Back Pain

Chronic low back pain is common, affecting at least 20-30% of adults. Causes range widely, including arthritis, spinal instability (including spondylolisthesis), degenerative disc disease, lumbar stenosis, vertebral fractures, failed back syndrome, sacroiliac joint disease, spinal tumors, and others.

For most patients, initial treatment should include non-invasive measures such as physical therapy and non-steroidal anti-inflammatories (i.e. NSAIDS like ibuprofen or naproxen). Some patients find relief with other therapies, including massage, yoga, and acupuncture. For those with bothersome pain despite these measures, I may recommend referral to a pain specialist for epidural steroid injections or radiofrequency ablations. In general, surgery is only considered after patients have not found lasting relief with the above interventions.

If surgery is needed, my philosophy is to select the least invasive option needed to address your pain. The appropriate type of surgery will depend on factors including your X-ray and MRI findings, medical history, and, importantly, the source of your pain.

Back pain due to spondylolisthesis, for example, may be treated with a spinal fusion such as an OLIF, ALIF, or TLIF. Pain from degenerative disc disease may be better suited to an arthroplasty (disc replacement). Pain in the low back or buttocks could be due to lumbar stenosis, which is treated with a lumbar decompression. Pain due to failed back syndrome is best treated with spinal cord stimulation. Sacroiliac joint dysfunction may call for an SI joint fusion. If your pain is due to the muscles and soft tissues around your spine (so-called myofascial back pain), I may recommend no surgery at all.

When preparing for your appointment, please consider the following questions. These help me distinguish the source of your pain (and thus, the recommended treatment):

  • Where is the pain the worst?

  • What activities or body positions make the pain better or worse?

  • Does the pain travel anywhere - particularly down to your legs? If so, where in your legs does it travel?

  • Have you previously tried physical therapy, steroid injections, or radiofrequency ablations? Which ones helped the most?

  • Have you previously had surgery on your spine or your abdomen (belly)?

If you live near Denver and have chronic back pain, please consider meeting me in consultation to learn about treatment options.