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Spine

Your backbone, or spine, is made up of several bones, called vertebrae, and the cushions between them, called intervertebral discs. The spine protects your spinal cord and allows you to stand and bend. A number of problems can change the structure of the spine or damage the vertebrae and surrounding tissue. Arthritis or disc problems in the spine can cause pain in the back. Some conditions in the spine may “pinch nerves”, which can lead to pain, numbness, tingling, or weakness in the arms or legs.

Orthopedic Associates of Hartford spine specialists treat a spectrum of spine disorders, including degenerative (arthritis) conditions, injury, and deformity.

Common Conditions

Some of the most common spine conditions include:

Arthritis and Osteoarthritis: Spinal arthritis – also called degenerative joint disease – is the breakdown of the cartilage between the facet joints in the spine, leading to low back pain and/or leg pain. 

Degenerative Disc Disease: Most patients with degenerative disc disease will experience low-level but continuous back pain that will occasionally intensify and can become severe.

Herniated Disc: A herniated disc occurs when the inner gel in the disc leaks out and puts pressure upon a spinal nerve, often leading to leg pain or arm pain.

Leg Pain: When the nerves exiting the spine in the lower back are impinged, the pain may extend down the leg as a general pain, tingling, numbness, or weakness. 

Lower Back Pain: There are many conditions that affect the lower back.

Neck Pain: The neck can be afflicted with spinal stenosis, herniated disc, osteoarthritis, degenerative disc disease, and also by muscle strain, whiplash or other conditions. 

Osteoporosis and Spinal Fractures: Most fractures in the spine are caused by osteoporosis, which is a condition in which bones lose structural integrity.

Sacroiliac Joint Dysfunction: The joint between the base of the spine and the hip does not normally have much movement, but any change in the joint may cause lower back pain and/or leg pain. 

Sciatica: The sciatic nerve exits the lumbar spine and carries information between the brain and the legs. When a lower back problem affects the sciatic nerve, pain can radiate down the leg and into the foot. 

Spinal Stenosis: Spinal stenosis is a condition in which parts of the spine narrows and can lead to compression of a spinal nerve or the spinal cord in the neck.

Spondylolisthesis: Spondylolisthesis occurs when one vertebra in the spine slips forward over the one below it, causing lower back pain and/or leg pain. It most commonly occurs in the lower levels of the spine. 

Sports and Spine Injuries: Certain sports and activities are likely to cause or worsen back pain due to repetitive motions and added strain on the spine.

Upper Back Pain: Pain from the thoracic spine is less common than from the cervical spine (neck) or lumbar spine (lower back). Muscular issues and joint dysfunctions are the most common problems in upper back.

Symptoms

Signs and symptoms that sometimes accompany back and neck pain include:

  • Pain that is dull or achy, confined to the lower back 
  • Stinging, burning pain that moves from the lower back to the backs of the thighs, sometimes into the lower legs or feet; can include numbness or tingling
  • Muscle spasms and tightness in the lower back, pelvis, and hips
  • Pain that worsens after prolonged sitting or standing
  • Difficulty standing up straight, walking, or going from standing to sitting
  • Soreness and difficulty moving the neck, especially when trying to turn the head from side to side
  • Sharp paint that may be localized to one spot and may feel like it’s stabbing or stinging.
  • General soreness in one spot or area on the neck or back that is tender or achy
  • Radiating pain along a nerve from the neck into the shoulders and arms; intensity can vary and this nerve pain may feel like it’s burning or searing
  • Tingling, numbness, or weakness that radiates into the shoulder, arm, or finger
  • Trouble with gripping or lifting objects

How We Diagnose

Medical History and Examination
During your first visit, our spine surgeon will talk to you about your symptoms and medical history. During the physical examination, your doctor will test your ability to stand and walk, examine your spine’s range of motion, check reflexes, assess leg strength, and determine your ability to detect sensations in your legs.

Imaging Tests
Other tests, which may help your doctor confirm your diagnosis, include:

  • X-rays: Spinal X-rays are taken to show alignment of your bones and check for breaks.
  • MRI (Magnetic Resonance Imaging): MRIs provide evaluation of the spinal cord and nerve roots and assesses your discs, muscles, ligaments, nerves and blood vessels
  • Myelogram: A type of x-ray where a dye or contrast material is injected into the spinal canal to allow for very specific evaluation of the nerve roots and spinal canal.
  • CT (Computed Tomography): A specialized x-ray allows evaluation of the bone and spinal canal
  • EMG (electromyogram): This test is used to evaluate nerve and muscle function

Depending on the type of injury or condition, your doctor may perform additional tests to determine the source of your pain and the best treatment plan.

Treatment Options

Back and neck pain are extremely common and there are a number of treatment options.

Non-Surgical Options:
There are several conservative treatments for back pain. Many back pain episodes can be treated with anti-inflammatory medications, such as ibuprofen and naproxen. If back pain is severe, your doctor may try other pain relieving medications. Your doctor may recommend cortisone steroid injections for severe back pain. Home remedies such as ice packs can help with inflammation, and warm compresses may help relieve pain after inflammation has subsided. Exercises and physical therapy can be used to improve posture, strengthen back and neck muscles, support lifting, and develop a strong core.

Surgical Options:
Back surgery is only considered when conservative measures do not work. It is considered when there are structural abnormalities that do not respond to medication or therapy, if the patient suffers from severe and constant pain, or there is nerve compression causing muscle weakness. Surgical options may include:

Spinal Fusion:
Entails fusing together painful bones in the spine so they heal into a single, solid bone. Fusion can be conducted to address a wide range of back and neck conditions.

Nerve Decompression: Used to decompress or relieve pressure on the spinal cord by removing pieces of bone or soft tissue.

Disc Replacement: When discs are worn or damaged, they can be removed and replaced with synthetic material in order to relieve back pain.

Not all surgeries are appropriate for patients with back or neck pain. There is a wide range of factors that influence whether an individual is a good candidate for surgery.

Physiatry: Interventional Pain Management

Physiatrists are medical doctors who focus on acute and chronic problems of the musculoskeletal system. They take a non-surgical approach to spinal care in order to relieve pain and restore function.

Orthopedic Associates of Hartford is proud to have three leading physiatrists on our team – Dr. Pietro Memmo, Dr. Vincent Codispoti, and Dr. Jonathan Ramin, who are are responsible for the diagnose and treatment of painful spinal conditions in a conservative, non-operative fashion, with minimal use of opioids. Each are board-certified in Physical Medicine and Rehabilitation, and have additional fellowship training in Interventional Pain Management.

As part of the OAH team, our Physiatrists:

  • Diagnose and treat musculoskeletal conditions
  • Prescribe physical therapy and medications
  • Perform ultrasound guided office injections
  • Conduct the most advanced, fluoroscopically-guided, minimally invasive spinal injections at one of our ambulatory surgical centers
  • Perform electrodiagnostic studies as part of the evaluation of patients with disorders of the peripheral nervous or musculoskeletal systems

Common Conditions

Our physiatrists focus on the non-surgical management of a wide range of spinal conditions with a particular focus on image-guided injections. They treat people of all ages who suffer from bone, joint, muscle or nerve ailments that cause pain and impair normal, everyday functions. When spinal issues cannot be successfully treated with conservative measures, they refer to an OAH surgical specialist for further evaluation. Patients may seek care for the diagnosis and treatment of symptoms associated with:

  • Back pain
  • Neck pain
  • Radicular pain/Sciatica
  • Spinal stenosis
  • Facet pain
  • Sacroiliac joint dysfunction
  • Sports injuries
  • Arthritis
  • Herniated disc
  • Pinched nerve in the neck or back
  • Work injuries

Physiatry Diagnosis

We pride ourselves on first being “compassionate diagnosticians” and strive to definitively diagnose the source of your pain, and to provide you with a broad spectrum of treatment options. Only after a firm can the appropriate treatment can begin.

During your office visit, we doctor will conduct a full initial assessment, which will include an extensive history and physical examination, as well as imaging studies such as X-rays of the spine.

For patients who require it or do not respond to initial therapy, additional imaging studies such as CT scans and/or MRI studies may be ordered to assess spinal anatomy.

One diagnostic test that may also be used is nerve conduction studies and electromyography, also known as an electrodiagnostic examination and commonly referred to as an “EMG.” An EMG is a minimally invasive test used to diagnose many neurological conditions. Electromyography can help a physiatrist to determine where the source of the pain is originating and the severity. Drs. Memmo and Codispoti alone have performed a combined total of over 10,000 EMGs in their careers.

Physiatry Treatment Options

Physiatrists take a multidisciplinary approach to non-operative musculoskeletal care. Initial treatments may include a round of customized and sport-specific physical therapy to address deficiencies in flexibility and strength, as well as a trial of basic analgesic medications. Most patients respond favorably to this initial intervention.

Depending on the injury and the response to treatment, minimally invasive image-guided spinal injections may be administered to treat pain and restore function. Physiatrists perform many different types of spinal procedures—from the neck to the tailbone. These injections are used for diagnostic and therapeutic purposes. Types of injections include but are not limited to:

  • Epidural steroid injections
  • Selective Nerve Root injections
  • Medial branch blocks
  • Facet rhizotomy/Radiofrequency lesioning
  • Sacroiliac joint injection
  • Coccygeal injections
  • Hip injections
  • Discography
  • Trigger Point injections
  • Bursa injections
  • EMG nerve conduction studies

We have performed over 30,000 spinal procedures accurately, safely, and without issue. These minimally invasive procedures are done in state-of-the-art surgical centers, under sterile conditions, with fluoroscopy (a live X-ray machine) and with a dedicated and compassionate nursing staff.

In the News

Dr. Heeren Makanji talks with WFSB about common reasons for back pain, conservative treatment options, the newest advancements in spine surgery, and when to see a spine specialist.