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Back - Thoracic and Lumbar Spine

Five percent of the United States population experiences back pain each year (1). Over your lifetime, you have a 60-80% chance of experiencing at least one episode of back pain. Most episodes are not severe and resolve without medical care. Some, however, are severe and disabling. But even the more severe cases which cause patients to seek medical or chiropractic care are usually transient. It has been estimated that 90% of patients who seek professional treatment for back pain will be pain free within 1-3 months. In this group of patients, after ruling out an underlying systemic cause such as a malignancy or infection, appropriate care consists of providing conservative treatment.

The gold standard of conservative treatment consists of management with NSAIDS (Non Steroidal Anti Inflammatory Drugs) and exercise therapy (chiropractic or physical therapy). If these modalities fail after a 3-6 week trial, referral to a specialist (neurosurgeon or orthopedic surgeon) is appropriate. Often, we as specialists will continue conservative measures. When this fails, surgery can be extremely effective. Surgery is only performed when conservative measures fail and diagnostic tests demonstrate abnormalities.

In our practice, the most frequently encountered causes of nerve impingement in the lumbar spine are herniated disk, spinal stenosis and painful mechanical instability with degenerated disk.

Epidural Injection

Back and leg pain can come from many different sources. Among these sources are herniated disks or degenerated disks that can irritate nerve roots causing them to become inflamed and producing pain. While in some cases surgery is required for relief of this pain, sometimes an epidural injection is all that is needed.

Epidural injections are performed to reduce inflammation around the nerve roots allowing nature to heal the problem and make the pain go away. Some patients experience relief that is short lived (days to weeks) while in others relief can be longer term (months to years) or permanent. Some patients have no relief at all. Sometimes one injection is all that is needed while in many cases, multiple injections over time are required to attempt to bring relief of pain.

Your doctor will provide details of the procedure that is right for you as well as the benefits and risks. He will also provide instructions for your care before and after the procedure.

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