back-spine

Back and Spine Pain

The spine program at MedStar Montgomery Medical Center is well-respected in the central Maryland and Washington region for the diagnosis, treatment, and rehabilitation of back pain and spine disorders. Our program brings together a variety of skilled specialists with experience in a wide range of spinal conditions, including some of the most complex conditions seen in orthopaedic medicine. Our multidisciplinary team includes orthopaedic spine surgeons, neurosurgeons, physiatrists (rehabilitative medicine physicians), nursing staff, physical and occupational therapists, radiologists, and an interventional pain management team—and we put all our expertise to work for you, to relieve your back pain and get you back to your active life. 

Back Pain and Spine Diagnosis and Conditions

When you arrive at a MedStar facility with back pain and spine pain, our orthopaedic teams will thoroughly review your medical history and symptoms and may perform a range of physical and laboratory examinations—all with the goal of making the most accurate diagnosis so we can give you the best treatment. The most common screenings to pinpoint the source of your back pain or associated pain include the following:

  • X-rays show the alignment of your bones and whether you have degenerative joint disease or possible tumors.
  • Magnetic resonance imaging (MRI) or computerized tomography (CT) scans can reveal herniated disks or problems with muscles, cartilage, ligaments, tendons, or blood vessels.
  • Myelography uses dye to show areas where your spinal cord may be getting pinched by the vertebrae in your back.
  • Bone scans detect bone tumors or compression fractures caused by osteoporosis.
  • Electrodiagnostic studies can confirm nerve compression caused by herniated disks or spinal stenosis.
  • Discograms determine any damage to disks.
  • Electromyography (EMG) assesses nerve or muscle damage

Understanding your back pain is the first step in relieving it. Once an accurate diagnosis is reached, your MedStar orthopaedic physician can discuss with you the specifics of your condition and determine a treatment plan that will meet your individual needs.

Learn more: Associated pain | Herniated Disk | Scoliosis and Spinal Deformities | Spinal Fractures | Spinal Stenosis | Spinal Tumors | Spondylolistheis

Associated Pain

The spine consists of bones (vertebrae) separated by soft cushions (discs). Nerves that travel from the brain to the rest of the body all pass through the spine. When pressure from spinal vertebrae is applied to nerves, pain, numbness, tingling, or weakness can occur. These sensations are not always relegated to the back or spine as back pain; rather, they can occur in many areas of the body, depending on what nerves are pressed, where they originate in the spine, and where they travel to. Pain is identified two different ways: acute and chronic. Most people with back or neck injuries suffer from acute pain, which lasts four to six weeks and can stop without medical treatment. Chronic pain lasts for more than three months and requires medical treatment. Common causes of associated back and spine pain include:

  • Degenerative disc disease (flattening of the disc)
  • Facet syndrome (inflammation of facet joints)
  • Hematoma (pocket of blood)
  • Herniated Discs (discs slip out of place or rupture and leak, pressure is applied to nearby nerves)
  • Infection
  • Muscle strain (pulled muscle) or spasm (overworked muscle)
  • Osteoarthritis (Cartilage surrounding the spinal vertebrae gradually erodes, causing bone to contact with nerve)
  • Osteoporosis(Bone density is lost, causing vertebrae to weaken, fracture, or collapse, putting pressure on spinal nerves)
  • Scoliosis (abnormal spine curvature)
  • Spinal stenosis (narrowing of spinal canal, compressing nerves)
  • Spondylolisthesis (slippage of one vertebra over another)
  • Spondylolysis (instability of vertebral column)
  • Tumor

Arm and Leg Pain

Experiencing serious pain in our arms and legs can make even the simplest tasks feel very difficult.  Arm and leg pain can arise from the common causes listed earlier, but also from the following spinal issues or injuries:

  • Brachial Plexus Injury: The brachial plexus is a group of nerves that transmit messages from the spine to the hand, shoulder, and arm. Inflammation, a tumor, or a serious shoulder injury can damage the brachial plexus and cause arm and shoulder pain, as well as numbness, weakness, or paralysis in the arm.
  • Sciatica: Sciatica occurs when a herniated disk puts pressure on or damages the sciatic nerve, which supports the muscles and controls sensation in the leg and foot. Those with sciatica often feel leg cramping, burning, weakness, numbness, and tingling as well as experience bladder control problems

Back Pain

No matter how sharp, or how long it lasts, back pain often limits our ability to feel active and productive. The top priority for anyone suffering from back pain is simply to eliminate the pain. Common causes of back pain include

  • Aging
  • Too much activity that strains the back muscles
  • Being out of shape or overweight, allowing extra weight to strain the back

Neck Pain

Common causes of neck pain include:

  • Poor posture, especially while using a computer or watching television
  • Quickly moving or twisting your head
  • Sleeping in a bad position

Treatment

Associated pain treatment generally depends on how severe it is and the underlying cause. Common non-surgical treatment options may include:

  • Prescription and over-the-counter anti-inflammatory or pain medications
  • Injections of steroids or anti-inflammatory medications
  • Physical therapy, including applying heat or ice, massage, and strengthening exercises
  • Braces

If non-surgical treatment does not relieve your pain, you may need surgery. The orthopaedic surgeons at MedStar Health have extensive training in the most advanced and innovative surgical procedures to treat back pain, including minimally invasive back surgery and motion sparing surgery.

Herniated Disc

Between your spinal bones (vertebrae) are pads of cartilage called discs. Natural use or strain can cause a disc to rupture (leak) or slip out of place (herniate). When a disc weakens, parts of it can shift and put pressure on a nerve or even the spinal cord. It may result in back pain, numbness, tingling, or weakness. A variety of factors reduces the amount of water in the discs, making them weaker and more likely to get injured. These include:

  • Natural aging process
  • Being overweight
  • Picking up heavy objects
  • Smoking

Symptoms

  • Pain in the back or neck
  • Burning sensation
  • Arm and/or leg weakness
  • Numbness
  • Tingling, like your arm or leg "fell asleep"
  • Bladder control problems

Treatment

Most people suffering from back pain from a herniated disc respond well to non-surgical treatment, which includes:

  • Resting the back
  • Taking prescription or over-the-counter anti-inflammatory or pain medications
  • Doing physical therapy, including applying heat or ice, massage, and exercises to strengthen the back

If non-surgical treatment does not relieve your pain, you may need surgery. MedStar Health orthopaedic surgeons will work with you to determine the least invasive and most effective surgical option, which include traditional open, minimally invasive, and endoscopic discectomy.

Scoliosis and Spinal Deformities

A healthy spine curves slightly, but some conditions cause the spine to curve dramatically. These conditions include:

  • Scoliosis, which causes the spine to curve in the shape of a C or an S. Scoliosis generally affects children, especially girls, but it can also develop in adults.
  • Kyphosis, which causes your spine to curve so much that your body is hunched and rounded. Postural kyphosis results from bad posture and slouching and is often less severe. Other types of kyphosis can cause deformities to individual vertebrae and more severe rounding.

Symptoms

  • Lopsided hips, shoulders, and waist
  • Protruding shoulder blades
  • Inability to stand straight
  • Bulge or bump on the back

Treatment

The team of expert orthopaedic spine surgeons at MedStar Health spends time with all patients and their families explaining conditions and treatment options thoroughly. Whenever appropriate, we also encourage families to consider alternatives to surgery, including physical therapy and bracing. Our doctors make recommendations based on the extent of the spine curvature, amount of pain, and age. A typical non-surgical treatment option for scoliosis and kyphosis is wearing a brace. This helps keep the curvature from getting worse. In some cases, non-surgical treatment options do not relieve the back pain and other symptoms of spinal deformities. In those cases, we will recommend surgery. Our expert team of orthopaedic surgeons will work with you and your family to determine the most effective and advanced surgical options.  Surgery to treat spinal deformities serves to straighten the spine and/or release the pressure on spinal nerves. This often requires uniting the vertebrae using special implants to keep the spine together.

Adolescent Scoliosis

If the spine grows unnaturally, this curvature can affect a person's posture for life. If your pediatrician has recommended you see an orthopaedist who specializes in scoliosis, contact a MedStar Health fellowship-trained orthopaedic surgeon with expertise in this area to perform this evaluation. We uses an innovative approach to predict the development of scoliosis in children who are adolescent or pre-adolescent.

SCOLISCORE™ AIS Prognostic Test

The SCOLISCORE™ AIS Prognostic test, approved by the U.S. Food and Drug Administration after a series of clinical trials, is a way to determine who is at risk for curve progression. Using a simple saliva test, the lab can determine, using a DNA footprint, whether your child's curve needs treatment. This test is exciting for doctors—because before SCOLIiSCORE, the majority of children and teenagers at risk for scoliosis used to have an X-ray every six months to determine the growth and development of their curvature. For the overwhelming majority of children, their curvature will not progress, but it was impossible to know this before SCOLISCORE. Now 60-70 percent of these children know, with certainty, they will not develop scoliosis; therefore, they wont need to be exposed to X-rays every six months.

Spinal Fractures

The spinal vertebrae are spongier and less dense than the other bones in your body in order to accommodate movements like bending and twisting.  This also means they are more vulnerable to fracture. A spinal fracture occurs when one of the bones in the spinal column breaks. This type of fracture is also known as a vertebral compression fracture because the bone that breaks (the vertebral body) often cracks and collapses, becoming compressed.

Causes

  • Certain diseases, such as osteoporosis or cancer, are known to cause loss of bone mass and changes in bone structure, making them brittle and weak.
  • Genetic factors and certain lifestyles, such as a low calcium diet, can also damage bone.
  • Over time, the vertebral bodies can become so weak that normal activities such as bending over or lifting a bag of groceries can cause a spinal fracture.

Symptoms

Although you can't feel your bones getting weaker, you might feel a spinal fracture when it occurs. Sudden and severe back pain, out of proportion to the activity at hand, is a hallmark sign of a spinal fracture. For most of us, the thought of breaking a bone during normal, non-strenuous activity is difficult to imagine. Many patients mistakenly attribute the pain of a spinal fracture to a muscle strain or bad back. Further complicating the issue is that spinal fractures often occur with only mild, or even indiscernible, back pain.

  • Symptoms commonly associated with spinal fractures that are caused by osteoporosis or cancer include:
  • Sudden onset of back pain, unrelated or out of proportion to activity
  • Back pain worsens with sitting or standing
  • Back pain often relieved by lying down

Two types of minimally invasive procedures are available provide relief from the pain of a vertebral fracture: vertebroplasty and kyphoplasty.

Spinal Stenosis

Spinal stenosis is a condition in which the bones that make up the spine tighten around the spinal cord, reducing the cushioning space between them and putting too much pressure on the spinal cord. It can be caused by:

  • The natural wear and tear of aging
  • Back problems since birth
  • Arthritis

Symptoms

  • Pain in the back, neck, legs, or bottom
  • Burning sensation or numbness in the legs
  • Weakness in the legs

Treatment

Treatment for spinal stenosis generally depends on the severity of the back pain. If non-surgical treatments, including anti-inflammatory or pain medications, steroid injections, or physical therapy, do not relieve the pain, surgery may be an option. The orthopaedic surgeons at MedStar Health are extensively trained in the most advanced and innovative surgical procedures to treat spinal stenosis.

  • Laminectomy, or decompression, removes the bones or ligaments that press on the nerves or spinal cord.
  • Spinal fusion unites vertebrae together to help stabilize the spine.

Spinal Tumors

Tumors that grow on or near the bones of the spine or around the spinal cord can disrupt the line of communication between the spinal cord and the brain. Spinal tumors can originate in the spine, or spread to the spine from another part of the body. A spinal tumor can cause different kinds of symptoms, depending on where it is located and what type of tumor it is. Generally, spinal tumor symptoms can include:

  • Back pain
  • Strange feeling, either of coldness or numbness, in the legs or hands
  • Incontinence
  • Muscle discomfort, including weakness and cramping

Treatment

Treatment for a spinal tumor aims to remove or shrink the tumor and prevent it from damaging the spinal cord. The spinal surgeons at MedStar Health will work with you and your family to determine the most effective treatment options for you. In many cases, we recommend surgery to remove the as much of the tumor as possible. Our orthopaedic surgeons have training and expertise in the most advanced microscopic and minimally invasive spinal surgeries. In other cases, we may recommend non-surgical treatment options, including:

  • Monitoring tumor growth
  • Medication, such as corticosteroids, to ease any swelling and inflammation
  • Radiation
  • Chemotherapy

Spondylolisthesis

Spondylolisthesis develops when an injury or deformity pushes one or more spinal vertebrae out of place, which then put pressure on the spinal cord and/or nearby nerves. The two common types of spondylolisthesis are:

  • Degenerative spondylolisthesis: The vertebrae lose flexibility and strength (either from natural aging or arthritis) and shrink, swell, and move out of place.
  • Spondylotic spondylolisthesis: A break in a lower back bone can cause a vertebra to move out of place.

Some people have spondylolisthesis for many years and do not realize it until the slipped vertebra starts to affect nearby nerves. Then, symptoms can include:

  • Leg pain
  • Lower back pain
  • Burning sensation or numbness in the legs
  • Weakness in the legs

Spondylolisthesis Treatment

Your orthopaedic team will first try to treat the pain and discomfort of spondylolisthesis with non-surgical treatment. Treatment options aside from surgery may include:

  • Prescription and over-the-counter anti-inflammatory or pain medications
  • Injections of steroids or anti-inflammatory medications
  • Physical therapy, including exercises to strengthen the back and abdominal muscles

If non-surgical treatment does not relieve the symptoms within six months, surgery may be necessary. The orthopaedic surgeons at MedStar Health have extensive training in advanced and innovative surgical procedures to treat spondylolisthesis, including:

  • Laminectomy, or decompression, removes the bones or ligaments that press on the nerves or spinal cord.
  • Spinal fusion unites vertebrae together to help stabilize the spine.

Make an Appointment

For more information or to schedule an appointment with a neurosurgery specialist, call 855-546-1984

Neurosurgery Specialists

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