The following information is intended as background only and is not intended as a substitute for professional health care.
Selected Treatment Options for Lower Back Pain
Spinal Manipulation and Mobilization

Selective Nerve Root Injection
Stabilization Exercise and Physical Rehabilitation
Microdisctectomy, Laminectomy and Fusion Surgeries


"There are many possible causes of lower back pain. Below are a few descriptions of treatment options for several conditions causing lower back pain. This information is presented as background and is not intended as a substitute for professional consultation. The reader is advised to use caution in drawing conclusions and to use critical thinking in evaluating any health condition. Lower Back pain is a huge problem in our society. Often those who suffer from chronic forms of the problem are left with little hope. However, I believe there is always hope. Avoiding things which can worsen the problem while doing more positive things can make a huge difference in the long run!

Unfortunately, there is a great deal of mis-information spread by the popular media regarding back pain.  Once thought to be an isolated condition which normally gets better with time, we now know that in most cases lower back pain can be a recurrent and progressive problem.  This means that we must shift many of societies attitudes about lower back pains causes, effects and treatments.  We must learn to exercise, stretch and care for injured tissues even After the pain has gone away"
Daniel Buch, BS, DC
, QME

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Spinal Manipulation and Mobilization

Some Conditions which may benefit:
Contained Intervertebral Disc Bulge / Annular Sprain
Mechanical Dysfunction of the soft tissue and facet joints
Sprain and Strain Injuries
Uncomplicated Lower Back Pain
Facet Joint "Subluxation"
May effect somatic - visceral irritation syndromes

Special Tests and Examinations Prior to Treatment May Include:
X-rays of the area of complaint may be required
MRI is occasionally required

Performed By: The vast majority of manipulative therapy is performed by Doctors of Chiropractic. Osteopathic Doctors may perform as well. Mobilization is performed by Chiropractors, Osteopathic Doctors and Physical Therapists

What is Done:
Manipulation is performed in office setting. The affected joint is gently moved through its full range of motion. It is then quickly moved at its end of range to "open" the joint space, realigning the joint surface, stimulating motion sensitive nerves and improving joint motion. Heat, electrical stimulation, ice, exercise and other modalities may be part of the treatment plan.   

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Selective Nerve Root Injection                                              
Some Conditions which may benefit:
Nerve Root Compression or irritation from Herniated Intervertebral Disc / Scar Tissue / Degeneration
Central canal stenosis due to scar tissue or trauma

Special Tests and Examinations Prior to Treatment May Include:
MRI is generally obtained prior to treatment to determine possibility of nerve root or cord compression
Regular blood labs may be required prior to treatment

Performed By:
Performed by Medical doctor, with training in anesthesia, neurology or orthopedics

What is Done:
Performed with local anesthesia, injection is directed under constant videoflouroscopy (video x-ray). Prior to injection, dye is injected into the space surrounding the nerve root. The movement of the dye is followed on the video monitor. Areas of constriction around the nerve are noted. The nerve is then electrically stimulated to see where the pain is felt. It the area of pain is the same as the patients primary complaint of AND the area is shown to be constricted, anti-inflammatory medications and anesthetics are injected at the site of constriction. After treatment stabilization exercises and stretching may be part of treatment plan.

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Functional Stabilization Exercise and Physical Rehabilitation                  

Some Conditions which may benefit:
Contained Intervertebral Disc Bulge / Annular Sprain
Mechanical Dysfunction
Sprain and Strain Injuries
Acute Reflex Muscular Hypertonicity
Uncomplicated Lower Back Pain

Performed By:
Performed by Doctors of Chiropractic, Medical Physiatrists and Physical Therapists
These exercises are designed to enhance the muscular stability, control and "adaptive strength" of the spine. Adaptive strength refers to the spines ability to quickly and correctly adapt to the demands place upon it. These exercises are usually performed daily and progressively get more difficult over time. As function increases, generally pain decreases. Furthermore, specific exercises decrease deep muscle atrophy making it easier to control the spinal column and maintain good balance and coordination.

Painful conditions over time may create "centralized pain"; pain which has been memorized by the brain and is every bit as real as the original pain. Exercise and motion help to trace NEW memory pathways which lessen this "memorized pain."

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Microdisctectomy, Laminectomy and Fusion Surgeries                          

Some Conditions which may benefit:
Intervertebral Disc Herniations and disc fragments
Unstable or fractured joints
Emergency situations where nerve tissue is being irritated or compromised.
Conditions where multiple problems exist at the same time, which are causing irritation to the nerves.

Performed By:
Performed by orthopedic surgeons, neuro surgeons and pain management surgeons

Special Tests and Examinations Prior to Treatment May Include:
MRI should always be obtained prior to treatment to determine possibility of nerve root or cord compression
Regular blood labs may be required prior to treatment
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What is Done:
Unless it is a medical emergency, surgery is most always a FINAL resort. This should only be performed in emergency situations or if conservative treatment has failed. In non emergency conditions, conservative treatment should be fully utilized for up to 3-6 months prior to making surgical decisions.

Surgical decompression refers to surgery which is intended to remove intervertebral disc material, bone or other "lesions" which are irritating or crushing nerve or vascular tissue within the spinal canal or at the exit of the spinal nerves from the spinal canal. There are many techniques utilized. The type of surgery will depend on the extent of the condition, the general health and physical requirements of the patient and the preferred technique of the surgeon.

Microsurgical techniques have the advantage of limiting the amount of tissue damage and limiting many of the risks of more invasive surgery. Microsurgery refers to the use of "arthroscopic" or "endoscopic" surgical tools (small tubes) through which the surgery is performed. Not all conditions requiring surgery can be performed with microsurgical techniques.