Low Back Pain

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Low back Pain: Q & A Basics

By JayDee Vykoukal, DPT

Who is affected by Low back pain?

Low back pain (LBP) is a health issue that all of us will deal with in some form over our lifetime. It can happen anytime in a person’s lifespan, but is particularly relevant in the 40 to 80 year age range (1) It is estimated by Medline that 8 out of 10 people will experience LBP at least once in their lifespan (1). It is the leading cause of job-related disability and the biggest contributor to missed work days.

What causes low back pain?

LBP is a very ambiguous condition that is typically caused by more than one variable. The spine and its associated muscles create the “core” of our body, giving us the strength and flexibility to do all of our daily activities and hobbies. Any kind of imbalance related to the spine itself or surrounding tissues (muscle, ligaments, tendons, discs) can lead to pain. Factors that can cause or exacerbate low back pain include stress level, diet, repetitive movements, poor posture, sedentary lifestyle, poor lifting habits, genetics, high impact work/hobbies, and age. With these factors in mind, the most common physiological/underlying causes of LBP include disc injury, narrowing of the spinal canal, compression of neural tissue, fracture, arthritis, and facet joint irritation.
No matter what the cause LBP is typically associated with painful muscle tension, trouble completing typical daily activities and an increase in pain when staying in one position for a prolonged amount of time. It is always important to keep in mind that any underlying organ issues can also cause radiating pain to the low back. This is why if pain persists or feels unbearable it is always good to get screened by a primary care physician or doctor of physical therapy.

How can low back pain affect me?

Acute LBP can cause temporary stress in a person’s life but can typically resolve on its own in 2-4 weeks. If symptoms do not improve by then, seeking medical attention to address any underlying issues is important. A physician and/or physical therapist can help you determine what is causing the pain with the goal of getting you back to your normal life activities.
LBP can have major psychological consequences, especially as the problem becomes chronic in nature. Sleep typically starts becoming disturbed. People begin to avoid certain situations or activities due to fear of pain: affecting their hobbies, everyday activities, and social life. People may begin avoiding physical activity altogether. The body’s physiological response to low back pain changes as time goes on and the body tries to adjust and cope. As pain becomes a long term, chronic issue it wears not only on physical but mental well-being as well. Thus, it’s not surprising that any type of chronic pain is a common cause of depression. Avoiding physical activity is very detrimental to recovery from LBP and should only be done acutely when pain levels are typically high.

What can I do to prevent low back pain?

Balanced and healthy lifestyle choices have a large impact on how we will deal with pain and injury. A survey from 2006 indicates that LBP is more associated with people who characterize their health status and lifestyle as “poor to fair” (2). Factors found to increase risk for LBP are a history of smoking, repetitive lifting/bending with daily activities or work, age, and any unhealthy lifestyle choices related to nutrition and exercise. Exercise is an important component of life, keeping us fit and balanced. Exercise regulates our body’s metabolism and releases endorphins that keep up “happy.” Leading a healthy lifestyle is associated with fewer injuries and quicker recovery when they do happen.
Whether an injury has occurred or not, the most crucial component for a happy spine is always a strong core. Without good spine habits and body awareness, an injury can happen from an activity as simple and bending over to tie a shoe to more stressful heavy lifting. Without a strong core, our bodies don’t work efficiently and cause unneeded stress on the spine. Unfortunately, even the majority of people who do participate in some type of regular ab exercise do not demonstrate good control. Good control is illustrated when the belly can stay flat and the spine neutral no matter what type of exercise is being completed. This is where the eyes of a therapist can help find faulty movement patterns and re-train muscles to work in a way that will prevent further injury and promote healing of injured tissues.

What are my treatment options?

Typically the first step in getting the correct treatment is seeing your doctor. They can provide a variety of options that are available, including medications, injections, imaging such as x-ray or MRI, chiropractic, acupuncture, physical therapy, and possibly surgery. All options can be helpful and typically the “less invasive” ones will be tried first to see if there is any benefit.
Building clinical research indicates that it is most beneficial to remain active after an injury (3). Staying active can bring benefits of increased flexibility and blood flow in an area that is trying to heal. Being active does not mean that someone should push themselves until they have severe pain. The goal should be to find activities that are relatively pain free. This leaves many people nervous, as some aren’t always sure what even caused the initial injury. This is where a physical therapist can be very helpful. They are specialized in movement analysis and can do a full evaluation to help determine what mechanisms are contributing and how to adjust habits accordingly. More often than not, LBP can be alleviated with simple education in body awareness. A surprising number of people are not aware of slight differences in their movement patterns that are causing their pain. This is where making simple habitual changes can make a BIG difference in daily function. As physical therapy treatment begins, the key is a balance of strength and flexibility in a safe and pain free range. “NO pain no gain” is not a phrase that should ever be followed when recovering from a back injury, as it can cause muscle guarding and additional injury. Several research articles have shown that core muscles do not activate as quickly when there is chronic pain (4). This means we have to “retrain” our core muscles to work correctly to make the spine less vulnerable when initiating any type of activity. No matter what form of treatment is used to treat LBP, if the underlying poor movement patterns aren’t addressed there is a much higher change that re-injury will occur; this makes seeing a PT crucial for the treatment process !!

What kind of outcome can I except?

Outcomes depend on many variables related to the underlying spine injury, motivation level and prior strength, flexibility and health status. In general, everyone eventually recovers from their LBP. With the help of the right professionals, this pain can potentially be treated quicker and get you back to your normal daily life!

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Artificial Disc Replacement

At Sierra Regional Spine Institute, we believe that the future is restoration of anatomy and function through motion. The artificial disc replacement is the answer to that problem. Sierra Regional Spine Institute continues to be a leader in Nevada when disc replacement surgery is needed.
It is a surgical procedure in which degenerated intervertebral discs in the spinal column are replaced with artificial disc implants in the lumbar or cervical spine.

The procedure is used to treat chronic, severe low back pain and cervical pain resulting from degenerative disc disease.

Artificial disc replacement has been developed as an alternative to spinal fusion, with the goal of pain reduction or elimination, while still allowing motion throughout the spine. Another possible benefit is the prevention of premature breakdown in adjacent levels of the spine, a potential risk in fusion surgeries.

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Revision Spine Surgery

Revision spine surgery is a surgery procedure performed in certain patients to correct the problems of earlier spine surgery. Revision surgery is only when working with patients who experience chronic pain or any worsening symptoms even after the initial surgery.
Other factors that can indicate the need for revision spine surgery include:

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At Sierra Regional Spine Institute we use Decompression in a few ways to treat and make the process of recovery smoother for people with fractures: Microdiscectomy, Microendoscopic Laminectomy, Minimally Invasive Cervical Foraminotomy (MICF), Vertebroplasty and Kyphoplasty.


Microdiscectomy, also called microlumbar discectomy (MLD), is a very common MIS decompression procedure performed in patients with a symptomatic lumbar herniated disc. The operation consists of removing the portion of the intervertebral disc that is herniated and compressing a spinal nerve root.

Minimally Invasive Cervical Foraminotomy

This is a MIS cervical foraminotomy decompression procedure that enlarges the space in which a spinal nerve root exits the cervical spinal canal (intervertebral foramen). This narrowing can be caused by a herniated disc, bone spurs, thickened ligaments or joints, which may result in pinched nerves.


Vertebroplasty for the treatment of vertebral compression fractures (VCFs) was introduced in the United States in the early 1990s. The procedure is usually done on an outpatient basis, although some patients stay in the hospital overnight. The procedure may be performed with a local anesthetic and intravenous sedation or general anesthesia.

Using x-ray guidance, a small needle containing specially formulated acrylic bone cement is injected into the collapsed vertebra. The cement hardens within minutes, strengthening and stabilizing the fractured vertebra. Most experts believe that pain relief is achieved through mechanical support and stability provided by the bone cement.
Kyphoplasty involves an added procedure performed before the cement is injected into the vertebra. First, two small incisions are made and a probe is placed into the vertebral space where the fracture is located.

The bone is drilled and one balloon (called a bone tamp) is inserted on each side. The two balloons are then inflated with contrast medium (which are visualized using image guidance x-rays) until they expand to the desired height and removed. The spaces created by the balloons are then filled with the cement. Kyphoplasty has the added benefit of restoring height to the spine.

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Cervical Fusion

Cervical Fusion is an operation that creates a solid union between two or more vertebrae in the upper spine (neck) area. This procedure may assist in strengthening and stabilizing the spine and may thereby help to alleviate severe and chronic back pain.
The best clinical results are generally achieved in single-level fusion, although fusion at two levels may be performed in properly selected patients.

Bone grafts may be taken from the hip or from another bone in the same patient (autograft) or from a bone bank (allograft). Bone graft extenders and bone morphogenetic proteins (hormones that cause bone to grow inside the body) can also be used to reduce or eliminate the need for bone grafts.

Fusion sometimes involves the use of supplemental hardware (instrumentation) such as plates, screws, and cages. This fusing of the bone graft with the bones of the spine will provide a permanent union between those bones. Once that occurs, the hardware is no longer needed, but most patients prefer to leave the hardware in place rather than go through another surgery to remove it.

Fusion can sometimes be performed via smaller incisions through MIS techniques. The use of advanced fluoroscopy and endoscopy has improved the accuracy of incisions and hardware placement, minimizing tissue trauma while enabling an MIS approach.

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Lumbar Fusion

This is a MIS technique that is performed in patients with refractory mechanical low back and radicular pain associated with spondylolisthesis, degenerative disc disease, and recurrent disc herniation. The procedure is performed from the back (posterior) with the patient on his or her stomach.

Using x-ray guidance, two 2.5-cm incisions are made on either side of the lower back. The muscles are gradually dilated and tubular retractors inserted to allow access to the affected area of the lumbar spine.

The lamina is removed to allow visualization of the nerve roots. The disc material is removed from the spine and replaced with a bone graft and structural support from a cage made of bone, titanium, carbon-fiber, or a polymer, followed by rod and screw placement.

The tubular retractors are removed, allowing the dilated muscles to come back together, and the incisions are closed. This procedure typically takes about 3 to 3 1/2 hours to perform.

Outcome & Benefits

Pioneers of both surgical and non-surgical techniques


Minimally Invasive Spine Surgery

MIS was first performed in the 80s but has recently seen rapid advances. Technological advances have enabled surgeons to expand patient selection and treat an array of spinal disorders, such as degenerative disc disease, herniated disc, fractures, tumors, infections, instability, and deformity.
This can result in quicker recovery, decreased operative blood loss, and speedier patient return to normal function. In some MIS approaches, also called, “keyhole surgeries,” surgeons use a tiny endoscope with a camera on the end, which is inserted through a small incision in the skin. The camera provides surgeons with an inside view, enabling surgical access to the affected area of the spine.

Benefits of Minimally Invasive Surgery

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