Degenerated Discs/ Bulging Discs/ Herniated Discs
Injury of a disc in the lower back is the most common reason for chronic lower back pain in adulthood. The spinal vertebrae are separated by flexible discs of shock absorbing cartilage. These discs are made of a supple outer layer with a soft jelly-like core (nucleus). When a disc herniates, the tissue located in the center of the disc is forced outward. Strong pressure on the disc may force a fragment of the nucleus to rupture the outer layer of the disc, inflaming and placing tension on a nearby nerve causing leg pain or sciatica. If the injured disc is in the neck, it may produce pain, numbness, or weakness in the shoulder, arm, or hand. Herniated discs can be treated through X-ray guided steroid injections.
Spinal stenosis can develop over time with age or congenitally as the spine develops. Stenosis refers to the narrowing of the spinal canal. It occurs as the discs of cartilage that separate the spine’s vertebrae lose water and the space between the vertebrae becomes smaller, causing friction between the bones. Daily wear and tear on the spine becomes more significant without these shock absorbers. As the discs degenerate, vertebrae may shift, causing the spinal canal to narrow. In some cases, the nerves that travel through the spinal column to the legs become squeezed. This can cause back and leg pain, and even leg weakness. Arthritis and falls also contribute to the narrowing of the spinal canal, compressing the nerves and nerve roots and causing pain and discomfort. Selective nerve root blocks can alleviate leg pain due to stenosis.
Sciatica/ Radiculopathy/ Radicular Pain
Radiculopathy refers to a condition in which the spinal nerve roots are irritated or compressed. Many people refer to it as having a “pinched nerve.” Pinched nerves can occur in the neck or lower back. In the lower back, nerves join to form the sciatic nerve, which runs down into the leg and controls the leg muscles. Sciatica is a condition that may cause radiating pain, numbness, tingling, and/or muscle weakness in the leg, but originates from nerve root impingement in the lower back. Injection of steroid and anesthetic around the inflamed and painful nerve root can effectively reduce nerve root pain from a herniated disc or stenosis. Studies show that on average, patients require two injections to experience significant relief of leg pain.
Whiplash injuries affecting the joints or discs in the neck are caused by acceleration-deceleration forces on the cervical spine in a motor vehicle collision. Diagnostic injections using X-ray guidance determine the source of the whiplash-induced neck pain in order to optimally treat it. Steroid injections can help reduce disc related neck pain while a radiofrequency neurotomy can successfully reduce neck pain arising from an injured facet joint.
Facet Joint Arthrosis
One common source of chronic lower back pain in patients over 55 years of age is facet joint arthritis. Facet joints are the small joints located between each vertebra that provide the spine with both stability and flexibility. Facet syndrome occurs when one or more of these joints become inflamed or irritated. Using fluoroscopic (X-ray) guidance, the affected joint can be targeted with diagnostic injections to confirm the cause of lower back pain. A radiofrequency neurotomy procedure can offer significant pain resolution without the potential risks and down time of surgery.
Sacroiliac Joint Dysfunction
The sacroiliac joints are at the base of the spine connecting the pelvis to the sacrum. There is one sacroiliac joint on each side of the sacrum which can cause pain in the lower back and legs. Sacroiliac joint pain occurs more frequently in adults over age 55 and in females. Steroid injections into the sacroiliac joints are effective at reducing low back pain. The sacroiliac joint is the most common source of residual low back pain in patients who have had a lumbar fusion surgery.
The sciatic nerve courses through the piriformis muscle as it travels down the leg. Runners and cyclists may develop piriformis syndrome, which is irritation of the sciatic nerve, causing pain into the buttock, back of the thigh and calf. A gentle stretching program in combination with injections of anesthetic into the piriformis muscle under X-ray guidance can help alleviate the symptoms.