Experienced NeuroEndospine Surgery Specialist
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Neck pain is common in the USA, affecting 10% to 20% of people annually.  Neck pain is more common in women, younger people and people with office and computer-based jobs.  Neck pain can be episodic, meaning that episodes will come and go. Unfortunately, people with episodic neck pain are very prone to relapse, meaning that severe symptoms tend to return and can even be constant.

There are several common causes of neck pain. Neck pain can be caused by repetitive over-stress.  This is seen among office workers.  Constantly looking down at a screen shifts the head’s center of gravity, making it heavier on the neck. 

Motor vehicle accidents are a common cause of neck pain.  This is often referred to as a whiplash injury because it is caused by a rapid high force whipping back and forth of the head.  Whiplash injury occurs in 3 million Americans a year and is seen in almost 1% of all emergency room visits.  About 1 out of 3 whiplash patients will develop chronic symptoms.  Chronic symptoms are those that last greater than 12 weeks and never completely resolve without significant treatment.  High velocity accidents have a greater incidence of chronic neck pain, although seemingly low impact accidents may also result in chronic symptoms. 

Neck pain can stem from several spinal structures.  Ligaments connect bones together in the spine.  When there is an injury to a neck ligament it is called a cervical sprain.  Tendons connect muscles to bone.  When there is injury to a neck tendon it is called a cervical strain.  Sprains and strains usually get better on their own or with therapy after 6-12 weeks. 

Cervical facet joints cause pain to the back and side of the neck.  Occasionally the pain can run down the arm.  MRI cannot see most cervical facet causes of pain.  Cervical facet joint pain requires anesthetic injections for diagnosis.  Cervical facet joint pain can become chronic, or longstanding.

Cervical disc herniations cause pain similar to cervical facet joints.  Unlike cervical facet joint pain, a cervical disc problem can be diagnosed on MRI. Cervical disc herniation pain can become chronic as well.

The cervical facet joint is a paired joint; there is one on either side and just behind the disc.  Each vertebra has a left and a right facet joint that joins it to the vertebra above and below.  The cervical facet joints allow the neck to flex, extend and twist.  Injury or pain to these joints usually is associated with stiffness and reduced motion. 

Unless there is a severe injury, cervical facet injury or pain cannot be seen on x-ray, CAT scan or MRI.  To diagnose the problem, a doctor examines the patient and makes an educated guess as to which joints are causing the pain (there are 16 right and left facet joints in the neck).   This educated guess is made by listening to the patient, examining range of motion and pressing on the neck to see where pain lies.

Once the physician has focused on a joint or group of joints, the physician inserts a tiny needle into the neck and anesthetizes the pain sensing nerve for that joint.  This is called a block.  The block lasts for about 6 hours.  If pain is relieved, the doctor and patient can be confident that the offending joint has been diagnosed.  After that, treatment can be planned.

The cervical disc sits in-between the vertebra of the neck.  The disc contains a cushiony material called the nucleus. The nucleus is surrounded by a dense fibrous band called the annulus.  The annulus holds the nucleus in the center of the disc and connects the disc to the vertebra above and below.  The disc cushions the spine and gives strength and stability to the spine.  Immediately behind the disc lies the spinal cord and nerves.

Because of repetitive stress or an accident, the annulus of the disc can tear.  This usually happens at its weakest point, in the back of the disc.  After a tear, nucleus material can enter the opening in the tear and interpose itself inside the tear.  This is called a herniation.  Often, the tear extends all the way through the annulus.  In these cases, the nucleus of the disc can travel all the way through and compress the spinal cord and nerves of the neck. 

Besides neck pain, a disc herniation that compresses nerves and spinal cord can lead to severe symptoms.  This includes arm pain, arm and hand weakness, hand clumsiness, balance problems and incontinence. 

Unlike neck and low back pain, upper back pain is a condition that is usually caused by pain radiating from another part of the spine.  Rarely, upper back, or thoracic, pain is caused by a problem with thoracic structures. 

The tendons and ligaments of the thoracic spine can be injured, resulting in sprains and strains.  Thoracic facet joint injury is less common than cervical facet joint pain, seen in 10% to 20% of whiplash cases.  However, one rarely sees a thoracic facet injury in a patient that does not also have a cervical facet injury. Lastly, though rare, thoracic disc injury and herniations do occur.  Because their treatment can be complex, patients should undergo additional diagnostic testing to confirm that these discs are the source of a patient’s pain before contemplating a procedure. 

In spinal stenosis there is narrowing of the normal nerve passageways of the spine.  The vertebra of the spine has openings on the side (called foramen) and a large opening in the back center (called the spinal canal).  The spinal cord travels through the spinal canal until the L1/2 level.  At that point, the spinal cord divides into many nerves that continue to travel down the spinal canal to the tail bone.  Individual nerves traveling through the canal exit the spine by traveling through the foramen openings.  With spinal degeneration, there is enlargement of the bones and ligaments that surround the spinal canal and foramen.  As the degenerated bones and ligaments enlarge, there is direct pressure on the traveling nerves.  This pressure causes nerve dysfunction that can lead to pain, loss of sensation and loss of limb strength. 

The foramen and spinal canal passageways tend to narrow with a standing or upright posture.  They also tend to enlarge with bending forward or sitting.  As a result, spinal stenosis patients tend to suffer limb pain and other symptoms when they are standing or walking.  The symptoms improve with sitting or bending forward. 

Spinal stenosis can be easily diagnosed on MRI.  MRI will detail the portions of the foramen and canal that are narrowed.  MRI can also determine exactly what surrounding structures are causing the narrowing. 

Musculoskeletal and joint problems are now the leading cause of disability in the United States.  Of the leading cause of disability, back pain accounts for most cases.  Today, nearly 30% of Americans suffer from back pain and nearly 10% suffer from chronic back pain.  Those with chronic pain have had symptoms lasting longer than 3 months.  They are likely to experience symptoms that come and go only to return or never completely resolve.

Low back pain can stem from several spinal structures.  Ligaments connect bones together in the spine.  When there is an injury to a low back ligament it is called a lumbar sprain.  Tendons connect muscles to bone.  When there is injury to a low back tendon it is called a lumbar strain.  Sprains and strains usually get better on their own or with therapy after 6-12 weeks. 

Lumbar facet joints commonly cause pain to the low and mid back.  Occasionally the pain can run down the leg.  MRI cannot see most lumbar facet causes of pain.  Lumbar facet joint pain requires anesthetic injections for diagnosis.  Facet joint pain is worse with standing, walking and sitting upright.  These activities tend to increase the stress on an inured and painful lumbar facet joint.  Fact joint pain can become long term, or chronic. 

Lumbar disc herniations cause pain similar to lumbar facet joints.  Unlike lumbar facet joint pain, a lumbar disc problem can be diagnosed on MRI.  When the lumbar disc herniation compresses or irritates a nerve, there is pain running all the way down the leg.  This is called sciatica.  Lumbar disc herniations tend to be worse with sitting.  Sitting or flexing forward bends the lumbar spine and places stress on the back of the disc.  This may increase back pain and sciatica. Lumbar disc pain can become long-standing, or chronic. 

Sciatica is seen in about a third of people who suffer from low back pain.  The sciatic nerve runs down the leg and is the longest and widest nerve in the human body.  The sciatic nerve connects the muscles of the back of the thigh, leg and foot to the nervous system.  The sciatic nerve provides sensation for parts of the leg and the foot.  The sciatic nerve is made up of nerves coming from the lower lumbar spine.  When a disc herniation or other problem causes compression and irritation to the nerves making up the sciatic nerve, the pain is felt along the nerve.  Most people sense this as thigh and leg pain.

Sciatica is generally easy to diagnose.  The pattern of burning pain running down the leg is typical.  There may or may not be associated numbness.  MRI will usually reveal the cause of the nerve irritation in the spine. 

Sciatica can be very severe, even excruciating.  Sciatica can be much worse than the low back pain that accompanies it.  Patients suffering from severe sciatica should be offered advanced treatments early, even if they have not completed a course of therapy.

The lumbar disc sits in-between the vertebra of the low back.  The disc contains a cushiony material called the nucleus.  The nucleus is surrounded by a dense fibrous band called the annulus.  The annulus holds the nucleus in the center of the disc and connects the disc to the vertebra above and below.  The disc cushions the spine and gives strength and stability to the spine.  Immediately behind the disc lies the spinal cord and nerves.

Because of repetitive stress, or an accident, the annulus of the disc can tear.  This usually happens at its weakest point, in the back of the disc.  After a tear, nucleus material may enter the opening in the tear and interpose itself inside the tear.  This is called a herniation.  Sometimes, the tear extends all the way through the annulus, allowing the herniation to travel all the way through the disc and into the spinal canal. 

Lumbar disc herniations can cause back pain.  If the tear in the annulus extends to the periphery of the disc, the microscopic nerves that provide sensation to the disc will transmit a sensation of pain.  If the tear is a partial tear on the inside of the annulus, disc pain may be delayed.  Over time, the herniation will cause inflammation.  This results in microscopic new nerves growing into the interior of the disc.  At that time, the inside of the disc becomes sensitized and painful. 

Since disc tears and herniations are usually in the back of the disc, back pain is worse with sitting.  Sitting bends the lumbar spine.  This increases pressure in the front of the disc which is transmitted to the back of the disc.  The back of the disc is sensitive and sitting results in a sensation of pain. 

Lumbar disc herniations can cause nerve problems.  This can occur in two ways.   In one way, there is compression of the nerves traveling behind or against the herniation.  Compression of these nerves can cause sciatica or other nerve pain.  Compression can also cause loss of sensation, tingling or weakness of the leg. Another way that herniations cause nerve problems is through inflammation of the disc. This inflammation can spread to nearby nerves, inflaming them as well.  When they become inflamed the nerve becomes sensitive and painful. 

The lumbar facet joint is a paired joint; there is one on either side, just behind the disc.  Each vertebra has a left and a right facet joint that joins it to the vertebra above and below.  The lumbar facet joints allow the low back to flex, extend and twist.  Injury or pain to these joints usually is associated with stiffness and reduced motion. 

Unless there is a severe injury, lumbar facet injury or pain cannot be seen on x-ray, CAT scan or MRI.  To diagnose the problem, a doctor examines the patient and makes an educated guess as to which joints are causing the pain (there are 10 right and left facet joints in the low back).   This educated guess is made by listening to the patient, examining range of motion and pressing on the low back to see where pain lies.

Once the physician has focused on a joint or group of joints, the physician inserts a tiny needle into the low back and anesthetizes the pain sensing nerve for that joint.  This is called a block.  The block lasts for about 6 hours.  If pain is relieved, the doctor and patient can be confident that the offending joint has been diagnosed.  After that, treatment can be planned.

The sacroiliac joint is commonly referred to as the SI joint.  The sacroiliac joint is a joint that connects the spine to the pelvis, specifically the sacral part of the spine to the ilium part of the pelvis.  There are two sacroiliac joints, one on either side.  The joints allow a limited amount of movement between the sacral spine and the pelvis.  Sacroiliac joint pain can be seen in conditions that over stress the joint, such as multiple pregnancies or a previous low back fusion.  Sacroiliac joint pain can also occur after injuries, including car accidents.

Sacroiliac joint pain can appear remarkably similar to other causes of low back pain.  However, there is a particular pain pattern to some cases of sacroiliac joint pain.  Patients with sacroiliac joint pain tend to have pain centered lower than the low back, usually on the buttocks.  They also tend to have pain on standing and making transitions, like going up stairs or standing from a chair. 

Unless there is a severe injury, sacroiliac joint injury or pain cannot be seen on x-ray, CAT scan or MRI.  To diagnose the problem, a doctor examines the patient and makes an educated guess as to whether the sacroiliac joints are likely to be causing the patient’s pain. This educated guess is made by listening to the patient and performing specialized physical examination maneuvers that are sensitive for the detection of sacroiliac joint pain. Sometimes it is necessary to rule out more common causes of pain, such as facet joint pain.

Once the physician has focused on the sacroiliac joint as a source of pain, the physician inserts a tiny needle into the low back and anesthetizes the pain sensing nerves for that joint.  This is called a block.  The block lasts for about 6 hours.  If pain is relieved, the doctor and patient can be confident that the offending joint has been diagnosed.  After that, treatment can be planned.