Please read about degenerative disc disease for a brief overview. In some patients, the outer part of the disc called the annulus may become weakened either due to an injury or wear and tear. If it becomes weak enough, the inner part of the disc (called the nucleus) may herniate or rupture through the outer fibers. This will often cause direct pressure on a spinal nerve resulting in neck, back, arm, or leg pain/numbness. An MRI or CT may be necessary to visualize the disc herniation. Nonsurgical treatment options include, but are not limited to, epidural steroid or stem cell injection, intradiscal steroid injections, and physical therapy.



Low Back Pain


Low back or lumbar pain is the second most common reason that patients visit the doctor, only behind the common cold.

The pain may be secondary to a trauma or injury, but frequently is not related to any specific event. Over time there are changes in the discs, facet joints, and supporting musculoskeletal system related to work activities and ergonomics, posture, obesity, repetitive motions, genetics and other systemic diseases.

As with many conditions of the spine, the pain can be significant. Low back pain is also one of the most challenging conditions because there are so many potential sources of pain (pain generators). Common causes are a bad disc irritating a nerve, joint inflammation, arthritis, muscle strain/spasm, sacroiliac joint pain, and stenosis.

The pain may be in the middle of the back, one or both sides. It can also radiate into the buttocks, hip, and groin regions. For some patients, the pain will radiate into the legs and individuals may also experience numbness, tingling, and/or weakness. Some patients report that the pain is worse after walking some distance. The reason for this is that all of the nerves in the legs come from the back. As a result, any issue with the low back can potentially affect the legs.

An MRI, CT, ultrasound evaluation or an NCS/EMG may be necessary to better determine the source of pain. Non-surgical treatment options include, but are not limited to physical therapy, customized home exercise programs, topical treatments, neuromodulation such as TENS, interferential stimulation, Biowave, trigger point injections, protein rich plasma (PrP), epidural steroid or stem cell injections, selective nerve blocks, facet joint injections, sacroiliac joint injections, radiofrequency ablations (nerve burns) intra-discal steroid injections, spinal cord stimulators, and dorsal root ganglion stimulation.



Piriformis Syndrome/Buttock Pain


The piriformis muscle is an under-diagnosed cause of buttock pain that frequently has a sciatic component as well. In some cases, patient's sciatic nerve may exit through the middle of this muscle, making nerve pain in the leg worse. Pain in the gluteal region is frequently due to the piriformis muscle dysfunction, possibly a strain, muscle spasm, tightening of the muscle or swelling in the muscle. The sciatic nerve exits the spine under the piriformis muscle, which can then cause symptoms in the leg. Sometimes the sacroiliac joint is the source of buttock pain as well. Non-surgical treatment options include, but are not limited to, ultrasound guided injections of the piriformis muscle with steroids and/or regenerative medicine treatments, sacroiliac joint injections, physical therapy and a dedicated home stretch program. An x-ray, MRI, or ultrasound evaluation may be necessary to help determine the source of pain.




The spine has many joints at each level, similar to the joints throughout the rest of the body. A facet joint is in the spine where the bones above and below each other meet. Over time or due to injury, the joint itself may become damaged or degenerated. Often, inflammation will occur resulting in significant neck or back pain. Facet joint inflammation often irritates the nearby deep muscles of the spine, resulting in restricted range of motion or muscle spasm. It is very common after car accidents as well as sleeping wrong. Sometimes described as a 'crick' in the neck. An xray, MRI, or CT may be necessary to accurately diagnose. Nonsurgical treatment options include trigger point injections, facet injections with steroid/stemcells/growth factors, and physical therapy.





A large joint that is found in the gluteal/buttocks region that connects the pelvis to the sacrum. It is called the sacroiliac joint or 'SI joint'. It can be aggravated from trauma such as falls, altered gait, or 'wear and tear' in which the joint becomes inflamed or degenerated over time. Unfortunately, many patients suffer with SI joint dysfunction/pain in addition to a low back issue. Fortunately, we have many treatment options available including diagnostic injections, corticosteroid injections for acute inflammation, stem cell / growth factor / PRP injections for regenerative changes.


Degenerative disc disease


Degenerative disc disease is not really a disease but a term used to describe the normal changes in your spinal discs  as you age. Spinal discs are soft, compressible discs that separate the interlocking bones (vertebrae) that make up the spine. The discs act as shock absorbers for the spine, allowing it to flex, bend, and twist. Degenerative disc disease can take place throughout the spine, but it most often occurs in the discs in the lower back (lumbar region) and the neck (cervical region).

The changes in the discs can result in back or neck pain and/or:

Osteoarthritis, the breakdown of the tissue (cartilage) that protects and cushions joints.

Herniated disc, an abnormal bulge or breaking open of a spinal disc.

Spinal stenosis, the narrowing of the spinal canal , the open space in the spine that holds the spinal cord



Failed Back Syndrome


Many patients will present to our spine center with continued pain despite having already undergone surgery. In these cases, the pain may be related to chronic nerve inflammation, facet joint inflammation, scar tissue related to the surgery, degenerative disc disease, or stenosis. Unfortunately, many patients have more than one ‘pain generator’, and there is another painful structure that was not corrected with surgery. An MRI, CT, or NCS/EMG may be necessary to better determine the source of pain. Nonsurgical treatment options include, but are not limited to, selective nerve blocks, facet injections, intradiscal steroid injections, and spinal cord stimulators. The most exciting development for failed back patients is regenerative medicine. Injection of stem cells and growth factors can provide significant relief. Many of our patients experience significant improvement despite minimal relief with previous treatments.




Changes with walking. When the spine abnormally twists and bends sideways enough, it can cause the hips to be out of alignment, which changes a person’s gait or how they walk. The extra compensating that a person does to maintain balance for the uneven hips and legs can cause the muscles to tire sooner. A person might also notice that one hand brushes against a hip while walking but the other does not.

Reduced range of motion. The deformity from spinal twisting can increase rigidity, which reduces the spine’s flexibility for bending.

Trouble breathing. If the spine rotates enough, the rib cage can twist and tighten the space available for the lungs. Bone might push against the lungs and make breathing more difficult.

Cardiovascular problems. Similarly, if the rib cage twists enough, reduced spacing for the heart can hamper its ability to pump blood.

Pain. If curvature becomes severe enough, back muscles could become more prone to painful spasms. Local inflammation may develop around the strained muscles, which can also lead to pain. It is possible for the intervertebral discs and facet joints to start to degenerate due to higher loads.