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Back pain in patients from many different causes can cause symptoms of sharp or dull pain in the low back. You could have radiating pain going down one or both legs. You could have an ability to bend without pain, to lie down, sit or stand or lift objects without pain. These are all very important symptoms to look after if you’re experiencing back pain. One of the emergent symptoms that you would really need to be evaluated for on an emergent basis would be if you have bowel or bladder dysfunction, meaning that you can’t go to the bathroom or you can’t control your bladder. That might mean that one of the very important nerves going to your bladder or your bowel system is being compressed. And if that does not get taken care of on a very quick basis, it may lead to permanent damage of the genitary urinary system.
So there are many different conditions that cause low back pain and part of the evaluation and determination of the cause of the low back pain and the diagnosis is based on the examination, the history, the studies, which might include an x-ray or an MRI. And once you have a diagnosis or potential diagnoses, you then determine a treatment plan for that patient that is custom made for that individual patient.
If you experience back pain and you have no other symptoms except just back pain, you have no radiating pain or Sciatica going down your legs, you have no bladder or bowel dysfunction, if the pain is not getting better on its own within the first few days, it’s very important to have it evaluated to make sure there isn’t any permanent damage or to make sure that there is no specific cause of that back pain that could be treated immediately. Otherwise, it could be that you’ll have chronic back pain, even if it does get treated at a later date.
When you go to your doctor, it’s very important to bring any studies that have been done already for that ailment. So for instance, if you had low back pain and you went to your internist and he ordered an x-ray,, blood work, an MRI, it’s very important to bring those actual studies. Usually they will burn it on a disc at the point of the evaluation where the physician can now read the radiologist’s report and what the radiologist has found when reviewing those images. The physician can overread those images and see for himself if there are any particular areas in the image that may have been missed by the radiologist, where he is now correlating with his examination and therefore being able to get a better determination of the findings and the diagnosis.
When you make an appointment with our center, you generally will not wait more than 10 minutes to see her physician. We have a program that allows you to see an update how long the waiting is in the waiting room. So if you have an appointment and you are running late, you are able to access the system and the staff and let them know that. If we are running late, you will be notified very similar lead to a airplane that is delayed, you get notified by text or by email. Most people who will make an appointment with me or with our clinic should bring all their medical records that they have from any of the physicians that they have seen for that particular condition.
A patient may have a car accident and sustain an injury to his low back. He would come in for an evaluation because of intractable low back pain. We would then examine the patient. We would obtain x-rays, Mris, nerve testing, or other such studies to better evaluate the reasons for why his back pain has not subsided. If all the studies came back negative, we would treat him with physical therapy, possibly anti-inflammatory or pain medication, and follow him in a fashion that would be suitable to make sure that his symptoms are improving with the course of treatment. There are times that the cause of the low back pain might be different than just a musculoskeletal strain or sprain. An MRI finding may come back with a significant herniated disc that is pushing on a nerve root, causing shooting pain down the leg or Sciatica and the back pain is not getting better with conservative management. Those types of patients, we might then go into more invasive management with injection therapy such as epidural injections or facet injections. If patients are getting worse in that type of a situation and all conservative management fails, they may have to undergo a microdiscectomy where we make a very small half an inch incision and their back and move away all the nerves and come down to the disc and take out the piece of disc that’s pushing on the nerve. It’s a relatively small procedure. It takes about 45 minutes and the patient goes home usually the same day or the following morning.
There is a small segment of the population, about 5% where their low back pain does not respond well to conservative management or the diagnosis of the back pain is an emergent diagnosis such as certain fractures in the spine, or compressions of certain nerves in the spine. And those would result in surgical intervention where the patient would have a decompression, possibly a fusion. A decompression is where you reduce the pressure on the nerves that are coming out of the spine, in order for those nerves to effectively wake up and reactivate and start working again. If you have a compression of any of those nervous for any prolonged period of time, there is a potential of strangulating the nerve where there’s irreparable damage. And even with surgical intervention, the patient may not recover.
Most back pain is curable. 95% of our patients do not require surgery. We have up-to-date technology that requires only minimally invasive techniques and conservative management to resolve those symptoms, and they work very well. Many people who experienced back pain feel that it might get better on its own and some back pain does. It’s very important to have an orthopedic surgeon evaluate that back pain and make sure that the pain generator or the cause of the back pain is not something that is serious and that might need immediate treatment. There are many conditions where back pain, if not treated immediately or urgently, can create a permanent damage for that patient.
My name is Jonathan Nissanoff. I’m an orthopedic surgeon. I’ve been practicing 24 years. I specialize in minimally invasive orthopedic surgery. I’ve also done two fellowships, one in complex trauma and one in sports medicine. We have a program where a patient who gets into a car accident or has a sports injury can make this phone call. Let’s say a patient broke their wrist and made this phone call and the doctor is now discussing with the patient their medical history and they’re fairly healthy. They get a video of the actual risk that is broken or injured. This way, they’re actually seen by the specialist on an immediate basis. If at the point of evaluation an hour or two hours later the patient is determined to be a surgical candidate, we have an operating facility fully accredited where we can activate the team and complete the care at that point in time. So the patient, if they needed an operation, would get that operation that evening and then would be on their way to healing.
Our center provides board certified fellowship trained surgeons, in very specific areas within orthopedics. We have immediate access for that type of care. Our equipment is state of the art equipment from fluoroscopic machines to arthroscopic systems. We have an operating room literally attached to our office, which is very unique, and we have the imaging center attached to the building, which is very unique. So it really becomes a true mini hospital even though it’s not truly a hospital, but it effectively mimics what a hospital would otherwise do on an immediate basis with highly specialized physicians and surgeons. We have a 24/7 orthopedic Urgent Care Center. It’s the only one of its kind in the country, that I know of.
Low back pain is one of the most common ailments patients come into our office for. Most people during the course of their life will wind up experiencing low back pain at one point in time or another. It could be just from waking up on the wrong side of the bed to falling, or to lifting something heavy that they’re not used to. It could also be from a sports injury or a car accident. It’s a very common ailment. Most low back pain issues can be treated conservatively. I would say 95% of my patients do not need surgical intervention for low back pain. Obviously it depends on the diagnosis as to what the pain generator is that’s causing the low back pain. But at the end of the day, we do a full evaluation. We do the appropriate studies and come to a diagnosis and based on the diagnosis, we use the latest techniques available to reduce that pain, hopefully to get rid of that pain, without surgical intervention. If after all the conservative management treatments fail, then we will consider surgical intervention if necessary.
There are some new research out there with stem cell injections with platelet rich plasma injectables and other types of minimally invasive techniques that will relieve patients symptoms and potentially improve their underlying pathology. These are generally temporary solutions. Technology is getting better and better by the day, and hopefully we will find a permanent solution that will avoid the need for surgical intervention.
My philosophy on patient care is to use the latest and greatest techniques and literature out there to reduce the patient’s symptoms and get them back to their pre-injury status. So if they were doing a particular sport event or they needed to get back to work, they would have immediate access to care and they would have the most minimally invasive or treatments that are the most up to date techniques to get them back to what they need to do as expeditiously as possible.
There are many different treatment modalities for back pain. It really depends on the diagnosis as to what treatment you’re going to determine is best suited for that diagnosis and for that particular patient. Some of those treatments include physical therapy, traction therapy, injection therapy, pain management, surgical intervention, and minimally invasive discectomies. There’s a lot of different treatments available. Most patients do very well, regardless of the diagnosis with the more conservative management, but there are some that do need the more invasive surgeries.
There are many alternative types of options that are available for patients with low back pain, as long as the reason for the low back pain is more from a soft tissue perspective, meaning that there is no compression of any of the nerve roots. So physical therapy, acupuncture, chiropractic therapy, homeopathic treatments can all work very well, but it’s really important to make sure that you know what the diagnosis is that’s causing the low back pain before you start any of the alternative therapies.
There isn’t really a good temporary solution for a sports injury. The goal of a sports injury treatment is to get the patient back on the field back into his game, back playing the sport that he really enjoys. So if you have a sports related injury, generally speaking, you want to get the treatment on an immediate basis, get the correct treatment from a specialist in order to get back into the game.
Okay, so neck and back pain are some of the most common problems that humans deal with. That and headaches are the most common complaints that patients bring to their doctors. There are so many things that can go wrong and cause pain in our necks and backs. Most common, of course, is muscle: a strain, a sprain, overloading, Particularly in our sedentary lifestyles we often let our core get weak, and then something may happen to tax it. We have to move when we start carrying heavy boxes, or we decided to do the weekend warrior and get more athletic on a weekend. But we haven’t maintained the muscle strength to support that. So muscle strains, muscle injuries are the most common cause and most of those will heal on their own over a period of one to two months.
Sometimes muscle problems can be prolonged and then we have to engage the patient in physical therapy. Sometimes we support that physical therapy with injections into the muscles to force the muscles to relax and kind of reset if you will. But the key again is the physical therapy. Often the problems can be the spine itself. You can have injuries to the ligaments that help hold the spinal vertebrae in sync with each other in good alignment, one on top of another. The joints that allow the vertebrae to be in sync yet flex and extend backwards and forward or even side to side. These can become inflamed. They can become injured. The ligaments can be injured. The tendons where the muscles connect to the spine can become injured. And then each vertebra is separated from its neighbor, by a disc. A disc is basically a shock absorber, but they’re kind of the structure of a jelly donut. So they have a soft squishy inside, which can protrude outward and cause a disc herniation that can, first of all, the insides of it are chemicals that are irritating to the nerves, inflammatory. But even physically, they can press against nerves and cause pain to radiate down a nerve into a arm or a leg. When it goes into the leg that’s often referred to as Sciatica, we call it radiculopathy. It can also shoot if if the problem is in the neck, the pain may shoot down into the arm.
So you can get nerve impingements from discs. You can get nerve irritation from the chemicals in the disc. You can have the bony structures start to get arthritic over time. And just like knuckles in an arthritic hand may get large, so to the joints in the spine can become large. And when they become large, it may crowd the nerves leaving them less room and actually leading to conditions that the public calls a pinched nerve, we call it stenosis or narrowing around the nerve. All of these conditions can cause pain and there’s more, there’s others, there’s infections, thank God, relatively rare. All kinds of things that can upset the delicate balance of what’s really an engineering marvel is the way our spines are put together to support our body and be a weigh station for the nerves from the brain to all parts of the body.
So we have many treatment options to help people with back pain. Of course, it depends on what the cause is. Starting with chiropractic we’re able to help the patient with musculoskeletal issues when there’s been strain and imbalances, helping the patient to build their strength and get things more balanced so they’re not putting an undue stresses on certain parts of their spine. Physical therapists are very useful in this teaching the patient the exercises to strengthen their torso, to strengthen their core. So again, they don’t end up in situations where there’s abnormal or sudden strains and stresses that their body isn’t prepared for.
Sometimes the patient may need surgery. They may need surgery to make room for nerves to remove a herniated disc, to fuse a segment that’s unstable. There’s a variety, different surgeries that might be needed at times to correct a problem. In some cases, we implant stimulators or we may implant spinal pumps. All of these techniques can be used for the more severe back pain conditions that don’t respond to the more common techniques.
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