractures or spine instability.

Treatment:

Mild cases of whiplash are typically treated with over-the-counter pain medication and ice applied to the injured areas. If pain continues, prescription medication, physical therapy, or chiropractic care may be advised. As long as more serious conditions have been ruled out, appropriate treatment for whiplash involves appropriate rehab exercises, strategies for symptom relief and time. In severe cases, whiplash symptoms may persist to some degree for months or even years.

The sacroiliac joint (SI joint) is the joint bridging the lowest segment of the spinal column (sacrum) to the bones of the pelvis. These joints support the upper body when we are standing. After time, the SI joint can develop arthritis and become painful, particularly when walking and climbing stairs. The location of pain is generally in the lower back, buttocks, and thighs.

Screening and Diagnosis:

A complete medical history and physical examination are performed. Imaging such as X-rays, MRI or CT may be ordered, but are often unrevealing for SI joint pain and are typically obtained to rule out other conditions. In addition, one of the most accurate ways to diagnose SI joint pain is to inject the area with an anesthetic. If the pain goes away, it is likely that the SI joint was causing the pain.

Treatment:

Non-surgical treatment options are most appropriate to relieve SI joint pain. The first treatment options usually include chiropractic care, physical therapy, and/or medication. If pain persists, injections may be done. Rhizotomy, a procedure done to deaden nerves around the SI joint, may be done to control pain. Rarely is surgery, other than rhizotomy, done to treat SI joint pain.

The facet joints help support weight-bearing and control movement between vertebrae. They work together with the discs to form a functional unit. There are two joints (one on each side) at each spinal segment. These joints are much like any other joint in the body and may become arthritic. Degenerative joint changes are common in the older population, but may occur in younger adults, particularly with prior trauma.

Screening and Diagnosis:

The diagnosis of facet joint pain is made after a complete medical history and physical examination. In addition, X-ray, CT or MRI may be ordered for further evaluation, but the appearance of facet joints on imaging studies is often non-specific. For patients who fail to improve with usual care and for whom facet joint pain is strongly suspected, anesthetic “blocks” are the most specific means to determine if the joint is causing pain.