Spine Conditions & Treatment


Interventional Spine Care

Your spine connects the rest of your body–when your spine is injured, inflamed, or out-of-alignment, the rest of your physical health suffers. There’s nothing more debilitating than a spine injury. Your pain may be constant or only when you perform certain motions, but your pain gives us insight into underlying issues and tells us what we need to do in order to begin the healing process.

Our own Dr. Derek Buck is an expert in Interventional Spine Care. He has extensive training and years of experience to diagnose, treat, and heal spine injuries. His experience with the management of lumbar pain, thoracic pain, disc herniation, and much more equips him with the knowledge and expertise to handle all your spine care needs.

Sideline Orthopedics is dedicated to resolving your spine care needs so you can enjoy life again. Do not waste another minute, contact Sideline Orthopedics today to begin the journey to resolve your back and spine issues.

Our team is experienced in diagnosing and treating conditions and injuries of the spine.

Spinal disks are like shock absorbers between the vertebrae, or bones, of your spine. They help your back stay flexible, so you can bend and twist. As you get older, they can show signs of wear and tear. They begin to break down and may not work as well.

Nearly everyone’s disks break down over time, but not everyone feels pain. If worn-out spinal disks are the reason you’re hurting, you have degenerative disk disease.

A herniated disc occurs when the spongy, soft material that cushions the bones of the spine (vertebrae) slips out of place or becomes damaged. You can have a herniated disc in any part of your spine. When a herniated disc presses on a nerve, it can cause pain, numbness, and weakness in the area of the body where the nerve travels.

Spinal stenosis is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. It occurs most often in the lower back and the neck. This is most commonly caused by wear-and-tear changes in the spine related to osteoarthritis. In severe cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves.

Small joints called facet joints link the vertebrae in the spine, providing stability and allowing the spine to move and bend appropriately. As these joints age, the cartilage that surrounds them can harden and thicken, causing pain and tenderness. Known as facet arthritis or facet arthropathy, this degenerative condition is a key cause of neck and/or lower back pain. Facet arthritis typically presents as pain in a general area or region of the neck or back. The pain associated with facet arthritis tends to worsen with physical activity. However, it can be more troublesome in the morning.

The low back supports the weight of the upper body and provides mobility for everyday motions such as bending and twisting. Muscles in the low back are responsible for flexing and rotating the hips while walking, as well as supporting the spinal column. Nerves in the low back supply sensation and power the muscles in the pelvis, legs, and feet. Most acute low back pain results from injury to the muscles, ligaments, joints, or discs. The body also reacts to injury by mobilizing an inflammatory healing response. While inflammation sounds minor, it can cause severe pain. Low back pain can incorporate a wide variety of symptoms. It can be mild and merely annoying or it can be severe and debilitating. Low back pain may start suddenly, or it could start slowly—possibly coming and going—and gradually get worse over time.

Thoracic spine pain is defined as pain in the back that is located between your first thoracic vertebra and your 12th thoracic vertebra. Your first thoracic vertebra represents the place where your neck ends and your rib cage area begins, approximately at the level of your shoulders. Your 12th thoracic vertebra corresponds to the bottom of your rib cage. There are a number of possible causes of thoracic spine pain. Mechanically, it can arise when something is going on in your thoracic spine or your cervical spine, but may also be due to issues in other areas of the body. For example, problems in your gastrointestinal tract, organs, cardiopulmonary system (heart and lungs), and/or your kidneys may refer pain to the thoracic region. Low bone density and myelopathy (symptoms that occur when your spinal cord is irritated) may also cause thoracic spine pain.

The cervical spine in your neck is made up of seven bones called vertebrae, which are separated by discs filled with a cushioning gel-like substance. Your cervical discs both stabilize your neck and allow it to turn smoothly from side to side and bend forward to back. Over time, these natural shock absorbers become worn and can start to degenerate. The space between the vertebrae narrows and nerve roots become pinched. This process is known as cervical degenerative disc disease.The most common and obvious symptoms of cervical degenerative disc disease are neck pain and a stiff neck. When one of these conditions presses on one or more of the many nerves running through the spinal cord, you also can develop pain, numbness, or weakness radiating down your shoulder, arm, and hand.

A nerve conduction study measures how fast an electrical impulse moves through your nerve. NCV can be used to distinguish between a nerve disorder and a muscle disorder and identify nerve damage. During the test, your nerve is stimulated, usually with electrode patches attached to your skin. Two electrodes are placed on the skin over your nerve. One electrode stimulates your nerve with a very mild electrical impulse. The other electrode records it. The resulting electrical activity is recorded by another electrode. This is repeated for each nerve being tested.

Electromyography (EMG) measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle. The test is used to help detect neuromuscular abnormalities. During the test, one or more small needles (electrodes) are inserted through the skin into the muscle. The electrical activity picked up by the electrodes is then displayed on an oscilloscope, which displays electrical activity in the form of waves. EMG measures the electrical activity of muscle during rest, slight contraction and forceful contraction. Muscle tissue does not normally produce electrical signals during rest. After an electrode has been inserted, you may be asked to contract the muscle, for example, by lifting or bending your leg. The action potential (size and shape of the wave) that this creates on the oscilloscope provides information about the ability of the muscle to respond when the nerves are stimulated. As the muscle is contracted more forcefully, more and more muscle fibers are activated, producing action potentials.

This minimally invasive spine surgery is used to relieve pain caused by herniated discs pressing on nerve roots. During an endoscopic procedure, the surgeon makes a small incision through which a guided wire is inserted. The guide wire is used to locate the damaged disc level. A fluoroscope (specially designed X-ray machine) is used to ensure the correct path is made to the affected disc. The surgeon will next use a number of dilating tubes placed over the guide wire to move apart the tissue to the vertebrae. The procedure is performed through a tubular retractor which is placed over the dilating tubes and onto the bone surface. A small camera and special surgical light are used to view through the tube. Surgical instruments are used gain access to the spinal canal and move away soft tissue and bone. The nerve is separated from the damaged disc by a nerve retractor. The surgeon next removes the herniated portion of the disc and cleans the area. The nerve then returns to the normal position.

At the end of the endoscopic spine procedure, the tubular retractor is removed, this allows the tissue to enclose the surgery area. Only a small bandage is needed to cover the incision area.

Evidence based treatment is the intentional use of current based evidence in making decisions about individual patients and their care along with clinical expertise and patient values. Clinical expertise refers to the clinician’s cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal preferences and unique concerns, expectations, and values. The best research evidence is usually found in clinically relevant research that has been conducted using sound methodology.

Spinal cord stimulation (SCS) is a pain-relief technique that delivers a low-voltage electrical current continuously to the spinal cord to block the sensation of pain. SCS is the most commonly used implantable neurostimulation technology for management of pain syndromes. During SCS, a device that delivers electric signals is implanted in the body through a needle placed near the spinal cord. A small incision is made to place the pulse generator.

A pinched nerve occurs when too much pressure is applied to a nerve by surrounding tissues, such as bones, cartilage, muscles or tendons. This pressure disrupts the nerve’s function, causing pain, tingling, numbness or weakness. With rest and other conservative treatments, most people recover from a pinched nerve within a few days or weeks. Sometimes, surgery is needed to relieve pain from a pinched nerve.

Regenerative medicine is a natural treatment solution that utilizes the body’s own healing process to repair damaged tissue, and bridges the gap between non-operative treatments (physical therapy and spinal injections) and surgery. It’s the process of creating living and functional tissues to repair or replace tissue that is lost due to age, disease, or damage. The key goal in using regenerative medicine is to aid in healing the damaged condition and to fix the root cause of the pain. For individuals that are not interested in pursuing surgical intervention, but are looking for a solution to their pain, regenerative therapy could be the answer to rejuvenate the damaged tissue.

Epidural Steroid Injections are a common method of treating inflammation associated with low back related leg pain, or neck related arm pain. Spinal nerves can become inflamed due to narrowing of the passages where the nerves travel as they pass down or out of the spine. Narrowing of the spinal passages can occur from a variety of causes, including disc herniations, bone spurs, thickening of the ligaments in the spine, joint cysts, or even abnormal alignment of the vertebrae (slipped vertebrae). The epidural space is a fat filled ‘sleeve’ that surrounds the spinal sac and provides cushioning for the nerves and spinal cord. Steroids placed into the epidural space have an anti-inflammatory action that can decrease pain and allow patients to improve function.

Nerve Root Injection is an injection of a long-lasting steroid (cortisone) around the nerve root as it exits the spinal column. The injection reduces the inflammation and pain caused by pressure on the nerve. It can also be used as a diagnostic tool to help doctors determine whether the nerve is irritated by numbing the nerve. One of the most common conditions to benefit from selective nerve root injections is a herniated disc that causes low back and leg pain (sciatica). The injection is performed with the patient lying on the stomach on an x-ray table. The surgeon uses fluoroscopy (x-ray) to help locate the specific nerve root. A needle is inserted into the area and the medication and an anesthetic are injected. The injection takes just several minutes. After the injection, the patient is monitored for 15-20 minutes and then released. Most patients start noticing pain relief after the third to seventh day, which can last weeks or months.

Facet ablation is achieved through the application of focused radiofrequency waves to the tissues of the medial branch nerves. During an ablation procedure, X-ray imagery is used to guide a thin, hollow device called a cannula or introducer needle through your skin to the medial branch nerves associated with your damaged facet joint. After confirming proper placement of the cannula, a radiofrequency-conducting tip is passed through its interior. Next, a machine that generates radio waves is attached and the focused energy is used from these waves to burn the targeted nerves in bursts that last roughly 90 seconds. Typically, your doctor will ablate multiple areas on any given nerve in order to ensure it is fully desensitized.

Nerve blocks are used for pain treatment and management. Often a group of nerves, called a plexus or ganglion, that causes pain to a specific organ or body region can be blocked with the injection of medication into a specific area of the body. The injection of this nerve-numbing substance is called a nerve block.

A discogram is an invasive diagnostic test that uses x-rays to examine the intervertebral discs of your spine and precisely locate which discs are damaged and causing back pain. A special dye is injected into the injured disc to make the disc visible on a fluoroscope monitor and x-ray film. A discogram works in two ways—both to view your disc and to find the source of your pain. Your doctor injects the dye into your disc space to try to recreate the pain. If you feel pain, then that disc is the likely source of your pain. If you don’t feel the same kind of pain—even if that disc appears degenerated on the MRI scan—then other possible causes of your pain should be explored.


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