Annular tears are mainly caused by wear and tear over time. As we age, the discs lose hydration and flexibility which causes the outer layer, annulus, to tear more easily. They can also be caused by playing sports (ie football, hockey), working in strenuous occupations (ie construction), from accidents (ie falls), or high impact activities. They can also be caused by excessive body weight which causes increased pressure on the vertebrae and discs.

Annular tear symptoms vary depending on how severe the annular ligament tear is. If you have a minor annular tear, you may not have any symptoms. With larger annular tears, the disc material can leak out and put pressure on the nerves and spinal cord. Most commonly, patients report pain and muscle spasms in the neck, mid, or low back. Symptoms also worsen with activity, sitting, or positions that load pressure on the disc. Patients may even report pain with coughing, sneezing, bending forward, or lifting.

Most annular tears are treated conservatively. Small and even large annular tears are able to heal themselves without surgery. However, because the annulus has such a limited blood supply, annular tears can take a quite long time to heal on its own. The time it takes for an annular tear to heal may be from weeks to months.

Bone spurs mainly form from joint damage associated with osteoarthritis. Because there is no more cartilage, the joint turns into “bone-on-bone”. Because it is unstable, the bone grows in ways to keep the joint stable. An example of a joint that is located in the spine where this occurs is the facet joints. These are the joints in the back of your spine that allow you to move, extend, and rotate your body. When these joints become arthritic, the bone rubs along each other and, hence, form. These bone spurs may be asymptomatic and are usually a show of wear and tear over time, though sometimes they produce symptoms.

Most bone spurs do not cause any symptoms and may be picked up incidentally during a routine X-ray of the spine. When there are bone spurs in the spine, it can cause a number of different symptoms depending on where the spur is located.

Joint grinding: When there is no cartilage or lubricant between the joints of the spine, the bones rub against each other which can cause pain. This occurs because nerves that supply the facet joint transmit pain to the brain. 

Compression of the spinal nerve: The facet joint helps form the neural foramina, which is the bone tunnel where spinal nerves exit to innervate muscles, skin, and other organs. If the opening is smaller, it may compress on the spinal nerve and cause pain, which inevitably leads to radicular pain, or pain that wraps around your abdomen, your groin, or down your arm or leg. It may also lead to tingling and numbness.

Compression of spinal cord: if it grows large enough, it can enter into the spinal canal. This may decrease the area for the spinal cord which can lead to weakness, pain, or problems with your bladder or bowel as the spinal cord gets pinched by the excess bone.

Most patients with bone spurs can be treated conservatively with anti-inflammatories and other pain medications. Just because a bone spur is present does not mean it is the source of the pain. Bone spurs may be asymptomatic, while something else may be causing the pain.

Like many forms of arthritis, this occurs with age. When we get older, the cartilage between the bones wears down and starts to diminish. As it diminishes, this causes one part of the bone to touch another part of your bone, causing pain. 

In addition, degenerative changes in your facet joints can begin with degeneration of your intervertebral disc or the cushion between the bones. When this cushion or “shock absorber” starts to degenerate, the loads of your body weight shifts to your facet joints. This increased shift to your facet joints causes the cartilage in the facet joints to break down quicker leading to “bone on bone” which can cause pain.

Facet joint degeneration can be painless until something causes it to become irritated. There are several symptoms that can indicate your pain may be coming from your facet joints. Generally, there is a diffuse, dull ache in your lower back directly over the spine that can spread to your buttocks. In your neck, it can be felt in your shoulders and back of your skull.

Any movements such as bending backwards or twisting sideways towards the affected joint may cause pain. Any movements that take load and pressure off the facet joints such as sitting, leaning forward, or changing positions may ease the pain. This pain may be chronic or intermittent during flare-ups.

Dr. Wilson uses a graded treatment regimen, starting with the most conservative treatments first. If level I conservative therapies fail to help manage your pain, then Dr. Wilson will likely recommend a diagnostic facet injection next. 

This injection is to confirm the facet joint as a cause of your pain. 

During this outpatient procedure, the facet joint is injected with a local anesthetic and steroid medication with the use of X-ray fluoroscopy. Fluoroscopy is used to ensure accurate placement of the needle in the facet joint.

Your pain level will be evaluated before the injection, 30 mins after the injection, and over the next few days to weeks. Facet joint involvement is confirmed if your pain level decreases by more than 75% 

If your pain level does not change after the injection, it is unlikely that the facet joint is the cause of your back or neck pain. Dr. Wilson will then discuss and look into other causes of your pain.

Spine surgery essentially does one of two things, decompress a nerve or the spinal cord stabilizes a painful segment of the spine. Spine surgery is not able to cure the pain, as in make the pain go away. It changes the anatomy of the spine and changing the anatomy decreases the pain.Description text goes here

Failed back syndrome is not a specific diagnosis in the traditional sense. It mainly comes either after operating for the wrong diagnosis, operating on the wrong level, performing inadequate decompression, failure of the surgery itself, or not giving the body enough time to heal. 

The best way to diagnose failed back syndrome is to obtain a history and perform a thorough physical exam. In addition, a review of your imaging studies may be helpful.

Each case of failed back syndrome is treated based on the patient, because there is no one-word answer that treats all cases.

A disc herniation happens when the inner core of the disc (the nucleus pulposus) pushes through a tear or weak spot in the outer layer (the annulus fibrosus). This can lead to various symptoms and complications, depending on the location and size of the herniation, as well as the degree of pressure it places on nearby nerves or the spinal cord.

Pain: Typically, herniated discs cause localized pain in the area of the spine where the herniation occurs. For example, if the herniation is in the lower back (lumbar spine), it can cause lower back pain. If it’s in the neck (cervical spine), it can cause neck pain.

Radiating Pain: Often, the pain can radiate into other parts of the body served by the affected nerves. For example, a herniation in the lower back can lead to pain that radiates down the leg (sciatica), while one in the neck can cause pain in the arm.

Numbness and Tingling: Herniated discs can compress nerves, leading to numbness and tingling sensations in the area served by those nerves.

Muscle Weakness: In more severe cases, muscle weakness or difficulty with coordination may occur, especially if the herniated disc is compressing the spinal cord.

Changes in bowel and bladder function: In some instances, bowel or bladder function may be affected due to nerve compression. This is usually an indication for surgery.

Treatment for a disc herniation can range from conservative measures like rest, physical therapy, and pain medications to more invasive options such as epidural injections or surgery, depending on the severity of symptoms and the specific circumstances of the herniation. The choice of treatment is usually determined on a case-by-case basis although most patients can successfully be treated with conservative treatment options. When surgery is indicated, Dr. Wilson carefully removes the herniated disc with special instruments to “decompress” or relieve the compression. This usually alleviates the nerve pain.  Please note that not all of the disc that resides in between your vertebra is removed, only the small portion of disc that is compressing your nerves.

This natural degenerative aging process is called spondylosis. Spondylosis causes alterations in the facet joints, which make them become larger. The facet joints are the bones in the back of the spine that allow your spine to twist, bend, and move in different directions. When these facets become enlarged (by forming bone spurs or from arthritis), they can impinge on and compress the lumbar spinal nerves. Aging also causes the intervertebral discs to collapse and get smaller, giving the spinal nerves less room to travel. Thickening of the spinal ligaments inside the vertebral canal can also lead to compressive forces on the spinal canal and nerves. All of these anatomical structures can become pathological and compress your lumbar spinal nerves.

DescriptioIf you develop pain in your legs while walking, which is relieved when you lean forward or when you stop to rest, you may have lumbar stenosis. Lumbar stenosis can also cause a number of different symptoms. Patients may report: 

increased pain, numbness, or tingling in the legs or feet when walking 

Weakness in your legs or feet

Cramping in your legs with walking, requiring short rests to walk certain distances

Back pain

Loss of bowel or bladder functionn text goes here

Lumbar spinal stenosis can often be treated without surgery. If you start to develop progressive muscle weakness or leg pain, bowel/bladder symptoms, or if you have failed conservative treatments, then surgery may be recommended. Surgery is always the last resort.