Spine and Back Pain
At St. Luke’s Medical Center, health care providers offer comprehensive care for a wide range of neck and back problems. On this page, you can learn more about a wide range of spinal-related conditions, diseases, and symptoms, including lower back pain, sciatica, arm and leg weakness, radiating pain, and much more. To schedule an appointment with a physician, please contact us at 1-877-351-WELL (9355). You deserve to have relief from your back pain. Call St. Luke’s Medical Center today to get started.
Spinal Conditions & Diseases Treated
Click on a condition to learn more about it:
- Cervical Disc Degeneration
- Cervical Myelopathy
- Cervical Radiculopathy
- Cervical Spinal Stenosis
- Failed Spinal Surgery
- Flat Back Syndrome
- Infections of the Spine (Osteomyelitis)
- Lumbar Disc Degeneration
- Lumbar Disc Herniation
- Lumbar Instability
- Lumbar Radiculopathy
- Lumbar Spinal Stenosis
- Neck/Back Surgery
- Neoplastic (Spine Tumors)
- Neurologic Disorders (Spinal)
- Osteoarthritis of the Spine
- Post-Traumatic Conditions (Syringomyelia, Spinal)
- Post-Traumatic Pain (Spinal)
- Ruptured/Herniated Disc
- Spinal Deformity (Kyphosis, Scoliosis, Spondylolisthesis)
- Spine Fractures
- Sports-Related Injuries of the Spine
- Thoracic Disc Degeneration
- Thoracic Disc Herniation
- Thoracic Instability
- Thoracic Radiculopathy
- Thoracic Spinal Stenosis
- Traumatic (Fractures, Dislocations, Muscle Strains, Ligament Sprains)
Spinal Conditions & Diseases Treated
Cause: Cervical Disc Degeneration often causes stiffness and pain in the neck. Injuring the soft disc that cushions the space between two vertebrae (bones) in the neck often begins the process of degeneration. This may occur during a traumatic fall, a sudden impact, or forceful twisting of the neck. As the disc collapses, the bones are unable to glide and rotate in a normal fashion causing stiffness and inflammation.
Diagnosis: Specialists at St. Luke’s Medical Center begin forming a diagnosis by reviewing your medical history as well as performing a physical examination. Diagnostic tests for neck pain may involve x-rays, MRIs, or CT-scans.
Treatment: The initial treatment for cervical disc degeneration is typically non-surgical. Ice and heat, pain medications, physical therapy, and – in some cases – appliances for the neck may be used to reduce pain and stiffness. If symptoms do not respond to conservative care, then your provider may recommend removing the disc (discectomy) and replacing it with a plastic disc; a fusion procedure may be used to reduce painful motion of the affected vertebrae.
Cause: Cervical myelopathy is a progressive condition that occurs when the spinal cord in the neck region of the spine is put under abnormal pressure becomes compressed due to spinal stenosis (age-related narrowing of the spinal canal), a herniated disc, bone spurs, inflammatory diseases or other related causes. This can result in loss of nerve function, causing chronic nerve pain in the affected limb(s), progressive weakness, and loss of sensation.
Diagnosis: Your health care provider at St. Luke’s Medical Center will review your medical history and perform a physical exam. The provider may perform an imaging test such as an MRI to look for spinal compression. Also, a history of specific symptoms (some of which may seem unrelated) like weakness, pain, numbness, difficulty walking or finding your balance as well as loss of bladder control could indicate cervical myelopathy.
Treatment: Medication provides many patients with a dramatic increase in quality of life. Other patients may need surgery to correct the underlying cause of the cervical myelopathy. The best treatment depends on the underlying cause. See related links on this page for more information about treating some of the underlying causes of myelopathy, including spinal stenosis and disc herniation.
Cause: Cervical radiculopathy refers to the symptoms caused by a pinched nerve. This includes pain, numbness, tingling or loss of motor control caused by nerve irritation in the neck region of the spine. Many nerves in the arms, hands and fingers are rooted to the spinal cord in the cervical region of the spine. If these nerve roots are pinched or irritated, the symptoms may be felt in the associated extremities (as opposed to the neck, where the injury originates). Symptoms in the fingertips, for example, may be the result of nerve irritation in the neck. Conditions that cause these symptoms may include disc herniation, degenerative disc disease, or spinal stenosis.
Diagnosis: The first steps in diagnosing the cause of your cervical radiculopathy include performing a physical examination and reviewing your medical history. Afterwards, the orthopaedic physician and staff at St. Luke’s Medical Center may order imaging studies such as an MRI, x-ray or CT scan to look for the causes of nerve irritation. If an imaging study is inconclusive, an EMG (a type of nerve test) may be used to help diagnose the root cause.
Treatment: Because radiculopathy is a symptom, treatment will vary based on the cause of the nerve irritation. Oftentimes, pain medications, NSAIDs, physical therapy or other non-surgical options provide relief to patients. Other circumstances may require surgery.
Cause: Some people experience compression or pinching of the spinal cord in the neck or cervical region of the spine. Aging is one of the primary causes (but other causes may also be present). Patients with this condition could experience arm pain, heaviness in the legs, or a loss of coordination, resulting in issues with walking, writing or other fine motor skills.
Diagnosis: The skilled practitioners at St. Luke’s Medical Center will review your symptoms and possibly order an imaging test, such as an MRI or CT scan, to see if there is tightening or pinching in the spinal cord. Additional nerve tests may be ordered to aid in or confirm the diagnosis.
Treatment: Treating spinal stenosis of the cervical vertebrae is customized based on the severity of the condition. Additionally, if the stenosis has other complicating conditions such as myelopathy, this will affect the recommended treatments. The first treatment that is very effective for some patients is exercise and physical therapy, as well as NSAIDs. Modifying activities may also provide pain relief and prevent additional damage. Using a walker or sitting in a recliner instead of a straight-back chair are possible recommended modifications that your provider may encourage. Another option for some patients is epidural injections. Though the injections will not cure the condition, they may provide significant relief. In severe cases – or circumstances in which other remedies are not providing adequate relief – your provider may recommend surgery.
Cause: Ongoing or recurring pain after spinal surgery is extremely frustrating for patients who have undergone a procedure. For some, relief never comes; for others, only temporary relief may be experience before the pain returns. Often this is called failed spinal surgery, and is sometimes (inaccurately) referred to as Failed Back Surgery Syndrome, or FBSS. While it describes the circumstance, it is not an accurate term. FBSS is not truly a syndrome. Rather, FBSS is a generic phrase describing the failure of surgery to alleviate symptoms or pain.
Diagnosis: The providers at St. Luke’s Medical Center fully listen to both your current symptoms and conditions, as well as the conditions that led to your initial surgery and your experience since then. The staff will also carefully review prior medical records and the imaging tests performed both before and after your previous surgery. Additional imaging tests may be required to accurately assess your condition.
Treatment: Treating the current pain or limited mobility after a failed spinal surgery will address both new and ongoing issues. Prior surgeries can sometimes create scar tissue or other traumas, which lead to the development of further health complications. Oftentimes, failed spinal surgery can be effectively treated through spinal manipulation, physical therapy and exercise, pain management (oral or injected), and injections or a pump that provides a steady stream of pain-relieving medication.
Cause: Flat Back Syndrome occurs when a patient’s lower spine, or the lumbarregions, loses the natural curve and becomes flat or straight. Because of the flattening, patients often lean forward and cannot stand up straight. The condition and symptoms often get more pronounced and painful as the day wears on because the muscles in the neck and upper back become tired and inflamed. People with flat back syndrome also often have back and leg pain. Patients previously diagnosed with scoliosis and treated with Harrington rod surgeries often experience flat back syndrome years or even decades later.
Diagnosis: Providers at St. Luke’s Medical Center use the patient’s medical history, symptoms and an image, such as an x-ray of the spine, to diagnose flat back syndrome. Knowing previous surgeries and their dates as accurately as possible is very helpful in making this diagnosis.
Treatment: Treating flat back syndrome usually starts with recommended exercises, including aerobic, strength training and abdominal core workouts. If sufficient relief is not provided via exercise, a secondary treatment option may include manipulation, physical therapy and medication. For severe cases that do not respond to traditional treatments, surgery may be necessary.
Cause: Osteomyelitis is a spinal infection that spreads through the circulatory system. It may appear after a urological procedure, though osteomyelitis is a rare condition. It is seldom seen in young, healthy adults. Patients of advanced age, those with compromised immunities and intravenous drug users are more prone to contracting osteomyelitis. Though back pain is a common symptom, additional symptoms may include fever, chills, pain that worsens inexplicably at night, unintended weight loss and swelling and redness on the infected section of the spine.
Diagnosis: It is often difficult to diagnose osteomyelitis at its earliest stages. The experts at St. Luke’s Medical Center will use imaging such as x-rays or MRI with a contrast to ensure an accurate diagnosis. Inflammatory markers can also be used to find a spinal infection. A lab study of blood and bone cultures may give more specific information that can result in accurate treatments.
Treatment: Osteomyelitis is usually treated with multiple rounds of antibiotics, first intravenously then orally. A back brace can also provide relief while the spine heals from the infection; rest may be required as well. Sometimes surgery is needed to remove infected tissue if antibiotics are insufficient or if nerves are affected.
Cause: Lumbar (the lower region of the spine) disc degeneration occurs when the disc between two vertebrae becomes inflamed and unstable. The disc becomes worn down until it cannot absorb stress in the spine between the vertebrae. The pain associated with lumbar disc degeneration is often described as low-grade and constant instead of sharp or burning. The pain may be more intense while bending, twisting or sitting.
Diagnosis: In order to accurately diagnose lumbar disc degeneration, the patient will need to provide their medical history, as well as when the pain was first noticed, how long it has been persisting and activities done at the time the pain initially was felt. The physicians at St. Luke’s Medical Center will also do a physical exam to test for specific symptoms often linked to lumbar disc degeneration, including range of motion, strength and localized tenderness. An MRI or other imaging test may also be ordered to rule out other possibilities.
Treatment: Lumbar disc degeneration can frequently be treated with medications (which may include steroids to reduce inflammation), physical therapy and exercise. Your specialist may also recommend that you modify your activities in order to reduce stress on the injured disc. Modifications may mean correcting your posture, revising your method of lifting or bending, or even changing how you sit at a desk. Changing your sleeping position may also provide some relief. Heat and ice therapy, as well as pain management modalities, such as injections, may be utilized to alleviate symptoms. Surgery is usually reserved for cases in which significant improvement has not been achieved over a six-month period via the non-invasive methods as described previously.
Cause: Between each bone of the spine there is a disc that acts as a cushion. If the disc in between two vertebrae breaks down, the soft inner core may bulge through the tough outer portion of the disc, causing pressure on the nerve near the root. When this occurs in the lower back, most often between the L4 and L5 vertebrae, it is called a lumbar disc herniation, or herniated disc. Disc herniations in the lower back cause leg pain along with numbness, tingling or weakness in the legs or buttocks; this radiating pain is more common than pain in the back itself.
Diagnosis: The providers at St. Luke’s Medical Center listen to the symptoms described by the patient, review medical records, perform a physical examination, and conduct imaging tests such as MRIs or x-rays.
Treatment: Non-invasive treatments such as pain medicine, physical therapy, alternating ice and heat therapy and manipulation are first-line therapies for lumbar disc herniation. If symptoms do not begin to subside within approximately six weeks, surgery may be needed. Oftentimes, surgery for a herniated disc can be done arthroscopically, allowing the patient to return home the same day and resume normal activities within a few weeks.
Cause: When excessive movement occurs between two vertebrae in the lower spinal (lumbar) region it causes a condition known as lumbar instability. This movement can lead to nerve roots becoming pinched or to excessive pressure on the joints of the spine. The resulting symptoms include inflammation, chronic pain, and the feeling that the back is weak or “goes out.” The spinal area is comprised of vertebrae, discs, muscles, ligaments and nerves that must all work together in order to allow strength and flexibility in the back while still remaining stable. When one or more of these components is injured, lumbar instability can develop.
Diagnosis: Unlike many conditions, lumbar instability does not have a standard that practitioners can agree upon. This makes diagnosing lumbar instability more challenging. However, the providers at St. Luke’s Medical Center will listen closely to your symptoms, medical history, former traumas that may have lead to instability and past treatments. Imaging tests, such as x-rays with the spine in various degrees of flexion or MRIs, may provide necessary information. The physician will perform a physical exam to gauge strength and mobility through a series of movements. A back brace might be used as a diagnostic tool. If using a back brace provides relief, this could indicate lumbar instability.
Treatment: Treatment usually begins with physical therapy as well as strengthening exercises for the back and the abdominal muscles, which will help stabilize the spine. Your provider will also teach you how to move correctly in order to protect your spine during everyday activities. In extreme cases, where conservative treatments cannot relieve the instability, surgery may be necessary. If surgery is needed, the surgeon will fuse the unstable vertebrae together, thereby restoring stability.
Cause: Lumbar radiculopathy refers to pain that originates from an irritated or damaged nerve in the lumbar region and travels down the leg. Pain is typically caused by a narrowing of the space between two vertebra. Sciatica is the most common form of lumbar radiculopathy, with pain and/or numbness that runs through muscles and tissues innervated by the sciatic nerve. It starts low in the buttock and radiates down the back of the leg into the lower extremity. In fact, few people with sciatica actually experience back pain.
Diagnosis: The physicians at St. Luke’s Medical Center understand that diagnosing the root cause of the radiculopathy is critical in providing accurate treatment. This is because lumbar radiculopathy is a symptom, not a condition itself. The radiculopathy is caused by an underlying condition like a disc herniation with nerve compression, lumbar stenosis, nerve root injury or scar tissue from a previous surgery affecting a nerve root. The provider will do a physical exam, review of the patient’s medical history and records and possible conduct an image study, such as an MRI to find the cause.
Treatment: Treating lumbar radiculopathy may involve pain medications, spinal injections to reduce inflammation and physical therapy. Patients who continue to suffer ongoing symptoms after about six weeks of treatment may require surgery.
Cause: The most common cause of lumbar spinal stenosis is simply aging. Most patients with this condition are 50 or older. As people age, the facet joints that stabilize the vertebrae as they stack one on top of the other enlarge. As the boney facets grow in size, the openings they create for the nerve roots to exit get smaller, eventually pinching or trapping the nerve. This happens especially when standing or walking, when compressive forces in the spine are the greatest. Common symptoms of lumbar spinal stenosis include pain and tingling/numbness in the legs and buttocks that gets progressively worse during walking. These symptoms are usually relieved almost immediately by simply stopping, sitting and resting.
Diagnosis: The providers at St. Luke’s Medical Center diagnose lumbar spinal stenosis with advanced technology, such as MRIs or CT scans and contrast dyes. These imaging studies inform the specialist if the condition is lateral stenosis, central stenosis, or foraminal stenosis. Knowing which form of lumbar spinal stenosis a patient is experiencing allows providers to recommend appropriate treatments.
Treatment: Relieving the symptoms associated with lumbar spinal stenosis requires a combination of treatments including modifying activities, adding new exercises and physical therapies, taking oral pain medication and receiving epidural injections for inflammation relief. Oftentimes these treatments work well together and alleviate the symptoms. In rare circumstances in which adequate improvement is not achieved, surgery may be considered. However, spinal stenosis surgery is usually only recommended when a patient’s daily quality of life is substantially affected. If a patient is still functional, surgery may not be the best route.
Patients suffering from pain, tingling, numbness and other symptoms stemming from compression, pinching or other injuries to parts of the spine (such as the vertebrae, discs or nerves) may be referred for surgery. However, surgery is seldom the first avenue of treatment and is often recommended only when conservative treatments cannot treat the condition or relieve the symptoms. Surgery on the neck or back is not done as a diagnostic or exploratory tool. It is only used once a diagnosis has been made and the condition and area of the spine pinpointed. Imaging studies such as MRIs can lead to accurate diagnoses, which allow the patient and surgeon the best opportunity for a successful procedure.
Cause: A tumor on the spine, whether on the cord or the column is known as a neoplasm. Tumors can either be classified as primary or secondary. Primary tumors form initially on the spine, as opposed to secondary tumors, which metastasize (or spread) from other parts of the body where cancer has originated. Secondary tumors are more common than primary tumors on spinal tissue.
Diagnosis: Your provider at St. Luke’s Medical Center will perform a physical exam, blood tests, and diagnostic imaging as well as a review of your medical history and lifestyle. Oftentimes, a biopsy is also necessary to determine the point of origin of the spinal tumor and what kind of cancer you may have.
Treatment: Treating a spinal tumor is difficult to narrow down because so many additional factors come into play. If the neoplasm is diagnosed without cancer being previously diagnosed in a patient, a full work-up may be needed to determine the type of cancer, the prognosis, and the best way to treat the specific disease. If cancer is known to be pre-existing, then the secondary neoplasm will be carefully monitored for growth or change and may be removed. If the tumor can be safely removed, your orthopaedic physician may attempt to do so in order to reduce pain and improve neurological health.
Cause: Messages are sent and received between the brain and the rest of the body through a bundle of nerves known as the spinal cord. Each bone in the spine has a central opening, or foramen. Stacked one on top of the other, they create a canal that protects the delicate network of nerves. Neurological disorders of the spine could be the result of trauma to the bones that protect the spinal cord. This includes fractures of the bone itself, or damage to the discs that maintain the normal spacing between the bones. It may also include disorders such as rheumatoid arthritis or osteoporosis that affect the quality of bone health. There are also other disorders that may cause injury to the spinal cord without trauma to the bone, such as MS, HIV, syphilis, tumors, genetic disorders, or even a copper deficiency. Depending on the underlying cause of the spinal neurologic disorder, symptoms can include back pain or weakness, loss of sensitivity to touch, loss of reflexes, a lack of control over bladder and bowel functions or even paralysis. If you suddenly and inexplicably experience paralysis or incontinence, seek immediate medical care at the nearest emergency room.
Diagnosis: The providers at St. Luke’s Medical Center are committed to best practices in diagnosing a neurological disorder in the spine. The tools used to diagnose a neurological disorder include a physical examination, a thorough review of symptoms and medical history, and imaging tests like MRIs or CT scans.
Treatment: Once diagnosed, treating neurological spinal disorders may involve physical and/or occupational therapy. If the prognosis from a specialist confirms that restoring full function or a cure is unlikely, then new treatment goals may focus on rehabilitation in order to restore as much function as possible and help the patient adapt to the new circumstances. In this situation, additional resources such as a social worker or therapist may be enlisted. It is especially important that patients have supportive family and friends during this time.
Cause: Osteoarthritis in the spine occurs when the cartilage between two bones in the spine becomes inflamed and degenerates, causing the bones to begin to rub together, creating bone spurs and pain. Flexibility and range of motion decrease progressively. Some causes of osteoarthritis include repetitive motions, continual heavy lifting, advanced age, obesity, and being genetically predisposed. Other conditions such as diabetes, rheumatoid arthritis and gout can also contribute to osteoarthritis.
Diagnosis: If you experience persistent back pain or stiffness for two weeks or more, you may wish to consult with an orthopaedic physician. A consultation with a practitioner at St. Luke’s Medical Center includes reviewing your medical and family history, performing a physical exam, and running medical tests. A bone scan might also be ordered. Accurately diagnosing spinal osteoarthritis is important in order to properly treat the condition. While there is no cure, therapies and early intervention may alleviate symptoms and provide for the best possible quality of life.
Treatment: Being proactive with treatments such as exercise, stretching, yoga or Pilates may provide relief. Gentle exercises will help the vertebrae stay healthy and reduce stiffness. If the osteoarthritis becomes severe and causes nerve impingement, surgery may be recommended.
Cause: A cyst that develops on the spinal cord after a trauma is known as a syringomyelia. The trauma could be a bad fall, a car accident, or a traumatic illness like spinal meningitis. The cyst expands and elongates slowly, destroying the portion of the spinal cord affected by the cyst. The damage may result in stiffness, weakness or pain in the back, headaches or the loss of feeling in the extremities. Because a syringomyelia is progressive, the symptoms may not be noticed immediately after the trauma. The cyst may not cause symptoms for years.
Diagnosis: After listening to a patient’s history, the specialists at St. Luke’s Medical Center use diagnostic imaging tools, such as MRI scans, to view the spine. The imaging study helps ensure the diagnosis of syringomyelia is accurate and that the symptoms are not the result of a different condition. Accurate and early diagnoses may improve the chances of a successful treatment and desired outcome.
Treatment: Surgery is usually required in order to treat and correct syringomyelia. In post-traumatic syringomyelia surgery, the procedure focuses on addressing the initial injury as opposed to the cyst itself. If the cyst is not causing symptoms, surgery is not needed. Syringomyelia surgery is only performed if the symptoms disrupt daily activities. A more conservative approach that may help relieve pressure involves inserting a shunt to drain the cyst. Another treatment option that is surgical but less invasive involves the orthopaedic surgeon expanding the size of the hole around the cyst to reduce pressure.
Cause: Post-traumatic spinal pain can be caused by several events, including a failed fusion procedure or other failed back surgery, whiplash resulting from an accident and more. If the injury is ignored or improperly treated, then post-traumatic pain could result.
Diagnosis: Your Phoenix-area provider at St. Luke’s Medical Center will do an exam, review your medical history, listen to past traumas that may not have been treated and use diagnostic tests in order to diagnose your spinal pain.
Treatment: Treatment for post-traumatic spinal pain varies from patient to patient depending on the initial traumatic injury. To learn more about specific sources of pain or injury in the spine, please review the conditions on this page.
Cause: A disc acts like a cushion between two vertebrae in the spine. When a disc bulges or slips out of alignment, it is known as a ruptured or herniated disc. A ruptured or herniated disc can pinch a nerve, resulting in pain in extremities such as the legs or fingers. Pain may also be localized to the damaged disc space in the back.
Diagnosis: Providers at St. Luke’s Medical Center have extensive experience in diagnosing and treating ruptured and herniated discs. Diagnosing this condition involves a physical exam, reviewing a patient’s medical history and using an imaging test to visualize the spine.
Treatment: Conservative therapies provide many patients with the sought-after relief using physical therapy, pain medicine and injections. If these non-surgical treatments are unsuccessful, then your orthopaedic physician may recommend a surgical procedure known as a microdiscectomy to remove a portion of the disc; another surgery commonly used for this condition is spinal fusion, which permanently stabilizes the nearby vertebrae.
Cause: Sciatica is a combination of several common symptoms, the four most common being numbness, weakness, tingling and pain that travels from the buttocks down into the leg. Sciatica is not, however, a condition. ‘Sciatica’ is a generalized term that describes a group of symptoms that often present together as a result of an injury to the sciatic nerve.
Diagnosis: Diagnosing the cause of sciatic pain can be challenging since many underlying conditions could be causing a patient’s symptoms. Lumbar spinal stenosis, SI joint dysfunction, disc herniation and degenerative disc disease may be some of the culprits causing the sciatic pain. At St. Luke’s Medical Center, specialists diagnose the cause of sciatic pain through a physical exam and a full review of your medical history. These two steps may lead to specific diagnostic tests to accurately pinpoint the source of your pain.
Treatment: Because the conditions leading to sciatic pain vary, treatments vary widely. Treatment is focused on the underlying condition. Many conservative methods provide relief to patients; these may include exercise, pain medication, epidural steroid shots, and alternating ice and heat therapy. If relief is insufficient through non-invasive methods, a patient and his or her orthopaedic physician may agree that surgery to remove tissue pinching the nerve root may be the best option.
Cause: Spinal deformities may be present from birth or develop later due to changes in the boney spine. Three of the most common deformities of the spine include kyphosis, scoliosis, and spondylolisthesis. With kyphosis, the spine has an exaggerated forward curvature in the thoracic (upper to mid) region of the spine, resulting in pronounced rounding of the back and hunching of the shoulders. In scoliosis, the spine is abnormally curved from side to side, giving the spine an s-shaped appearance. Spondylolisthesis occurs when one vertebra slips forward over the vertebra beneath it. Because the bones do not stack on top of each other normally, normal movement is inhibited or absent altogether.
Diagnosis: Some spinal deformities are present at birth. Scoliosis, a commonly observed spinal deformity, may not be obvious until school age or early adolescence. Other deformities, such as kyphosis, may develop later in life. Sometimes, other conditions, such as osteoporosis, rheumatoid disease and connective tissue disorders, may lead to progressive spinal deformity in both adults and children. Orthopaedic providers at St. Luke’s Medical Center will do a physical evaluation, review the patient’s family and medical history, and use one or more diagnostic imaging tests to diagnose a spinal deformity.
Treatment: Treatment is tailored specifically to your particular spinal deformity; treatment also varies depending on the severity of the deformity. Patients with minor spinal deformities that do not cause significant changes in daily activities may defer treatment. Conservative treatments, such as a brace or other recommended orthopaedic device, may provide relief and correct the spinal curves for some patients. For patients with more severe deformities, surgery may be necessary.
Cause: A fracture of the spinal bones (sometimes called a broken back) is a serious condition that merits an immediate response. Most often a spine fracture happens during a sudden impact, such as an auto accident, sports injury or fall. In seniors, osteoporosis can make a patient more prone to fracturing the spine.
Diagnosis: For acute spinal fractures (sudden and unexpected such as an impact), patients should be transported to the nearest emergency room by trained professionals who can immobilize and stabilize the spine. Imaging, diagnosis, prognosis and treatment can begin quickly. For fractures caused by vertebral compression (which may develop progressively in patients with osteoporosis), choosing a competent orthopaedic doctor and obtaining care as soon as possible is very important. Your Phoenix-area provider at St. Luke’s Medical Center will perform an evaluation of your physical condition, symptoms, and history of both your medical past. A common practice in diagnosing a spinal fracture is to first rule out other injuries or conditions as possible causes. An x-ray and/or other imaging tests may be used to confirm the diagnosis.
Treatment: Treating a fracture of the spine often includes conservative treatments like rest, alternating ice and heat therapy, bracing and pain relieving medicines. Some patients may require surgical treatment such as a vertebroplasty or a kyphoplasty. Both procedures are minimally invasive and help restore loss of height in the damaged vertebra, providing stability to the fractured portion of the spine and relieving the patient of pain and discomfort associated with the injury.
Cause: Sports-related injuries in the spine are not limited to high caliber athletes. Non-athletes are just as susceptible to sports injuries. Some competitive sports like football and wrestling increase the risk for spinal injuries. A condition known as spondylolisthesis (described on this page) is a common sports-related spinal injury that happens when a patient hyperextends their back.
Diagnosis: Regardless of the origin of the injury, spinal injuries are diagnosed in much the same way as other problems of the spine. Your orthopaedic physician at St. Luke’s Medical Center will start by providing a physical exam and discussing exactly how the injury occurred. They will also complete a thorough medical history to make sure there are no outside factors that might add to or confuse the injury picture. Based on the mechanism of injury, the symptoms you are experiencing, and your medical history, imaging tests ranging from plain films to an MRI may be ordered to get an accurate diagnosis.
Treatment: Regardless of the type of injury, a spinal injury will always require rest and a break from athletic activities, and a slow and deliberate return to play. Initially, rest, cold alternating with heat, cold laser therapy and medication to control pain or back spasms may be utilized. In more severe injuries, injections or surgery may be warranted. Regardless of the type or extent of injury, rehabilitation (physical therapy) is always recommended to re-train and strengthen the muscles of the back. Physicians at St. Luke’s Medical Center will work with you and your trainers and coaches to develop the right plan for you.
Cause: The upper back or thoracic region of the spine can suffer disc degeneration. This occurs when the cushioning disc between two vertebrae becomes inflamed and unstable. As a result, the worn-down disc no longer functions properly in its duties of absorbing stress along the spine. This is a progressive and degenerative disorder; for some patients, this degeneration of the thoracic discs is very painful. However, other patients with the same condition have no pain or symptoms.
Diagnosis: Many times, diagnosing thoracic disc degeneration happens as a result of imaging tests like MRIs that are ordered to help determine the cause of other symptoms. Oftentimes, thoracic disc degeneration is not the primary reason patients seek treatment from an orthopaedic physician at St. Luke’s Medical Center.
Treatment: Thoracic disc degeneration may not always require intervening treatment. Rest, non-steroidal anti-inflammatory drugs and non-prescription pain relievers like acetaminophen are sometimes sufficient in treating the condition. However, surgery might be required to treat a thoracic disc herniation. See below.
Cause: Between each bone of the spine there is a disc that acts as a cushion. If the disc in between two vertebrae breaks down, the soft inner core may bulge through the tough outer portion of the disc, putting pressure against the nerve root as it exits the spinal canal. When the area of the spine involved is in the thorax (the bones extending from the top of the shoulders to just below the ribs) it is called a thoracic disc herniation. Though the hernia usually does not cause pain at the site of the injury, it may cause pain that radiates to different parts of the body, including the chest. For some, the pain may become more severe when coughing or sneezing.
Diagnosis: Because the symptoms commonly associated with a thoracic disc herniation are often reported as stemming from other areas of the body, diagnosing the hernia can be a challenge. At St. Luke’s Medical Center, specialists will review your medical records, perform a physical evaluation and order imaging tests to determine if a herniation is indeed the cause of your symptoms.
Treatment: If the disc herniation is not causing significant symptoms, or if the symptoms are mild, no treatment may be required. However, if the ruptured disc is applying pressure on the spine and causes pain or numbness, surgery may be required to alleviate the pressure on the spine.
Cause: Thoracic instability occurs when the joints in the middle to upper spinal region have excessive movement, a condition that can cause significant back pain. Sometimes thoracic instability can lead to bone spurs, which can cause additional pain by irritating nerve roots and the spinal cord itself. This instability may also lead to overworked and fatigued muscles around the instability, resulting in tension and knots in those muscles.
Diagnosis: Thoracic instability is not an easy diagnosis. The providers at St. Luke’s Medical Center will take a patient’s medical history and review their symptoms and past traumas. Providers may also put patients through a variety of movements to evaluate flexion and strength in the spine. Imaging studies, such as MRIs or x-rays, may be used to evaluate the bone and muscle structures. If a provider suspects thoracic instability, a brace may be recommended as a diagnostic tool. If the patient finds symptomatic relief through wearing the brace, it provides additional information to determine the underlying cause of the instability.
Treatment: Treatment for thoracic instability often includes a combination of physical therapy, strengthening exercises, patient education and pain medication such as NSAIDs. If sufficient relief is not provided through conservative methods of treatment, surgical fusion may become necessary.
Cause: When a nerve root in the chest is compressed or pinched, a rare condition called thoracic radiculopathy may develop. This nerve compression may cause pain in the chest, abdomen, or elsewhere. (Pain sometimes radiates to different parts of the body.) The symptom is often described as a band-like pain encircling the chest. Radiculopathy is substantially more common in the lumbar (lower back) and cervical (neck) regions of the spine.
Diagnosis: Your Phoenix-based orthopaedic physician at St. Luke’s Medical Center will do a full physical exam, evaluate your symptoms and medical history, and order imaging tests.
Treatment: Treatment for thoracic radiculopathy usually begins with physical therapy, injections and pain medicine. When the orthopaedic physician determines the source of the thoracic radiculopathy, he or she may determine surgery is needed to stabilize the spine or alleviate nerve pressure.
Cause: While spinal stenosis in the thoracic (upper-to-middle) region of the spine does not occur as frequently as stenosis in the neck or lower back, it is still experienced by patients every year in the greater Phoenix area. Thoracic spinal stenosis causes pain in the back and legs. It may also affect some patients’ balance or ability to control their bowel or bladder. Spinal stenosis is a condition in which the canal becomes too narrow or obstructed, causing pressure to be placed on the spinal cord.
Diagnosis: Diagnosing thoracic spinal stenosis starts with the orthopaedic specialist at St. Luke’s Medical Center performing a physical exam and reviewing your medical history and symptoms. Imaging studies are also frequently used to look for compression in the spinal cord.
Treatment: When caught early, treatments for thoracic spinal stenosis usually begin conservatively using rest, NSAIDs, epidural injections of steroids to reduce inflammation and physical therapy. The orthopaedic physician may recommend surgery to remove bone spurs or discs pressing on the nerve roots if significant relief cannot be achieved using non-invasive methodology.
Cause: If you experience a trauma to the back involving the spine or surrounding structures, carefully consider the severity to determine if immediate action is required. A spinal fracture, for example, requires immediate emergency attention. If you strain or sprain the muscles or ligaments in the back, an emergency room visit may not be necessary. However, seeking the opinion of a medical professional is always a good idea, especially if muscle soreness or spasms last longer than 48-72 hours. Low-grade sprains and strains should be treated at home using rest on a firm, flat surface, ice, and OTC anti-inflammatories such as ibuprofen or naproxen. If symptoms do not improve, or if you experience numbness and tingling or loss of bowel or bladder control, it is important that you see a physician.
Diagnosis: Diagnosing a traumatic injury will start with a physical exam, an in-depth review of exactly how the injury occurred, a review of your medical history, and imaging tests like x-rays, MRIs, or CT scans when appropriate.
Treatment: The first step for traumatic injuries is to treat with conservative methods, such as anti-inflammatory medications, medications to reduce muscle spasm, ice, rest and manual therapies such as physical therapy, cold laser, and massage. Depending on the type and severity of the trauma, injections or surgeries may be necessary. Seek further guidance from the specialists at St. Luke’s Medical Center.