The Vault

Back Pain

Facet disease

Back pain can be caused by a variety of factors. One is facet disease, or degeneration of the joints of the low back. These joints allow us to rotate our spine back and forth and forwards and backwards. The facets of the low back are at risk of early degeneration because they are at the junction of a rigid bony pelvis attached to a stable rib cage.

Facet disease is one of the most common causes of back pain. Patients will experience pain in the middle of the back that often radiates down the buttocks and into the back of the thighs. It usually feels worse with leaning back and rotating, and better with bending forward. Anything we can do to off load the spine will help with this condition. This includes weight loss, core strengthening, and back bracing. Advanced disease may require further interventions such as medial branch blocks and radiofrequency ablation. Please see our treatment section for a detailed explanation of these treatments.

Radiculapathy or “Sciatica”

Radiculapathy is a term describing a pinched nerve. The nerves exit the spinal cord through an opening called the neural foramen. Either a bulging or herniated disc or an enlarged facet joint can pinch the nerve. Bone spurs can also form, all of which can put pressure on the nerve. Patients will complain of back pain and spasm, as well as pain that radiates down the leg into the foot. This pain is described as electrical or a “shock” down the leg, and can feel like it’s burning and numb. Severe case will cause weakness in the leg or foot as well.

Radiculapathy is diagnosed by history, physical exam, and imaging. EMG and nerve conduction studies may also be performed to provide objective information of potential nerve damage. Off loading the spine with weight loss, core strengthening, and back bracing can provide relief. Minimally invasive treatments such as epidural steroid injections may be necessary. Sometimes the condition is too severe and requires surgical correction. Please see our explanation of epidural steroid injections and lumbar interbody decompression and fusion for an in depth explanation of treatment.

Degenerative disc disease

Discs in the spine serve as both shock absorbers and spacers that lie between the bones of the spine. They have a fibrous outer ring called the annulus and a jelly middle called the nucleosus pulposis. The outer ring is constructed like a tire, with alternating fibers that mimic that or a radial tire lying on its side. Over time these radials can snap, and the disc begins to bulge.

The outer portion of the disc has pain fibers while the inside does not. As the disc degenerates it starts to expose the outer pain fibers to the inner jelly middle, which is full of inflammatory mediators. Once that occurs, the disc itself can become painful and is now known as discogenic pain. This can be treated with epidural steroid injections, physical therapy, core strengthening, and back bracing. Sometimes the condition is too severe and needs surgical correction.

Please see our treatment section on lumbar interbody fusion for a detailed description.

Trigger point.

A trigger point is a localized area of muscle damage that remains in spasm and causes localized pain as well as referred pain. This condition is diagnosed by history and physical exam. This condition can be treated with deep tissue massage as well as trigger point injection. Please see our explanation of trigger point injection for more information.