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Spinal Pain Diagnostic Center

The Spinal Pain Diagnostic Center tells you how we diagnose causes of spinal pain.  Several common diseases are described and some other neurosurgery problems are also included.  The Spinal Pain Diagnostic Center is a virtual center describing my diagnostic practices.  The goal is the make an accurate diagnosis of the cause of your spinal pain.  Then we are more likely to plan an effective treatment.

Spinal pain is one of the most common reasons for work-related disability.  Enormous sums are spent on the treatment of the complaint of spinal pain.  The most common reason for use of physical therapy and rehabilitation measures is spine pain.  Surgery on the spine now ranks third in surgical volumes and is growing more rapidly than any other field.  The majority of patients suffering from a chronic pain syndrome and in chronic pain treatment have the spine as the origin of the pain.  Most manipulation therapy is directed to the spine.

In spite of the frequency of the complaint of spinal pain and many therapies available, the actual cause of the spinal pain is often unknown.  Arthritic changes in the spine called spondylosis are common.  Virtually all of us develop them with age.  The simple discovery of degenerative disc disease or other signs of spinal arthritis does not correlate with complaints.  In the absence of a specific diagnosis to define the origins of spinal pain specific treatments are not possible.  Understanding the causes of pain also allows disability to be estimated more accurately, and allows advice for an appropriate lifestyle to minimize pain and maximize function.  The key to any satisfactory treatment program is the understanding of why the spine is painful through the most accurate determination of the generators of the spinal pain.  Then best available therapies can be matched to those diagnoses.

Spinal pain can come from a number of sources.  The most common are probably strains and minor injuries to muscles and ligaments.  Muscles can spasm when irritated.  Discs degenerate after injury or with time.  They lose their water and their spongy shock-absorbing character.  These changes can usually be seen on imaging studies.  Sometimes these injured discs actually herniate or slip.  That is, a portion of the disc breaks out of where it is located in the spine and slips into the spinal canal pressing on nerves.  Most of these slipped discs disappear by themselves.  Some require surgery because pain is severe or loss of function has occurred.  Many can be treated by needle injections without surgery.  It is extremely important to determine when a disc is herniated and whether the patient requires surgery, injection, or simple pain relief while recovery occurs.

Some bony abnormalities require surgery also.  Spinal stenosis (spinal canal is too small) is one of these, if symptoms are severe.  There are many others to be diagnosed.

Arthritic joints called facets are common sources of pain, and direct treatments with injection is often helpful.  Sometimes the nerves carrying pain from these joints can be interrupted by simple needle techniques.  Sometimes surgical fusion is required.  Again, it is extremely important to determine when these joints are causing the pain so that the best treatment for the individual patient can be recognized.

Slips occur in the spine bones.  The spine becomes unstable and the bones move with relationship to each other.  Sometimes the movement is constantly occurring every time the patient moves, and sometimes it is slow.  Then it is called glacial.  In some patients it is possible to see the movement by imaging.  These movements often result in misalignment of the spine.  Some of these are so severe that only surgery will correct them.  When nerve root pressure is present, surgery is often required.  It is important to determine which patients should proceed to surgery promptly for some with these slips can still be treated with simple injections or physical measures.