Overview: Radiculopathy is a painful condition that occurs when a nerve root within the cervical, thoracic or lumbar spine becomes irritated.
Causes: Potential causes for radiculopathy include disc bulge or herniation, annular tear, soft tissue changes within the spine or degeneration of local facet joints.
Symptoms: Radiculopathy presents with a very specific pattern of pain, depending on which nerve root is irritated. If a cervical nerve root is irritated, arm pain exists, with or without neck pain. If a thoracic nerve root is irritated, mid-back pain that wraps around to the chest is present. If a lumbar nerve root is irritated, leg pain exists, with or without low back pain. The pain associated with nerve root irritation can consist of a sharp and stabbing sensation and can be associated with numbness and tingling. Weakness of the muscles in the distribution of the nerve may also occur.
Treatment: Treatment options can include medications for neuropathic pain and inflammation and physical therapy for improved range of motion and strength. Interventional spine injections, such as epidural steroid injections, can give dramatic acute and sub-acute relief, and regenerative medicine products can provide long-term relief of nerve pain and heal injured disc material. Surgery is an option reserved for those who fail more conservative measures or have potential nerve damage.
Overview: The facet joints are small synovial joints that occur on both sides of the spine at every vertebral level of the cervical, thoracic and lumbar spine. Facet syndrome is an irritation of part of the facet joint, leading to local pain and decreased range of motion.
Causes: Facet syndrome is often seen after trauma, such as whiplash-type injuries or falls, as well as heavy physical labor or repetitive movements. Other times, it is difficult to fully explain what is causing local facet joint irritation.
Symptoms: Facet syndrome presents with spine pain, with a pattern of radiation that depends on which joints are most affected. Extremity (arm and leg) pain is less prevalent, and weakness is not expected. The pain is usually described as a deep ache that often has a burning quality. Local muscle spasm is often seen as well. Cervical facet syndrome can radiate into the upper back, and lumbar facet syndrome can radiate into the gluteal region and back of the legs.
Treatment: Treatment options can include medications such as muscle relaxants and anti-inflammatories. Physical therapy and massage therapy can be helpful to decrease muscle spasm and improve range of motion and flexibility. Interventional spine injections can include facet joint injections, medial branch blocks and radiofrequency neurotomy. Regenerative medicine products have proven successful when placed directly into the facet joints.
Overview: Discogenic pain occurs due to degeneration and tearing of the outer portion of the disc, the annulus. Discogenic pain can be symptomatic in the cervical, thoracic and lumbar spine, yet it is much more commonly found in the lumbar spine.
Causes: Potential causes for disc injury include heavy labor, repetitive lifting, bending and twisting, and prolonged sitting. Genetics likely plays an integral role in disc injury and pain.
Symptoms: There is a varied presentation to discogenic pain. Typically, spine pain is prevalent with or without local nerve root irritation. Prolonged sitting, bending or lifting can aggravate symptoms.
Treatment: Treatment of discogenic pain can include medication management with anti-inflammatories. Physical therapy can help to teach a home exercise program and improve core strength and flexibility. Interventional spine procedures can help with acute to sub-acute pain. More recently, placing stem cells into an injured disc has been very effective in healing tears in the outer portion of the disc and decreasing disc herniations, which leads to significant pain relief and improved function. Surgery is reserved for those who fail conservative measures.
Sacroiliac Joint Dysfunction
Overview: The sacroiliac joint is a large, stable joint that connects the sacrum to the pelvis. The joint can become inflamed and cause pain and dysfunction.
Causes: Common causes of sacroiliac joint pain include local trauma, such as a fall, and childbirth.
Symptoms: Typically, pain is present in the region of the sacroiliac joints, with referred pain seen into the gluteal region and groin and occasionally into the legs.
Treatment: Treatment options include anti-inflammatory medications and physical therapy for strengthening. An injection of steroid can help to reduce acute or sub-acute pain. Regenerative medicine, including PRF and stem cells, have proven to be very successful in giving significant pain relief and help to heal local injured tissue. All injections into the sacroiliac joint can be done under ultrasound guidance.