Vertebral Column Anatomy

Your spinal column consists of  24 vertebrae, a sacrum and a tailbone.  Between each vertebrae resides an intervertebral disc. This flexible design supports your body and protects the spinal cord. The spinal nerve roots that are attached to the spinal cord is responsible for two way communication between the body and the
central nervous system.

Certain Disorders Of The Vertebral Column That Can Result In Back Pain

Herniated Nucleus Pulposus (Slipped Disc) - Commonly occurs in the lumbar spine, followed by the cervical spine and the thoracic spine.  The inner nucleus pulposes slips past the fibrous outer layer and in its new location causes severe epidural inflammation resulting in pain, numbness, tingling or weakness in your arms or legs. 

Spinal Stenosis - Narrowing of the bony spinal canal causes pressure on the spinal cord and spinal nerve roots.  Patients usually have pain, with numbness, tingling or weakness that
worsens with walking. 

Degenerative Disc Disease - the flexible disc shrinks and degenerates as a normal part of aging.   It is accelerated repetitive stress in the area and arthritis.  Limited range of motion of the spine and back or neck pain are common.  The disc itself may also be directly responsible for the pain.

Spondylolisthesis - Spondylolisthesis is the forward slippage of one vertebra on an adjacent vertebra that most commonly occurs in the lumbar area. This condition results in lower back and leg pain that worsens with activity. The pain is due to narrowing of the spinal canal where the spinal cord resides and the foramen where the spinal nerves exit.

Facet Syndrome - a form of arthritis of the joints at the back of the spinal column (facet joints).  The degenerated joint can directly cause pain as well as cause narrowing of the canal where the
spinal nerves exit.

Scoliosis/Kyphosis - conditions where the natural curves of the spine are altered. The altered anatomy may result in neck pain, upper and lower back pain and numbness and weakness of
arms and/or legs.

Treatment

Initial treatment is conservative and usually includes up to 4 weeks of bedrest followed by a gradual return to normal activities. During this time patients receive a course of medications such as anti-inflammatory agents, muscle relaxants and physical therapy.  For many this is sufficient to treat their symptoms, however for those in whom conservative therapy has not worked, spinal injection therapy is the most logical and appropriate next step:

• Trigger Point Injection
  
• Interlaminar or transforaminal epidural steroids deposited into the narrowed and inflamed areas "transforaminally" (across the narrowing) act to suppress nerve inflammation and firing in many patients thereby lessening their pain and allows them to tolerate physical therapy, ultimately resulting in
  improvements in their functionality.
  
• Intraarticular Facet Injection is indicated for those patients with arthritis and degeneration of their facet joints.  The inflamed joint is the major contributor to the patient pain and depositing potent anti-inflammatory medications into the joint serves to cool the area and provide pain relief.
  
• Radiofrequency Nerve Lesioning is another therapy that can offer six to eight months or longer duration of relief in spondylolisthesis and lumbar facet syndrome. This technique literally interrupts the firing of the nerve that supply the facet joints causing dramatic pain relief in the properly selected patient. 
  
• Discogram or Discography -provocative testing of the intervertebral disc that may help discover the intervertebral disc as a significant pain generator.  Also allows for morphologic evaluation of a disc's structure when combined with CT scan.  This test has no therapeutic value but does help the surgeon in planning for the type of operation that should be performed.

In summary, spinal injection techniques are safe and effective nonsurgical options that can provide prompt pain relief and return to productivity while avoiding the risks of surgery.