Degenerative Disc Disease
Degenerative disc disease refers to when the disc itself is the source of back pain or neck pain as a result of a damaged and degenerative disc. Degenerative disc disease may be treated with medications, ice/heat, active physical therapy/exercise, or behavioral and lifestyle changes, or require spinal fusion or artificial disc replacement surgery for uncontrollable, severe pain that has not responded in time to previous non-surgical care and when an anatomical cause of the pain has been identified.
A herniated disc can produce lower back pain and/or leg pain (sciatica) or less often neck pain and/or arm pain as a result of the disc's soft, inner core extruding through its tough, outer core, and coming in contact with and irritating a nearby spinal nerve. A herniated disc may be effectively treated with pain medications, injections, chiropractic care, physical therapy and exercise, or require surgery for symptoms that have been unresponsive to non-surgical care.
Sciatica describes symptoms of leg pain and possible tingling, numbness or weakness that travels from the lower back down the sciatic nerve in the back of the leg, often as a result of a pinched nerve from a herniated disc or other conditions like degenerative disc disease, spinal stenosis or spondylolisthesis. Sciatica symptoms may be treated with heat/ice, over-the-counter or prescription medications, epidural steroid injections, acupuncture, massage therapy, manual manipulation, physical therapy or exercise, or require surgery for severe pain that has not responded to non-surgical care.
Spinal stenosis can produce leg pain, tingling, weakness or numbness, or arm pain as a result of compression of the spinal nerve roots in the lumbar spine (lower back) or the spinal cord in the cervical spine (neck), respectively. Spinal stenosis is often managed through non-surgical treatments like exercise, epidural injections, non-steroidal anti-inflammatory drugs (NSAIDs) and activity modification, but can require a decompression surgery for symptoms that have not improved following non-surgical care.
Spondylolisthesis refers to when one vertebral body slips forward over another, often as a result of a defect in a small segment of bone (the pars interarticularis) that joins the facet joints in the back of the spine, possibly leading to back pain and leg pain that restricts normal activity levels. Another common cause of spondylolisthesis is degeneration within the facet joints (degenerative spondylolistheisis). Typically recommended treatments for spondylolisthesis include non-surgical care like bracing that immobilizes the spine for short periods of time, pain medications and/or anti-inflammatory medications, hamstring stretches and other controlled, gradual exercises. Surgery combining a decompressive laminectomy with a spinal fusion is rarely needed for spondylolisthesis symptoms that are not healing or have neurological components.
Scoliosis is an abnormal curvature of the spine that usually occurs in adolescents and develops in the upper back or in the area between the upper back and lower back. Most cases of scoliosis have no known cause and may go unnoticed until the curve has significantly progressed. For adolescents, scoliosis treatment typically includes simple observation and/or the use of back braces that are designed to stop the curve. A corrective surgery from the anterior or posterior of the spine is usually only recommended for adolescents with curves that are more than 40 to 45 degrees and progressing.
Osteoporosis and Vertebral Fractures
Osteoporosis is a thinning of the bones that occurs with aging (more often in women than men, especially after menopause), leaving the bones porous, fragile and susceptible to vertebral fractures that are frequently dismissed as general back pain. Osteoporosis is treatable with non-surgical treatments like exercise, medications and education on diet and nutrition aimed to slow bone loss and prevent fractures. Osteoporotic vertebral fractures may be treated with rest, rigid back braces that support the spine, ice and heat, pain medications or surgeries such as kyphoplasty or vertebroplasty when the fracture is causing severe pain and deformity and has failed to respond to non-surgical care.
Osteoarthritis is a very common form of arthritis that occurs when the cartilage between aligning facet joints in the back portion of the spine mechanically breaks down over time, leading to common symptoms like inflammation, stiffness and pain in these joints, and possibly resulting in bone spurs that irritate or trap the spinal nerves. Non-surgical care such as medications, exercise, physical therapy and chiropractic is typically the first line of osteoarthritis treatment. In rare cases, osteoarthritis may require a spinal fusion surgery when the joint is severely unstable or a lumbar laminectomy surgery when the spinal nerves are affected.