Common Conditions. Visit our homepage for more info >> TABLE OF CONTENTS. Bulging/Herniated Disc... PAGE 2. Cervical (Neck) Pain...

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1 Common Conditions TABLE OF CONTENTS Bulging/Herniated Disc... PAGE 2 Cervical (Neck) Pain... PAGE 3 Degenerative Disc Disease... PAGE 4 Sciatica...PAGE 5 Spinal Stenosis... PAGE 6 Spondylolisthesis... PAGE 7-8 Scoliosis...PAGE 9-10 Spondylosis...PAGE Foraminal Stenosis...PAGE Pinched Nerve... PAGE Facet Joint Disease...PAGE Radiculopathy...PAGE Failed Back Surgery Syndrome...PAGE Annular Tears...PAGE Bone Spurs...PAGE Disc Extrusion... PAGE Sacroiliac Joint Pain... PAGE Visit our homepage for more info >>

2 Bulging/Herniated Disc A bulging disc results when an intervertebral disc, which serves as a cushion between the spinal bones, loses its typical shape and compresses a nerve root in the spinal canal. A herniated or ruptured disc results when a disc tears and releases its soft core material. Often, the leaking core material puts pressure on the upper spinal cord and/or nerve roots, which can lead to various painful or uncomfortable symptoms including pain, numbness, tingling, and muscle weakness. Bulging Disc Herniated Disc How and where you experience pain will help indicate what disc(s) may be damaged and what nerve roots are being affected. Known as L1 L5, your lumbar (lower) back is the part of the spine that gives you the most mobility and, as part of that, it sustains the most wear and tear. If you have a bulging/herniated lumbar disc, it may be compressing the sciatic nerve, which could result in pain originating in your lower back and radiating through your buttocks, legs and feet. In addition to pain, you may experience numbness and/or weakness. Most people experience these symptoms, known in total as sciatica, on only one side of their bodies. If you have a bulging/herniated cervical disc (neck), you could experience pain, numbness, tingling or weakness anywhere from your head and neck to your hands. Herniation in one of the thoracic discs in your upper back can also affect your spinal cord or nerve roots, although most people don t develop symptoms originating in this part of the spine. Treatment Most physicians will first recommend a conservative approach, such as hot/cold compresses, medication, exercise or physical therapy. They could also recommend epidural steroid injections (ESI), selective nerve root block injections (SNRB), or a combination of the two. These injections are usually performed in a series of three: a physician injects an anti-inflammatory, typically a mix of steroid and local anesthetic, into the problem area. If symptoms persist, a minimally invasive procedure might be an option for long term relief. If you have a bulging/herniated disc, you may be a candidate for a minimally invasive laser spine procedure. If the herniation is more severe and/or coupled with another condition, a minimally invasive spine surgery such as a discectomy or fusion might be an option to relieve your symptoms. 2

3 Cervical (Neck) Pain Cervical pain refers to pain in the neck. Problems in the cervical spine can also radiate pain, numbness, and weakness to the shoulders, arms and hands. If you overuse your neck muscles, you can develop a muscle strain. Repeated overuse of these muscles can lead to the onset of chronic or ongoing neck pain. You can also develop neck pain if your nerves don t have enough room to pass through the spaces in and between the vertebrae. Potential sources of this problem, called nerve compression, include bulging or herniated discs, a narrowing of the spinal canal called stenosis, and arthritis-related bone growths called bone spurs. Neck pain can range in intensity from minor to severe, and can include shooting pain that extends into the arm or shoulder, alterations in normal bowel or bladder function, strength loss or numbness in the hands or arms, loss of balance and coordination, and pain that leaves you unable to lower your chin to your chest. These typically require rapid medical attention. Treatment Most physicians will first recommend a conservative approach, such as hot/cold compresses, medication, exercise or physical therapy. They could also recommend epidural steroid injections (ESI), selective nerve root block injections (SNRB), or a combination of the two. These injections are usually performed in a series of three: a physician injects an anti-inflammatory, typically a mix of steroid and local anesthetic, into the problem area. If symptoms persist, a minimally invasive procedure might be an option for long term relief. If the source of your neck pain is a bulging/herniated disc, you may be a candidate for a minimally invasive laser spine procedure. If disc degeneration, bone-related stenosis or spondylosis is causing your pain, if your condition is more severe or if your spine stability is compromised, a minimally invasive spine surgery such as a fusion or disc replacement might be an option to relieve your symptoms. 3

4 Degenerative Disc Disease Degenerative disc disease is a condition that can develop in all sections of the spine due to wear and tear in the cushioning discs that sit between your spinal bones and protect them from being damaged. Degeneration in the discs of the spine is a natural occurrence that progresses with age, but some people have more severe degeneration due to genetics, lifestyle, or injury. Each cushioning disc in your back contains a gel-like interior surrounded by a tough covering. Typically, problems begin when there are tears in the tough covering and scar tissue forms. This scar tissue has less structural integrity than the healthy tissue, and over time repeated tearing or scarring in more than one place can cause the entire disc to weaken. When the disc weakens, it begins to lose its water content and the ability to properly cushion and protect your spine. Weakness can also cause the disc to tear, bulge, or herniate and compress a nerve root, causing pain. In many cases, degeneration in the spinal discs does not lead to the onset of any noticeable symptoms. Typically, the first symptom of degenerative disc disease is pain in the lower back (lumbar spine) that can extend down into the buttocks and the upper parts of the thighs. When lumbar degeneration is accompanied by abnormal growths of bone, called bone spurs, nerves may be compressed and trigger the onset of additional symptoms such as tingling, numbness, or burning in the same areas. The main symptom that people experience with disc degeneration in the neck (cervical spine) is neck pain that worsens when standing or moving the head. If neck degeneration occurs in combination with spurs, potential consequences include the same nerve-related symptoms associated with lumbar bone spurs, as well as a loss of normal mobility in the neck. Treatment Most physicians will first recommend a conservative approach, such as hot/cold compresses, medication, exercise or physical therapy. They could also recommend epidural steroid injections (ESI), selective nerve root block injections (SNRB), or a combination of the two. These injections are usually performed in a series of three: a physician injects an anti-inflammatory, typically a mix of steroid and local anesthetic, into the problem area. If symptoms persist, a minimally invasive procedure might be an option for long term relief. If your degenerative disc disease has caused a bulging/ herniated disc, you may be a candidate for a minimally invasive laser spine procedure. If disc degeneration has caused bone-related issues such as bone spurs, is more severe or if spine stability is compromised, a minimally invasive spine surgery such as a fusion or disc replacement might be an option to relieve your symptoms. 4

5 Sciatica Sciatica refers to pain and possibly numbness, tingling, and weakness that originates in the lower back and travels through the buttock and down the large sciatic nerve located in the back of each leg. Your sciatic nerve and its branches allow you to control the muscles in your lower legs and the back of your knees, while also providing feeling in the soles of your feet, the back of your thighs and certain portions of your lower legs. When one or more of these nerve roots is compressed, you may feel pain, numbness and weakness in these areas. You can develop sciatica if a spinal disc in your lower back tears, bulges, or herniates, compressing the root of the sciatic nerve. Sciatica can also be caused by an abnormal narrowing of your spinal column, called stenosis. Other potential causes of sciatica include spondylolisthesis, a condition that develops when one or more spinal bones slips out of place. In its classic form, the pain of sciatica follows the course of your sciatic nerve and extends from your lower back through your buttocks to the rear of your upper legs. For some people, the sensation is similar to a mild leg cramp; however, unlike a leg cramp, the pain lingers for weeks at a time. For others, the pain is more severe and feels like an electric shock or a burning sensation. Sciatica-related pain often grows worse at night, directly after you sit or stand, walk for any substantial distance, or bend your body at the waist. Treatment Most physicians will first recommend a conservative approach, such as hot/cold compresses, medication, exercise or physical therapy. They could also recommend epidural steroid injections (ESI), selective nerve root block injections (SNRB), or a combination of the two. These injections are usually performed in a series of three: a physician injects an anti-inflammatory, typically a mix of steroid and local anesthetic, into the problem area. If symptoms persist, a minimally invasive procedure might be an option for long term relief. If the source of your sciatica is a bulging/herniated disc, you may be a candidate for a minimally invasive laser spine procedure. For more severe herniation, a minimally invasive discectomy may be performed. If stenosis, bone spurs or spondylolisthesis is the source of your sciatica, a minimally invasive spine surgery such as laminectomy/laminotomy, or fusion might be an option to relieve your symptoms. 5

6 Spinal Stenosis Spinal stenosis is defined as abnormal narrowing of the spinal canal. This may arise when bones, ligaments, or other tissues make the space inside the spinal canal or foramina smaller, which in turn irritates or pinches your spinal nerves. The most common cause of spinal stenosis is age-related change that may include increases in the size of your bones and joints, hardening and thickening of the ligaments that help support your spine, the formation of bone overgrowths called bone spurs, and bulging or herniated discs. Potential symptoms of spinal stenosis include back or neck pain, pain that radiates down your leg, arm or leg weakness, a weakening of the foot called foot drop, and muscle cramping or numbness that appears in your back, neck, arms, legs, buttocks or shoulders. In many cases, your symptoms may be triggered or grow more intense if you walk or stand, and subside if you lean your body forward or sit. Spinal stenosis symptoms usually only affect a single side of the body, and will frequently become more pronounced with age. Some people develop a dangerous form of lower back stenosis known as cauda equina syndrome. of this severe form of spinal stenosis can include sexual impotence, bladder or bowel dysfunction, and numbness, pain or weakness that affects the legs. Treatment Most physicians will first recommend a conservative approach, such as hot/cold compresses, medication, exercise or physical therapy. They could also recommend epidural steroid injections (ESI), selective nerve root block injections (SNRB), or a combination of the two. These injections are usually performed in a series of three: a physician injects an anti-inflammatory, typically a mix of steroid and local anesthetic, into the problem area. If symptoms persist, a minimally invasive procedure might be an option for long term relief. If your mild spinal stenosis is caused by a bulging or herniated disc, you may be a candidate for a minimally invasive laser spine procedure. If the source of stenosis is bone-related, such as bone spurs or osteoarthritis, or if your condition is more severe, a minimally invasive spine surgery such as a laminectomy/laminotomy or foraminectomy/foraminotomy might be an option to relieve your symptoms. 6

7 Spondylolisthesis Spondylolisthesis occurs when a vertebra slips forward over the vertebra beneath it. While spinal columns are very strong, they are subject to a host of problems, many of which can cause painful narrowing. Some of the underlying causes of spinal stenosis include: Additional common Spondylolisthesis causes include: Age-related wear and tear, which can lead to Degenerative Disc Disease Other conditions, such as arthritis, bone spurs, herniated discs, spondylolisthesis and others Back or neck strain due to repetitive physical activity, poor posture, imbalances in the musculature, or heavy lifting Direct physical injuries such as a car accident or fall Genetics, whether or not the symptoms appeared in your parents You also may develop spondylolisthesis if you have any of a number of health problems that weaken the structural integrity of your spinal column. These problems include spinal tumors and osteoporosis, and spinal infections. You can also develop symptoms of the condition if you undergo a surgical procedure that produces forward slippage in your spine. Some people with spondylolisthesis have no obvious symptoms, while others develop a host of symptoms that vary in their severity. While the condition usually affects the lumbar or lower spine, it can occur in other regions. include: Common symptoms of Spondylolisthesis include: Back and leg pain. The most common symptoms of spondylolisthesis are pain in your lower back (lumbar spine region) and pain in one or both of your legs. Sciatica. When the shifting of your spinal bones produces pressure on the sciatic nerve, the resulting condition is called sciatica. Lordosis and Kyphosis symptoms. In some cases, spondylolisthesis can produce a symptom called Lordosis (also known as swayback), or Kyphosis (also known as roundback). In the cervical spine: pain, numbness, tingling, burning, and weakness in the neck, arms, hands, and sometimes in the head. In the thoracic spine (less common): pain in the mid or upper back, radiating through the stomach or chest, which patients often confuse for cardiovascular problems. 7

8 Spondylolisthesis Prior to having a surgical procedure to treat your spondylolisthesis, conservative measures such as physical therapy, chiropractic, and steroid injections should be attempted. If these measures do not meaningfully relieve your pain, a North American Spine procedure may be in order. Treatment Treatment and procedure options for Spondylolisthesis range from conservative options like injections to more intensive procedures like spinal fusions. Conservative Options Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator or STIM which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes. Decompression Decompression including North American Spine s unique IntelliSpine procedure may be used for cases in which the structural integrity of the vertebrae or spinal cord is not threatened. These procedures concentrate on freeing entrapped nerves, typically be enlarging the space through which nerves pass. Depending on the demands of the procedure and your unique physiology, a special surgical laser may be used. Fusion/Stablization Fusion, also called stabilization, procedures may be used when the stability of the spine or vertebrae are compromised or threatened. In some of these cases, more than one harmful condition may exist. While these procedures are minimally invasive and enjoy a high success rate, some patients may be required to stay overnight for observation. 8

9 Scoliosis Scoliosis occurs when the backbone curves instead of standing straight. Scoliosis is typically considered an idiopathic disorder, meaning there is no known cause. Genetics certainly play a part, and babies born with the signs of scoliosis are congenital cases, but the root cause is still unknown. In general, there are two types of scoliosis: structural and non-structural scoliosis. Additional common Scoliosis causes include: Structural scoliosis refers to a curve in the spine that is irreversibly rigid. Nonstructural scoliosis refers to scoliosis that is secondary to other problems, like the uneven length of the legs, muscular dystrophy, and more. In scoliosis treatments, your physician will first seek to understand if your scoliosis is due to an underlying cause, and if that cause can be fixed. Non-invasive measures like bracing may be attempted, but some cases will require corrective, or painrelieving, surgery. The most obvious symptom of scoliosis is curvature in the spine. Scoliosis often first appears during the growth spurts of a person s teenage years. While scoliosis strikes girls and boys relatively equally, the condition tends to worsen in women in than men. Adult-onset scoliosis is usually a result of the wear-and-tear on the body that comes with age. Even if curvature is not pronounced or even invisible to the naked eye, MRIs and CT-scans can often pick it up. Other symptoms include: Common symptoms of Scoliosis include: Changes in gait when walking Reduced range of motion Pain at any point in the back or neck Prior to having a surgical procedure to treat your scoliosis, conservative measures such as physical therapy, chiropractic, and steroid injections should be attempted. If these measures do not meaningfully relieve your pain, a North American Spine procedure may be in order. Treatments Treatment and procedure options for Scoliosis range from conservative options like injections to more intensive procedures like spinal fusions. Conservative Options Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator or STIM which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes. 9

10 Scoliosis Decompression Decompression including North American Spine s unique IntelliSpine procedure may be used for cases in which the structural integrity of the vertebrae or spinal cord is not threatened. These procedures concentrate on freeing entrapped nerves, typically be enlarging the space through which nerves pass. Depending on the demands of the procedure and your unique physiology, a special surgical laser may be used. Fusion/Stablization Fusion, also called stabilization, procedures may be used when the stability of the spine or vertebrae are compromised or threatened. In some of these cases, more than one harmful condition may exist. While these procedures are minimally invasive and enjoy a high success rate, some patients may be required to stay overnight for observation. 10

11 Spondylosis Spondylosis is a general term meaning degeneration of the spinal column. It is commonly referred to as spinal arthritis. Spondylosis is what is often called a secondary disorder, meaning it is the result of other harmful processes. Here are common causes: Age-related wear and tear, which can lead to Degenerative Disc Disease Other conditions, such as arthritis, bone spurs, herniated discs, spondylolisthesis and others Back or neck strain due to repetitive physical activity, poor posture, imbalances in the musculature, or heavy lifting Direct physical injury such as a car accident or fall Genetics, whether or not the symptoms appeared in your parents The most obvious symptom of scoliosis is curvature in the spine. Scoliosis often first appears during the growth spurts of a person s teenage years. While scoliosis strikes girls and boys relatively equally, the condition tends to worsen in women in than men. Adult-onset scoliosis is usually a result of the wear-and-tear on the body that comes with age. Even if curvature is not pronounced or even invisible to the naked eye, MRIs and CT-scans can often pick it up. Other symptoms include: Common symptoms of Spondylosis include: In the lumbar spine: pain, numbness, tingling, burning, and weakness in the lower back, buttocks, legs, and feet In the cervical spine: pain, numbness, tingling, burning, and weakness in the neck, arms, hands, and sometimes in the head In the thoracic spine (less common): pain in the mid or upper back, radiating through the stomach or chest, which patients often confuse for cardiovascular problems Prior to having a surgical procedure to treat your spondylosis, conservative measures such as physical therapy, chiropractic, and steroid injections should be attempted. If these measures do not meaningfully relieve your pain, a North American Spine procedure may be in order. Treatments Treatment and procedure options for Spondylosis range from conservative options like injections to more intensive procedures like spinal fusions. Conservative Options Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator or STIM which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes. Decompression Decompression including North American Spine s unique IntelliSpine procedure may be used for cases in which the 11

12 Spondylosis structural integrity of the vertebrae or spinal cord is not threatened. These procedures concentrate on freeing entrapped nerves, typically be enlarging the space through which nerves pass. Depending on the demands of the procedure and your unique physiology, a special surgical laser may be used. Fusion/Stablization Fusion, also called stabilization, procedures may be used when the stability of the spine or vertebrae are compromised or threatened. In some of these cases, more than one harmful condition may exist. While these procedures are minimally invasive and enjoy a high success rate, some patients may be required to stay overnight for observation. 12

13 Foraminal Stenosis Foraminal stenosis refers to an abnormal reduction in the size of nerve channels associated with your spinal bones. In addition to aging, foraminal stenosis may develop as a consequence of one or more of a few other problems: Additional common Foraminal Stenosis causes include: Age-related wear and tear, which can lead to Degenerative Disc Disease Scoliosis, A genetic condition causing curvature of the spine, scoliosis can also lead to the development of foraminal stenosis. Back or neck strain due to repetitive physical activity, poor posture, imbalances in the musculature, or heavy lifting Direct physical injuries such as a car accident or fall Genetics, whether or not the symptoms appeared in your parents Arthritis, which can lead to joint deterioration Herniated discs in the spinal column. Foraminal stenosis may produce symptoms of a nerve-damaging condition called radiculopathy. Additional symptoms may include: Common symptoms of Foraminal Stenosis include: In the lumbar spine: pain, numbness, tingling, burning, and weakness in the lower back, buttocks, legs, and feet. If impingement affects one of the roots of your sciatic nerve, you can develop sciatica In the cervical spine: pain, numbness, tingling, burning, and weakness in the neck, arms, hands, and sometimes in the head In the thoracic spine (less common): pain, tingling, or numbness in the upper or mid back, radiating through the stomach or chest, which patients often confuse for cardiovascular problems Prior to having a surgical procedure to treat your foraminal stenosis, conservative measures such as physical therapy, chiropractic, and steroid injections should be attempted. If these measures do not meaningfully relieve your pain, a North American Spine procedure may be the best option for long-term relief. Treatments Treatment and procedure options for Foraminal Stenosis range from conservative options like injections to more intensive procedures like spinal fusions. Conservative Options Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator or STIM which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes. 13

14 Foraminal Stenosis Decompression Decompression including North American Spine s unique IntelliSpine procedure may be used for cases in which the structural integrity of the vertebrae or spinal cord is not threatened. These procedures concentrate on freeing entrapped nerves, typically be enlarging the space through which nerves pass. Depending on the demands of the procedure and your unique physiology, a special surgical laser may be used. Fusion/Stablization Fusion, also called stabilization, procedures may be used when the stability of the spine or vertebrae are compromised or threatened. In some of these cases, more than one harmful condition may exist. While these procedures are minimally invasive and enjoy a high success rate, some patients may be required to stay overnight for observation. 14

15 Pinched Nerve A pinched nerve in the spine occurs when soft or hard tissue in your spine puts abnormal pressure on a nearby nerve. There are many causes of pinched nerves. Repetitive stress and load-bearing, as well as one-time injuries, are common causes. Obesity, and pregnancy have also been shown to cause pinched nerves. The condition may also result from an underlying primary condition like arthritis, diabetes, and bone spurs. Additional common Pinched Nerve causes include: Age-related wear and tear, which can lead to Degenerative Disc Disease Back or neck strain due to repetitive physical activity, poor posture, imbalances in the musculature, or heavy lifting Direct physical injuries such as a car accident or fall Genetics, whether or not the symptoms appeared in your parents In scoliosis treatments, your physician will first seek to understand if your scoliosis is due to an underlying cause, and if that cause can be fixed. Non-invasive measures like bracing may be attempted, but some cases will require corrective, or painrelieving, surgery. The symptoms of a pinched nerve depend on two basic factors: the location or type of the damaged nerve and the amount of pressure placed on that nerve. Common symptoms include: Common symptoms of Pinched Nerve include: In the lumbar spine: pain, numbness, tingling, burning, and weakness in the lower back, buttocks, legs, and feet. If impingement affects one of the roots of your sciatic nerve, you can develop sciatica, which is characterized by localized or radiating pain, numbness, or other uncomfortable sensations in the lower body In the cervical spine: pain, numbness, tingling, burning, and weakness in the neck, arms, hands, and sometimes in the head In the thoracic spine (less common): pain, tingling, or numbness in the upper or mid back, radiating through the stomach or chest, which patients often confuse for cardiovascular problems Prior to having a surgical procedure to treat your pinched nerve, conservative measures such as physical therapy, chiropractic, and steroid injections should be attempted. If these measures do not meaningfully relieve your pain, a North American Spine procedure could be a better option to provide long-term relief. Treatments Treatment and procedure options for Pinched Nerve range from conservative options like injections to more intensive procedures like spinal fusions. Conservative Options Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator or STIM which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes. 15

16 Pinched Nerve Decompression Decompression including North American Spine s unique IntelliSpine procedure may be used for cases in which the structural integrity of the vertebrae or spinal cord is not threatened. These procedures concentrate on freeing entrapped nerves, typically be enlarging the space through which nerves pass. Depending on the demands of the procedure and your unique physiology, a special surgical laser may be used. Fusion/Stablization Fusion, also called stabilization, procedures may be used when the stability of the spine or vertebrae are compromised or threatened. In some of these cases, more than one harmful condition may exist. While these procedures are minimally invasive and enjoy a high success rate, some patients may be required to stay overnight for observation. 16

17 Facet Joint Disease Facet joints are small joints that connect the spine s vertebrae at the sides. They are essential for normal back and neck movement. A number of conditions and causes can result in pain at the facet joints, and can develop into facet joint disease, also called facet hypertrophy (which means excessive growth), or arthritis (which means inflammation). Facet joint disease is typically considered a wear-and-tear disease, meaning age and repetitive stress on the facet joints increase the likelihood of developing the condition. The condition also may be a result of another degenerative condition called Spondylolisthesis. Additional common Facet Joint Disease causes include: Age-related wear and tear, which can lead to Degenerative Disc Disease Back or neck strain due to repetitive physical activity, poor posture, imbalances in the musculature, or heavy lifting Direct physical injuries such as a car accident or fall Genetics, whether or not the symptoms appeared in your parents Depending on the location of the facet joints affected, symptoms can appear along the following lines, usually localized to a joint or joints: Common symptoms of Facet Joint Disease include: In the lumbar spine: Tenderness, pain, and tingling in the lower back In the thoracic spine: Tenderness, pain, and tingling in the middle to upper back In the cervical spine: Tenderness, pain, and tingling in the neck or head, headaches, and difficulty turning the head In some cases, inflammation in a facet joint can impinge upon a nearby nerve and trigger a painful condition called a pinched nerve, sometimes classified as a source of facet joint disease. Prior to having a surgical procedure to treat your facet joint disease, conservative measures such as physical therapy, chiropractic, and steroid injections should be attempted. If these measures do not meaningfully relieve your pain, a North American Spine procedure may help you get long-term relief. Treatments Treatment and procedure options for Facet Joint Disease range from conservative options like injections to more intensive procedures like spinal fusions. Conservative Options Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator or STIM which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes. 17

18 Facet Joint Disease Decompression Decompression including North American Spine s unique IntelliSpine procedure may be used for cases in which the structural integrity of the vertebrae or spinal cord is not threatened. These procedures concentrate on freeing entrapped nerves, typically be enlarging the space through which nerves pass. Depending on the demands of the procedure and your unique physiology, a special surgical laser may be used. Fusion/Stablization Fusion, also called stabilization, procedures may be used when the stability of the spine or vertebrae are compromised or threatened. In some of these cases, more than one harmful condition may exist. While these procedures are minimally invasive and enjoy a high success rate, some patients may be required to stay overnight for observation. 18

19 Radiculopathy Radiculopathy occurs when nerve roots, also called radicular nerves, are damaged for any reason. Nerve roots are the segment of a nerve that exits the central nervous system, allowing the rest of the nerve to travel to different regions of the body. A fairly common condition, radiculopathy may affect any region of the spine, but the most commonly affected area is the cervical, or neck, region. Radiculopathy has several typical immediate causes, as well as a range of underlying causes. These include: Additional common Radiculopathy causes include: A herniated disc in your spinal column is the most likely cause of radiculopathy. When a disc herniates, it leaks material from its inner core into the surrounding area of your spine, where it may press upon a nerve root. Stenosis refers to the narrowing of the spaces in your spinal column that provides passage for your spinal cord, spinal nerve roots, and spinal nerves. This narrowing can cause radiculopathy when nerve tissues do not have enough room to pass smoothly through the surrounding bony structures. The most likely place for spinal stenosis to occur is the foramina the small holes that let nerves pass out of the spinal column. Age-related wear and tear, which can lead to Degenerative Disc Disease Back or neck strain due to repetitive physical activity, poor posture, imbalances in the musculature, or heavy lifting Direct physical injuries such as a car accident or fall Genetics, whether or not the symptoms appeared in your parents Radiculopathy produces symptoms that vary according to the location of your irritated or compressed nerve tissue. Radiculopathy pain may be progressive, meaning it worsens with time. Common symptoms include: Common symptoms of Facet Joint Disease include: In the lumbar spine: pain, numbness, tingling, burning, and weakness in the lower back, buttocks, legs, and feet. If impingement affects one of the roots of your sciatic nerve, you can develop sciatica, which is characterized by localized or radiating pain, numbness, or other uncomfortable sensations in the lower body In the cervical spine: pain, numbness, tingling, burning, and weakness in the neck, arms, hands, and sometimes in the head In the thoracic spine (less common): pain, tingling, or numbness in the upper or mid back, radiating through the stomach or chest, which patients often confuse for cardiovascular problems Prior to having a surgical procedure to treat your radiculopathy, conservative measures such as physical therapy, chiropractic, and steroid injections should be attempted. If these measures do not meaningfully relieve your pain, a North American Spine procedure may be in order. Treatments Treatment and procedure options for Radiculopathy range from conservative options like injections to more intensive procedures like spinal fusions. Conservative Options Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator or STIM which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes. 19

20 Radiculopathy Decompression Decompression including North American Spine s unique IntelliSpine procedure may be used for cases in which the structural integrity of the vertebrae or spinal cord is not threatened. These procedures concentrate on freeing entrapped nerves, typically be enlarging the space through which nerves pass. Depending on the demands of the procedure and your unique physiology, a special surgical laser may be used. Fusion/Stablization Fusion, also called stabilization, procedures may be used when the stability of the spine or vertebrae are compromised or threatened. In some of these cases, more than one harmful condition may exist. While these procedures are minimally invasive and enjoy a high success rate, some patients may be required to stay overnight for observation. 20

21 Failed Back Surgery Syndrome Failed Back Surgery Syndrome (FBSS), also called failed back syndrome, is a general term used to describe the chronic pain that can appear in the aftermath of any back surgery that fails to relieve a preexisting pain-causing condition. A number of different risk factors can contribute to the onset of this condition. Fortunately, North American Spine can provide treatments that have been found to be effective in treating patients with failed back surgery syndrome. Failed back surgery syndrome has a range of possible causes, including misidentification of your back problems before surgery, and the selection of a surgical procedure that has a relatively small chance of reducing or eliminating your symptoms. Additional common Failed Back Surgery Syndrome causes include: Misidentification of problems. Back problems with similar symptoms may have distinctly different underlying sources. This means that a surgical procedure on your back must always be preceded by a careful and accurate process of diagnosis. In most cases, the cause of failed back surgery syndrome is simply misdiagnosis of the origin of your pain or other related symptoms. Low-success procedures. Not all forms of back surgery have equal odds of achieving their aims and relieving your symptoms. As a rule, your chances for experiencing a failed back surgery rise when you or your doctor chooses an unproven procedure or a procedure known to have a limited track record of success. Scar tissue formation. Scar tissue can cause failed back surgery syndrome if it essentially recreates the original problem by impinging on nerves or nerve roots. Because traditional, open surgery tends to create larger formations of scar tissue, minimally invasive surgery may decrease the risk of FBSS. Incomplete surgical results. Even if a surgeon properly identifies the cause of your back-related symptoms, he or she must make sure that this cause is thoroughly corrected on the operating table. For example, if you have a herniated disc pressing against your spinal nerves, pressure from this disc must be completely removed in order to provide relief. Failure to fully ease pressure on your nerve tissue can lead to continuing problems in the aftermath of surgery. Other, less-common causes for the onset of failed back surgery syndrome include a recurrence of the original cause of your symptoms, collateral nerve damage caused by a surgeon during a corrective operation, permanent nerve damage from the original source of your problems, and the appearance of pain from another source following surgery. The symptoms of FBSS may be similar to the pain a patient experienced before his or her initial surgery. These include: Common symptoms of Failed Back Surgery Syndrome include: In the lumbar spine: pain, numbness, tingling, burning, and weakness in the lower back, buttocks, legs, and feet. If impingement affects one of the roots of your sciatic nerve, you can develop sciatica. In extreme cases, a condition called foot drop, in which the ability to flex the foot upward is compromised may develop. In the cervical spine: pain, numbness, tingling, burning, and weakness in the neck, arms, hands, and sometimes in the head In the thoracic spine: pain, tingling, or numbness starting in the upper or mid back and radiating through the stomach or chest, which patients often confuse for cardiovascular problems Prior to having a surgical procedure to treat your failed back surgery syndrome, conservative measures such as physical therapy, chiropractic, and steroid injections should be attempted. If these measures do not meaningfully relieve your pain, a North American Spine procedure may be in order. 21

22 Failed Back Surgery Syndrome Treatments Treatment and procedure options for Failed Back Surgery Syndrome range from conservative options like injections to more intensive procedures like spinal fusions. Conservative Options Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator or STIM which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes. Decompression Decompression including North American Spine s unique IntelliSpine procedure may be used for cases in which the structural integrity of the vertebrae or spinal cord is not threatened. These procedures concentrate on freeing entrapped nerves, typically be enlarging the space through which nerves pass. Depending on the demands of the procedure and your unique physiology, a special surgical laser may be used. Fusion/Stablization Fusion, also called stabilization, procedures may be used when the stability of the spine or vertebrae are compromised or threatened. In some of these cases, more than one harmful condition may exist. While these procedures are minimally invasive and enjoy a high success rate, some patients may be required to stay overnight for observation. 22

23 Annular Tear An annular tear is a condition in which the outer layer of one of the interior discs that cushion vertebrae in the spine develops a tear. A tear in the disc weakens it, increasing the likelihood that the disc could deteriorate further and impinge on a spinal nerve. Annular tears are also called by a variety of other names, including annular, radial, concentric, and transverse tears. Annular tears occur when pressure on a spinal disc damages or breaks down the once healthy disc, causing it to compress or change its normal shape. Potential causes of this pressure include: Additional common Annular Tear causes include: Age-related wear and tear, which can lead to Degenerative Disc Disease Back or neck strain due to repetitive physical activity, poor posture, imbalances in the musculature, or heavy lifting Direct physical injuries such as a car accident or fall Genetics, whether or not the symptoms appeared in your parents In some cases, damage only affects the inner layers of the disc s outer covering and leaves the inside of the disc intact this describes a bulging disc. In other cases, the outside of the disc tears and the discs inside protrude outward. This is called a disc protrusion or herniated disc. Sciatica treatments depend on the severity of the condition. In many cases, conservative treatments such as ice packs and antiinflammatory medication may dull the pain. More advanced cases may require physical therapy or chiropractic treatment. For chronic cases that have not responded to conservative measures, discover how we can help. The symptoms of an annular tear depend on two basic factors: the location or type of the damaged nerve and the amount of pressure placed on that nerve. Common symptoms include: Common symptoms of Annular Tear include: In the lumbar spine: pain, numbness, tingling, burning, and weakness in the back, buttocks, legs, and feet. If impingement affects one of the roots of your sciatic nerve, you can develop sciatica, which is characterized by localized or radiating pain, numbness, or other uncomfortable sensations in the lower body In the cervical spine: pain, numbness, tingling, burning, and weakness in the neck, arms, hands, and sometimes in the head In the thoracic spine (less common): pain, tingling, or numbness radiating through the stomach or chest, which patients often confuse for cardiovascular problems Prior to having a surgical procedure to treat your annular tear, conservative measures such as physical therapy, chiropractic, and steroid injections should be attempted. If these measures do not meaningfully relieve your pain, a North American Spine procedure may be in order. Treatments Treatment and procedure options for Annular Tear range from conservative options like injections to more intensive procedures like spinal fusions. 23

24 Annular Tear Conservative Options Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator or STIM which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes. Decompression Decompression including North American Spine s unique IntelliSpine procedure may be used for cases in which the structural integrity of the vertebrae or spinal cord is not threatened. These procedures concentrate on freeing entrapped nerves, typically be enlarging the space through which nerves pass. Depending on the demands of the procedure and your unique physiology, a special surgical laser may be used. Fusion/Stablization Fusion, also called stabilization, procedures may be used when the stability of the spine or vertebrae are compromised or threatened. In some of these cases, more than one harmful condition may exist. While these procedures are minimally invasive and enjoy a high success rate, some patients may be required to stay overnight for observation. 24

25 Bone Spur Bone spurs form when discs or cartilage tissue that cushion bones are injured, damaged or worn down. When bones touch, or when ligaments holding the spine together thicken and harden to support the spine, it can lead to significant pain and a diminished range of motion. A bone spur can occur in any area of the spine, including the cervical spine in the neck region, as well as the lumbar spine in the lower back. Sometimes, a bone spur and a bulging disc occur at the same time. This is a condition known as disc osteophyte complex. Additional common Bone Spur causes include: Arthritis, which can lead to joint deterioration Back or neck strain due to repetitive physical activity, poor posture, imbalances in the musculature, or heavy lifting Direct physical injuries such as a car accident or fall Genetics, whether or not the symptoms appeared in your parentss In some cases, bone spurs form as part of the normal aging process and do not cause any significant health problems. Bone spur treatments are as varied as their causes. Your North American Spine physician will perform a thorough work-up and discuss the range of treatment options available to you. Common symptoms of Bone Spur include: In the lumbar spine: pain, numbness, tingling, burning, and weakness in the lower back, buttocks, legs, and feet In the cervical spine: pain, numbness, tingling, burning, and weakness in the neck, arms, hands, and sometimes in the head In the thoracic spine (less common): pain in the upper back, radiating through the stomach or chest, which patients often confuse for cardiovascular problems Prior to having a surgical procedure to treat your bone spurs, conservative measures such as physical therapy, chiropractic, and steroid injections should be attempted. If these measures do not meaningfully relieve your pain, a North American Spine procedure may be in order. Treatments Treatment and procedure options for Bone Spurs range from conservative options like injections to more intensive procedures like spinal fusions. Conservative Options Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator or STIM which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes. Decompression Decompression including North American Spine s unique IntelliSpine procedure may be used for cases in which the structural integrity of the vertebrae or spinal cord is not threatened. These procedures concentrate on freeing entrapped nerves, 25

26 Bone Spur typically be enlarging the space through which nerves pass. Depending on the demands of the procedure and your unique physiology, a special surgical laser may be used. Fusion/Stablization Fusion, also called stabilization, procedures may be used when the stability of the spine or vertebrae are compromised or threatened. In some of these cases, more than one harmful condition may exist. While these procedures are minimally invasive and enjoy a high success rate, some patients may be required to stay overnight for observation. 26

27 Disc Extrusion Disc Extrusion is a degenerative spine condition that can lead to nerve compression, pain, discomfort and other debilitating symptoms. Spinal discs act as cushions between vertebrae. A number of underlying conditions including Degenerative Disc Disease may cause a disc to weaken and lose its shape. In some cases, the weakened disc will protrude outside of its normal position and begin to migrate away from the main disc body, and intrude on spinal nerves or on the spinal cord, causing significant pain. Additional common Disc Extrusion causes include: Age-related wear and tear, which can lead to Degenerative Disc Disease Back or neck strain due to repetitive physical activity, poor posture, imbalances in the musculature, or heavy lifting Direct physical injury such as a car accident or fall Genetics, whether or not the symptoms appeared in your parents Arthritis, which can lead to joint deterioration You can develop a disc extrusion at any section in your spine, but they most commonly appear in your lower back or neck. The pain from a disc extrusion can range from mild to severe, and grow worse when you engage in a variety of normal actions such as sneezing, standing, sitting, walking or bending your back. In severe cases, you may experience heaviness in your legs or difficulty walking. Disc extrusion can cause the following symptoms: Common symptoms of Disc Extrusion include: In the lumbar spine: pain, numbness, tingling, burning, and weakness in the lower back, buttocks, legs, and feet In the cervical spine: pain, numbness, tingling, burning, and weakness in the neck, arms, hands, and sometimes in the head In the thoracic spine: pain in the upper back, radiating through the stomach or chest, which patients often confuse for cardiovascular problems Prior to having a surgical procedure to treat your disc extrusion, conservative measures such as physical therapy, chiropractic, and steroid injections should be attempted. If these measures do not meaningfully relieve your pain, a North American Spine procedure may be in order. Treatments Treatment and procedure options for Disc Extrusion range from conservative options like injections to more intensive procedures like spinal fusions. Conservative Options Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator or STIM which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes. Decompression Decompression including North American Spine s unique IntelliSpine procedure may be used for cases in which the structural integrity of the vertebrae or spinal cord is not threatened. These procedures concentrate on freeing entrapped nerves, 27

28 Disc Extrusion typically be enlarging the space through which nerves pass. Depending on the demands of the procedure and your unique physiology, a special surgical laser may be used. Fusion/Stablization Fusion, also called stabilization, procedures may be used when the stability of the spine or vertebrae are compromised or threatened. In some of these cases, more than one harmful condition may exist. While these procedures are minimally invasive and enjoy a high success rate, some patients may be required to stay overnight for observation. 28

29 Sacroiliac Joint Pain Pain in the Sacroiliac SI joint can extend into the lower back, buttocks, groin, and leg, and may result from wear and tear or injury, particularly when the ligaments supporting the joint are stretched. This SI joint is instrumental in the transfer of weight between your upper body and legs. It also acts as a shock-absorber during motion. Damage to the SI joint is common and may be caused by too little movement (called hypomobility) or too much movement (hypermobility). As with other joints in the body, the SI joint can become damaged, can suffer from wear and tear, or the ligaments supporting the joint may be stretched or injured. Sacroiliac joint dysfunction and associated pain can be caused by a specific traumatic event (disruption) or can develop over time (degeneration). Additional common Sacroiliac Joint Pain causes include: Previous lumbar surgery (e.g., lumbar fusion of the L3/L4, L4/L5, or L5/S1) Stresses to the SI joint due to leg length differences, joint replacement, or scoliosis Pregnancy chronic lower back pain during pregnancy and/or after giving birth (Post-partum Pelvic Girdle Pain, frequently described as PGP or PPGP) Osteoarthritis Previous iliac crest bone graft (ICBG) Prior infection of the SI joint Pain from sacroiliac joint disorders can be felt anywhere in the lower back, buttocks, or in the legs. Chronic SI joint pain can make it difficult to perform common daily tasks such as sitting, standing, and climbing stairs. Common symptoms of Sacroiliac Joint Pain include: Lower back pain Sensation in lower extremities: pain, numbness, tingling, weakness Pelvis/buttock pain Hip/groin pain Feeling of leg instability (buckling, giving way) Disturbed sleep patterns due to pain Disturbed sitting patterns (unable to sit for long periods, sitting on one side) Pain going from sitting to standing Prior to having a surgical procedure to treat your Sacroiliac Joint Pain, conservative measures such as physical therapy, chiropractic, and steroid injections should be attempted. If these measures do not meaningfully relieve your pain, a North American Spine procedure may be in order. Treatments Treatment and procedure options for Sacroiliac Joint Pain range from conservative options like injections to more intensive procedures like spinal fusions. 29

30 Sacroiliac Joint Pain Conservative Options Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator or STIM which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes. Decompression Decompression including North American Spine s unique IntelliSpine procedure may be used for cases in which the structural integrity of the vertebrae or spinal cord is not threatened. These procedures concentrate on freeing entrapped nerves, typically be enlarging the space through which nerves pass. Depending on the demands of the procedure and your unique physiology, a special surgical laser may be used. Fusion/Stablization Fusion, also called stabilization, procedures may be used when the stability of the spine or vertebrae are compromised or threatened. In some of these cases, more than one harmful condition may exist. While these procedures are minimally invasive and enjoy a high success rate, some patients may be required to stay overnight for observation. 30