Upper,Middle and Lower Back Pain

Laser Spine Institute provides gentle, effective and

safe procedures to alleviate back pain
Description of Back Pain

Back pain affects 90% of Americans at some time in their lives and is the leading
cause of visits to the doctor. Low back pain is the most prevalent cause of disability in
people under age 45, $100 billion is spent annually in the management of low back
pain, with more than half of that spent on surgical treatment.

The lower back is a well designed construction of bone, muscle and ligament. Your
backbone (vertebral column) is actually a stack of more than 30 small bones called
vertebrae. Together, they create a bony canal that surrounds and protects your spinal
cord. Small nerves enter and exit the spinal canal through spaces in your vertebrae
called the foramen.

These vertebrae are held together by muscles, tendons and ligaments. Between the
vertebrae are discs, which act as "shock absorbers" and prevent the vertebrae from
hitting one another when you walk, run or jump. They also allow your spine to twist,
bend and extend. Since the lower back is the hinge between the upper and lower body
and carries most of your weight, it is especially vulnerable to injury and is the site of
most back pain. When low back pain strikes, we become acutely aware of just how
much we rely on a flexible, strong back.
The Casues of Back Pain

The most common causes of low back pain are:

Pinched Nerves - Pressure or impingement on nerve roots in the spinal canal can be
caused by:

Herniated Disc - A herniated disc, (also called bulging disc or slipped disc) is a
rupture often brought on by repeated vibration or motion (as during machine use or
sport activity, or when lifting improperly), or by a sudden heavy strain or increased
pressure to the lower back. Back pain and leg pain can result when the herniated disc
pinches one of the nerves. A herniated disc in the lumbar region can affect the nerves,
which runs from your spinal cord to your leg. Compression or inflammation of this
nerve causes sciatica - a sharp, shooting pain in your lower back, buttocks and leg. \

Degenerative Disc Disease - As we age, the water and protein content of the body's
cartilage changes. This change results in weaker, more fragile and thin cartilage.
Because both the discs and the joints that stack the vertebrae (facet joints) are partly
composed of cartilage, these areas are subject to wear and tear over time
(degenerative changes). The gradual deterioration of the disc between the vertebrae is
referred to as Degenerative Disc Disease.

Bone Spurs - also termed osteophytes (os-tee-o-fights) . Osteophytes may be found in

areas affected by arthritis such as the disc or joint spaces where cartilage has
deteriorated. The body's production of osteophytes is a futile attempt to stop the
motion of the arthritic joint and deal with the degenerative process. It never
completely works. The evidence of bony deposits can be found on an x-ray or MRI. A
bone spur may cause nerve impingement at the neuroforamen (nu-row for-a-men).
The neuroforamen are passageways through which the nerve roots exit the spinal
canal. Sensory symptoms include pain, numbness, burning and pins and needles in the
extremities below the affected spinal nerve root. Motor symptoms include muscle
spasm, cramping, weakness, or loss of muscular control in a part of the body.

Spinal Stenosis is the narrowing of the spinal canal by a piece of bone, ligamentus
flavus thickening or disc material. This can cause weakness in your extremities and
typically develops with age.

Osteoporosis, which means "porous bones," causes bones to become weak and brittle
- so brittle that even mild stresses like bending over, lifting a vacuum cleaner or
coughing can cause a fracture. In most cases, bones weaken when you have low levels
of calcium, phosphorus and other minerals in your bones. The pain from an
osteoporotic spinal fracture can last for several weeks as the bone heals, and then
typically turns into more of a chronic, achy pain concentrated in the area of the back
where the fracture occurred. This aching may be similar to the sensation reported by
those with osteoarthritis. A bone density test, which measures bone mass, preferably
taken of both a long bone and a vertebral body, is used to diagnose osteoporosis.
Osteoarthritis or Facet Disease is a degenerative joint condition that causes slow
deterioration of cartilage. Osteoarthritis of the spine results in narrowed cartilage
disks between the bones that make up your backbone. Without this cartilage
cushioning, the joints (facets) between adjacent bones compress and become irregular,
causing inflammation, pain, swelling and stiffness. Your body tries to compensate for
this form of arthritis, but the repairs are often inadequate, resulting in little growths of
additional bone called bone spurs.

Cervical spondylosis is a common condition that results from degeneration

(osteoarthritis) of the bones of the neck (cervical vertebrae). This can lead to
increasing pain in the neck and arm, weakness, and changes in sensation.

Spinal deformities such as scoliosis, which is an abnormal curvature of the spine.

Most cases are mild, but severe cases may require treatment with braces or surgery.

Small injury to a muscle (strain) or a ligament (sprain) from improper lifting, excess
body weight and poor posture. Strains and sprains can also develop from carrying
heavy handbags or briefcases or sleeping in an awkward position.
Compression fractures, more common among postmenopausal women with
osteoporosis, or after long-term corticosteroid use. In a person with osteoporosis, even
a small amount of force put on the spine, as from a sneeze, may cause a compression
fracture.

Fractures of the vertebrae caused by significant force (as from an auto or bicycle
accident, a direct blow to the spine, or compressing the spine by falling onto the
buttocks or head).

Most pain in the low back (lumbar region) is triggered by some combination of
overuse, muscle strain, or injury to the muscles and ligaments that support the spine.
Many experts believe that over time, chronic muscle strain can lead to an overall
imbalance in the spinal structure. This leads to a constant tension on the muscles,
ligaments, bones, and discs, making the back more prone to injury or re-injury.

The causes of low back pain tend to be interrelated. For example, after straining
muscles, you are likely to use your back differently than usual. As other parts of your
back work harder or move in unaccustomed ways to make up for the injured muscles,
they also become more prone to injury.

The Symptoms of Back Pain

Back pain can be:

 Acute, lasting less than 3 months. Most people gain relief after 4 to 6 weeks of
home treatment.
 Recurrent, a repeat episode of acute symptoms. Most people have at least one
episode of recurrent low back pain.
 Chronic, lasting longer than 3 months.

The term "low back pain" is used to describe a spectrum of symptoms. Depending on
the cause, low back pain may be dull, burning, or sharp, covering a broad area or
confined to a single point. It can come on gradually or suddenly and may or may not
be accompanied by muscle spasms or stiffness.

Leg symptoms can be caused by lower spine problems that place pressure on a nerve
to the leg; they can occur on their own or along with low back pain. Leg symptoms
can include pain, numbness, or tingling, usually below the knee.
Weakness in both legs, along with loss of bladder and/or bowel control, are symptoms
of cauda equine syndrome, which requires immediate medical attention.

Numbness and tingling are felt when nerve impulses aren't traveling properly from the
skin to the brain. A patient with back problems may also experience numbness in
other parts of the body, especially the legs and feet. This always indicates some kind
of nerve damage in the peripheral nervous system or the central nervous system (i.e.
the spine or the brain) and requires prompt and serious attention.

Common causes of numbness include the following:

 Radiculopathy - A pinched nerve due to a herniated disc.

 Stenosis - A narrowing of the spinal canal, which can compress sensory nerve
fibers causing loss of sensation.
 Multiple Sclerosis
 Stroke, and
 Diabetes

Treatment of Back Pain

Your health professional can assess acute low back pain by talking to you about your
medical history and your work and physical activities, and doing a simple physical
examination. For 95% of people with low back pain, this type of assessment is all that
is necessary for a health professional to make treatment recommendations.

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Laser Spine Institute

Occasionally imaging tests are used to gather more information about back problems.
Imaging tests for lower back problems include magnetic resonance imaging scan
(MRI), computed tomography scan (CT), bone scan and X-Ray. If your examination
suggests a serious underlying health condition, your symptoms have lasted longer
than 4 to 6 weeks, or you have persistent severe back pain, leg pain, or leg numbness,
an imaging test might shed more light on your condition and its cause.

You have an increased risk for developing low back pain if you are middle-aged and
male, have a personal or family history of back problems, or have carried a pregnancy
to term. Lifestyle factors that increase your risk include smoking; being overweight;
being sedentary; regularly straining, vibrating, or twisting your back; sitting for long
periods; and taking medication that weakens the bones, such as corticosteroids, for a
long time.
Recommended treatment for disc associated conditions and nerve impingement is
generally open back surgery, with high risks, hospital stays and lengthy recuperation
time.
Laser Spine Institute (LSI) has minimally invasive, outpatient surgery, laser-assisted
procedures that can correct the causes of many back pain issues and leave the patient
free of painful symptoms, performed by our Chief Surgeon, Dr. James St. Louis, and
his staff.

There are 4 procedures at LSI, targeting specific back pain conditions:

1. PERCUTANEOUS DISCECTOMY used to treat the following conditions:

 Herniated Disc
 Bulging Disc
 Degenerative Disc Disease
 Sciatica
 Nerve Impingement

This procedure is performed without the need for general anesthesia in an outpatient
surgical setting. After a local anesthetic is administered, a small incision is made and
a round Depuy tube is put into the incision. This tube allows us to perform
percutaneous discectomies with minimal damage to the surrounding muscles. The
muscles are pushed out of the way and are not torn or cut. Through this working tube
we insert the laser, camera, suction, irrigation and other surgical instruments. Once
everything is in place, the surgeon utilizes a laser to vaporize the disc material,
therefore diminishing the pressure on the spinal cord and/or the spinal nerve. Some
patients feel immediate relief of their back pain during the percutaneous discectomy
as the pressure is minimized.

When the procedure is complete, the tube is slowly removed, allowing the muscles to
move back into place. A percutaneous discectomy is a relatively short procedure, only
taking ½ hour to 45 minutes to perform with a quick recovery ensured afterwards.
After 1 - 2 hours of monitoring, the patient (with a companion) is free to go. We
generally encourage patients to take a long walk the afternoon or evening of their
percutaneous discectomy procedure. The patient then returns the following day for a
post-operative visit to get clearance from the doctor to return home.

2. FORAMINOTOMY - used to treat the following conditions:

  Foraminal Stenosis
 Sciatica
 Pinched Nerve
 car Tissue Formation
 Bone Spurs
 Arthritis of the Spine

At LSI we use an arthroscopic approach to open up the foramen without the need for
general anesthesia in an outpatient surgical setting. After a local anesthetic is
administered, a small incision is made and a round Depuy tube is put into the incision.
A series of tubes of increasing Read real testimonials from real patients size are
placed over this first tube, one at a time, to slowly create a small opening to the spine.
That allows us to perform foraminotomies with minimal damage to the surrounding
muscles. The muscles are pushed out of the way and are not torn or cut. The last tube
is about 18 millimeters in diameter (about as big as a small marker) and through this
working tube we insert the laser, camera, suction, irrigation and other surgical
instruments. Once everything is in place, the surgeon can begin removing the bone
and tissue that is compressing the nerve without distress to the patient. Some patients
feel immediate relief from back pain during the procedure as the nerve is released.

When the procedure is complete, the tube is slowly removed, allowing the muscles to
move back into place. Occasionally, a stitch or two is needed for the incision. After 1
- 2 hours of monitoring, the patient (with a companion) is free to go.

We generally encourage patients to take a long walk the afternoon or evening of their
foraminotomy procedure. The patient then returns the following day for a post-
operative visit to get clearance from the doctor to return home.

3. LAMINOTOMY - used to treat the following conditions that cause back pain:

 Spinal Stenosis
 Scar Tissue Formation
 Bone Spurs
 Arthritis of the Spine
 Herniated Disc
 Bulging Disc
 Nerve Impingement

A laminectomy is a procedure used in traditional open back surgeries that involves

removing the lamina to increase the amount of space available for the neural tissue.
The term laminectomy is derived from the Latin words lamina (thin plate, sheet, or
layer), and -ectomy (removal).

A laminotomy is also a procedure used to remove the ligamentum flavum. The

ligamentum flavum is a ligament in the spinal canal that can thicken to the point
where it is actually compressing on the spinal cord, attributing to spinal stenosis.
Through a laminotomy, the ligament can be removed, therefore opening up the spinal
canal and releasing the nerve(s).
At the Laser Spine Institute(LSI) in Tampa, Florida, we perform laminotomies
removing only the scar tissue, bony obstructions, ligamentum flavum and/or
herniated/bulging discs that are causing the nerve impingement, leaving most of the
lamina intact. This is done through an arthroscopic approach to laninotomies to open
up the spinal canal without the need for general anesthesia in an outpatient surgical
setting. Click here to view an animation of this procedure performed at LSI After a
local anesthetic is administered, a small incision is made and a round Depuy tube is
put into the incision. A series of tubes of increasing size are placed over this first tube,
one at a time, to slowly create a small opening to the spine. That allows us to perform
laminotomies with minimal damage to the surrounding muscles. The muscles are
pushed out of the way and are not torn or cut. The last tube is about 18 millimeters in
diameter (about as big as a small marker) and through this working tube we insert the
laser, camera, suction, irrigation and other surgical instruments. Once everything is in
place, the surgeon can begin the procedure. Some patients feel immediate relief
during the laminotomy as the nerve(s) are released.

When the procedure is complete, the tube is slowly removed, allowing the muscles to
move back into place. Occasionally, a stitch or two is needed for the incision.

After 1 - 2 hours of monitoring, the patient (with a companion) is free to go. We

generally encourage patients to take a long walk the afternoon or evening of their
laminotomy procedure. The patient then returns the following day for a post-operative
visit to get clearance from the doctor to return home.
The patient will generally experience relief of back pain during these procedures and
after a short post-operative period most patients walk out of the Laser Spine Institute
free of the pain caused by back conditions.

4. FACET THERMAL ABLATION - used to treat the following conditions:

 Facet Disease
 Facet Joint Syndrome
 Facet Arthritis
 Facet Hypertrophy
 Degenerative Facet Joints

In general, all of the above terms mean pretty much the same thing - arthritis or
degeneration of the facet joint. The facet joint is like any other joint in your body - it
has cartilage that lines the joint, (this allows the bone to glide smoothly over one
another) and a capsule surrounding the joint.

The function of the facet joint is to provide support, stability, and mobility to the
vertebrae (spine). There are two facet joints between each vertebrae. They are located
on each side of the vertebrae. Facet disease can occur at any level of the spine, but are
most common in the lumbar region.

5. At Laser Spine Institute (LSI) in Tampa, Florida, we perform Facet Thermal

Ablations without the need for general anesthesia in an outpatient surgical setting.
After a local anesthetic is administered, a small incision is made and a round Depuy
tube is put into the incision. This tube allows us to perform Facet Thermal Ablations
with minimal damage to the surrounding muscles. The muscles are pushed out of the
way and are not torn or cut.

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This procedure is performed through a small tube - 5mm (about the size of a straw.)
The laser, fiber optics and irrigation are all placed in the tube and surgery is
performed on the facet joint. The surgeon will use the laser to debride (clean the joint)
and deaden the nerve that innervates the joint. This procedure takes about 40 minutes
and will resolve the pain associated with the facet joint. After 1 -2 hours of
monitoring, the patient (with a companion) is free to go.