Deterioration of joints in the spine over a period of time is generally referred to as spondylosis. This can be caused by poor mechanics due to injury, chronic poor posture, and constant increased stress on the joints.
The most common symptoms of spondylosis are stiffness and pain in the spine.
Treatment modalities include physical therapy, lifestyle changes, pain medications, and in severe cases, surgery.
Chronic Migraine
Severe headaches with dull, throbbing sensation usually on one side of the head accompanied by nausea, sound and light sensitivity are characteristic of migraine. When such episodes occur over 15 times a month and last 4 hours or more, chronic migraine is diagnosed.
Such a debilitating condition is due to a combination of genetics and environmental factors. Migraines can sometimes be prevented by avoiding triggers like caffeine, MSG, and dehydration.
Treatment includes pain medications, and recently, successful prevention has been achieved with Botox injections as well.
Compression Fractures
A traumatic injury or osteoporosis can cause fractures in the vertebral bodies of the spine, a condition known as compression fracture.
This can be extremely painful, hampering daily activities and can be source of physical and emotional burden.
Treatment options available for compression fracture include pain medications, physical therapy and back bracing. In addition to conservative options, vertebroplasty or kyphoplasty procedures have a high success rate as well.
Degenerative Disc Disease (DDD)
DDD is a condition that refers to normal wear and tear with age of the discs between the vertebral bodies. The discs that act as cushions between the bony vertebral bodies deteriorate over time causing inflammation and pain.
This most commonly occurs in lower back and neck region. Physical exam, and imaging modalities like MRI and discograms are utilized to diagnose DDD.
Treatment choices are pain medications, physical therapy and epidural injections.
Failed Back Surgical Syndrome / Post Laminectomy Syndrome
Back pain in the spine that remains despite spinal surgery is referred to as failed back surgical syndrome.
For such condition treatment varies between medications, physical therapy and procedures such as caudal adhesiolysis and/or spinal cord stimulation.
Adhesiolysis aims at breaking down surgical scars, while spinal cord stimulation uses electrodes to send signals to the spinal cord that block pain.
Fibromyalgia
Fibromyalgia is a complex condition that signifies chronic pain distributed throughout the body with specific trigger points.
This condition is associated with fatigue, sleep disturbances and depression.
Treatment for fibromyalgia consists of medications, physical therapy and trigger point injections.
Lumbar Herniated Discs
Commonly known as slipped disc, herniated disc is a condition where too much pressure on the disc can cause it to bulge out through tears in the outer fibrous ring.
Symptoms can vary from minor pain to numbness, tingling, weakness and severe pain that radiates into other regions such as arms or legs.
Treatment consists of medications, physical therapy, epidural and transforaminal injections. Advanced procedures like percutaneous disc decompression and intradiscal electrothermal disc procedures are other valid options.
Lumbar Radiculopathy
Lumbar radiculopathy is also known as sciatica, and is defined as leg pain, tingling, numbness or weakness caused by lumbar disc herniation compressing on the sciatic nerve.
Other causes in addition to disc herniation can include bone spurs, tumors, infection or other injuries causing pinching of the sciatic nerve.
Treatment aims at combining a rehabilitation program as well as steroid epidural injections.
Myofascial Pain Syndrome
Chronic pain in localized places on the muscle characterized by trigger points, tenderness to touch, weakness and limited range of motion is known as myofascial pain syndrome.
Causes of this syndrome are poorly understood and therefore treatment can be challenging.
Trigger-point release, physical therapy and dry-needling are some of the various techniques employed in order to address this condition.
Peripheral Neuralgia
The nerves throughout the body, except brain and spinal cord, are referred to as peripheral nerves. Conditions comprised of pain, weakness, numbness or abnormal sensation of these nerves is known as peripheral neuralgia.
Conditions such as diabetes, chronic alcohol use, abnormal thyroid function, or injuries causing compression of peripheral nerves can result in neuralgia.
Medications, physical therapy and neuromodulation with spinal or peripheral nerve stimulation are promising treatment modalities.
Sacroiliac Joint Dysfunction
The joint between the pelvis and lower spine, known as the sacroiliac joint, is susceptible to inflammation and pain caused by abnormal motion.
It is important to distinguish this condition from other causes of low back pain such as spondylosis, disc herniation with radiculopathy, DDD and myofascial pain syndrome.
A direct steroid injection to the sacroiliac joint can help in diagnosing as well as treating this condition. Other options like pain medications and physical therapy can also be utilized for symptom relief.
Scoliosis
When a normally straight spine has a sideways curvature, it is known as scoliosis.
Scoliosis can range from a slight bend to a severe curve, which can be deforming as well as disabling, affecting range of motion as well as respiratory function.
Facet joint injections, medial branch block, and facet radiofrequency neurotomy aim at treating pain caused by the impaired forces on spine from scoliosis.
Spondylolisthesis
When one vertebral body slips forward or backward over another vertebra, it leads to a condition known as spondilolisthesis.
Symptoms of spondilolisthesis arise from a pinched nerve and can therefore consist of pain, weakness, and abnormal sensation in the area affected by the nerve.
Symptom resolution is attained with medications, physical therapy, epidural or facet joint injections and nerve ablation.
Spinal Stenosis
Spinal stenosis is defined as narrowing of spaces in the spinal canal due to abnormal mechanics. Such space constriction can pinch the exiting nerve causing pain, numbness and even weakness.
Stenosis in the spine can be caused due to arthritic bony spurs, disc herniation, or swelling of spinal ligaments, and even space occupying lesions such as tumors.
Treatment for symptoms associated with spinal stenosis are pain medications, physical therapy, steroid injections, and in some cases surgery and spinal cord stimulation.
Sympathetic Mediated Pain
A condition, also known as complex regional pain syndrome, is a complex condition that affects the arm or leg and is characterized by severe burning or aching pain, and/or abnormal sensations like extremes of temperature, sweating, skin discoloration and hypersensitivity of the affected area.
Apart from pain medication and physical therapy, treatment focuses on nerve blocks to liberate patients from pain and intense sensitivity.
Localized nerve blocks such as stellate ganglion block, celiac plexus block, lumbar sympathetic block, superior hypogastric block, ganglion impar block, as well as, generalized spinal cord stimulation are available procedural choices.
Whiplash Injuries
Common during motor vehicle accidents, falls and contact sports, whiplash injuries are caused from a rapid acceleration and deceleration of the neck.
The jerking motion where head is whipped back and forth extends the neck beyond its normal range of motion causing injury to vertebrae and associated muscles, joints and ligaments. Such whiplash can cause headache, neck and shoulder pain, dizziness, and even difficulty swallowing or chewing.
Immobilization of the neck, medications, physical therapy and nerve blocks are common treatment options. Facet joint injections, medial branch block, and facet radiofrequency neurotomy provide promising relief for whiplash injuries.
