What Causes Back Pain Or Neck Pain

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First the Good News!

The good news is 85% of all people who experience back pain will have a resolution of the pain within the first 3 months.

What causes your neck pain or back pain?

This is a much more difficult question to answer. The vast majority of cases are considered “nonspecific” meaning we don’t know the exact cause of the back pain. Causes can include nerve, muscle, ligament, facet joint, vertebral body or disc injuries. Unfortunately, it is often difficult to tell which of these structures are causing the problem. Physicians would like to think, with all our professional training, that we are “smart enough” to know all the answers. However, there are numerous studies which demonstrate the physical exam does not always diagnose the problem. Additionally, imaging studies are not very good at diagnosing most causes of back pain. For example, most people over 40 will have abnormalities on their MRI scans such as “bulging discs” or even “disc protrusions” (better known as disc herniations) and most of these people do not have symptoms. So, how do we know whether an abnormality that we see on an MRI scan is significant or not?

You have back pain or neck pain… so what do you do?

If your pain does not go away, we do have a number of diagnostic tests that we can perform to see what is causing your pain. We can perform a discogram study which is a provocation study where we stimulate the suspected disc to see if it reproduces the pain. Another study is an EMG (which means Electromyography) study where we perform electrodiagnostic tests to see if there is nerve damage that could be causing the pain. We also can perform pain management procedures such as selective nerve root blocks or facet blocks to see if the pain is coming from the nerve or the facet joint. We don’t have quantifiable tests to evaluate for possible muscle or ligament injuries, but fortunately these injuries usually get better on their own.

Try the easy things first

Since most causes of back pain are self-limiting, we will usually try some basic treatments first such as physical therapy, joint manipulation, and medication. If these do not work, then we will do a more thorough diagnostic workup (performing some of the tests that have already been mentioned) to see if we can determine the cause of your pain. Once we know the cause, there are pain management procedures that can help relieve your symptoms and help “cure” you. Procedures such as epidural blocks can help alleviate pain that is coming from the disc injuries and facet blocks can be used to alleviate pain originating from facet injuries.

New Back Pain / Neck Pain Technologies

There are new and exciting technologic advances that are being developed such as neuroablation that can provide long-term relief from facet mediated pain problems and intradiscal procedures such as percutaneous microdiscectomy techniques that can alleviate disc-related pain problems. If these pain management techniques are not successful, there are surgical techniques such as open microdiscectomy, decompression surgery and disc replacement surgery that often times is very successful in relieving pain.
At Sierra Regional Spine Institute, we have board certified spine specialists who are trained to perform all of these procedures, thereby making us the “one stop shop” for anyone with neck or back problems. Call for an appointment with one of our experts!

Article written for “We’ve Got Your Back Magazine”
By Robert G Berry Jr, MD

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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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