Low Back Pain
 Anatomy
The normal anatomy of the spine is usually described by dividing up the spine into 3 major sections: the cervical, the thoracic, and the lumbar spine. (Below the lumbar spine is a bone called the sacrum, which is part of the pelvis).
The lumbar spine is in the lower back region. Each section of the spine is made up of individual bones called vertebrae. There are 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae. An individual vertebra is made up of several parts. The body of the vertebra is the primary area of weight bearing and provides a resting place for the fibrous discs which separate each of the vertebrae. The lamina covers the spinal canal, the large hole in the center of the vertebra through which the spinal nerves pass. The spinous process is the bone you can feel when running your hands down your back. The paired transverse processes are oriented 90 degrees to the spinous process and provide attachment for back muscles.
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Conditions
 Facet Joint Syndrome
The vertebral bodies are stacked one on top of another to form the entire structure we call the spine. In between vertebral bodies are tiny joints called facet joints. As arthritic change and inflammation of the joints occur, the nerves to the facet joints can convey severe and diffuse pain.
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Muscular Spasm
 The muscles around the spine can tighten up as the result of trauma or underlying disease and result in a painful spasm. This is usually the component of pain which responds to massage and heat the best. Often there are several things going on at the same time which necessitate treatment. When the underlying condition causing the spasm is improved and treated, the spasm often resolves.
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Lumbar Radiculopathy ['Pinched Nerve']
 Degeneration of the spine can result in several different conditions that cause problems. These are usually divided between problems that come from mechanical problems in the neck and problems which come from nerves being irritated or pinched. A radiculopathy is a a problem that results when a nerve in the back is irritated as it leaves the spinal canal. This condition usually occurs when a nerve root is being pinched by a herniated disc or a bone spur.
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 Spinal Stenosis
Most back pain is due to degenerative changes that occur in the intervertebral discs and the joints between each vertebra. In the late stages of spinal degeneration, bone spurs from the degenerative process can cause a condition known as spinal stenosis.
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 Discogenic Low Back Pain
We now know that the nucleus center of the intervertebral discs contains a noxious irritating substance called phospholipase A2. This is a strong irritant, and is actually a component of cobra venom! When it leaks out, pain can occur.
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 Sacroiliac ['SI'] joint pain
Similar to the facets, the SI JOINT can become inflamed and irritated. This usually presents as lower back pain which worsens with extension and rotation and flexion to either side. Treatment includes SI JOINT INJECTION or BRANCH BLOCK.
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 Vertebral Compression Fracture
In the United States alone, more than 700,000 vertebral body fractures from osteoporosis are diagnosed yearly, resulting in more than 100,000 hospital admissions. These compression fractures are the reason for the 'hump-back' deformity [kyphosis] often seen in elderly osteoporotic women. A relatively new procedure known as VERTEBROPLASTY (ver-tee-bro-plasty) promises dramatic relief from painful vertebral body compression fractures.
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Procedures
 Epidural Anesthetic Block and Steroid Injection
A block that is performed under fluoroscopy to confirm a specific diagnosis and/or decrease pain and inflammation.
 Selective Nerve Root Block (SNRB)
A block that is performed to determine if a specific spinal nerve root is the source of pain and reduce inflammation around the nerve root (usually from a herniated disc at this level) thus decreasing or relieving the pain.
 Facet Block
A block (or local anesthetic injection) that is performed to confirm that a facet joint is the source of pain and decrease pain and inflammation in a facet joint or joints. Actually this is the only true way to diagnose Facet Joint Syndrome, as an abnormal looking joint on X-ray or CT scan, may be painless, and vice versa a normal looking joint may be the pain generator.
 SI Joint Injection
A block (or local anesthetic injection) that is performed to confirm that the SI joint is the source of pain and to decrease pain and inflammation.
 Branch Blocks
A block (or local anesthetic injection) that is performed to confirm that the SI joint or Facet joint is the source of pain. It is purely a diagnostic measure, and does not in itself improve the pain on a long term basis.
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 Radiofrequency Ablation
Once Branch blocks have confirmed the origin of pain from a given joint, if the test produces about 80% pain improvement on two separate tests, we then know that blocking the tiny nerve fibers from the involved joint can result in pain relief. If this is the case, a tool called a radiofrequency ablator can often result in long term pain relief from the joint inflammation.
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 Discography
A discogram is a diagnostic test performed to view and assess the internal structure of a disc and determine if it is a source of pain.
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 Intradiscal Electrothermy ['IDET']
SpineCATH IDET therapy is a minimally invasive treatment in which the physician applies controlled levels of thermal energy (heat) to a broad section of the affected disc wall. This heat contracts and thickens the collagen of the disc wall. Therapy may result in contraction or closure of the disc wall fissures and a reduction in the bulge of the inner disk material.
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 DeKompressor
Percutaneous Discectomy is an option for patients suffering from low back and leg (radicular) pain due to contained disc herniations who have failed conservative treatments and are interested in trying minimally invasive options prior to having traditional surgery.
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 Vertebroplasty
A relatively new procedure known as vertebroplasty (ver-tee-bro-plasty) promises dramatic relief from painful vertebral body compression fractures. Bone cement is injected into the crushed vertebral body, filling it back up and correcting the deformity while alleviating the pain as well.
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 EMG/NCS
An electromyogram/nerve conduction study (EMG/NCS) is a diagnostic test that looks at the function of the nerve roots leaving the spine as well as their terminal branches in the arms and legs. The test is done by inserting tiny electrodes into the muscles of the lower extremity and by surface electrodes to check the speed and magnitude of signal transmission.
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Nonprocedural Treatments
Physical and Occupational Therapy
This type of therapy may consist of exercises to improve range of motion, strength and conditioning. A good therapist will examine you, assess your deficits and disease and formulate a plan based on optimizing function and minimizing pain. These exercises are specific for the nature of your injury and should be executed under the supervision of a physician who understands your case.
Modalities
Modalities include simple age-old treatments such as heat, cold and massage as well as newer treatment methods such as acupuncture, manipulation, and electrical stimulation. Your physician and therapists should formulate an optimal treatment protocol to maximize your healing potential. These modalities are often used in conjunction with Physical and Occupational therapy.
Medications
Depending on the nature of your problem, Non-steroidal antiinflammatory drugs ['NSAIDS'], corticosteroids, and opioids [narcotic] medications may be used. If there is a muscular spasm, a muscle-relaxant may help alleviate that aspect of your pain. Narcotics should be minimized and used only for short periods if at all possible due to rapid tolerance and all the attendant risks associated with abuse of a controlled substance. back to top
Surgery
Dr. Sandhu performs minimally invasive surgeries which result in a rapid recovery and minimal risk to the patient. Although we do not perform large-scale open surgeries in our clinics, there are occasions where a problem requires surgical intervention.
We can help screen potential surgical candidates and send them for evaluation by the appropriate specialist. These surgeons are usually orthopedic surgeons or neurosurgeons with specialized training for the particular disease process involved.
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