Spine pain

The Curious Case of the Typical/Atypical L5-S1 Disc Herniation

In this article: Symptoms What happens when an epidural doesn’t work? Treatment This week I saw a patient with an L5-S1 disc bulge/herniation who seemed to be a mystery to his physicians but in fact, just had a slightly atypical problem that presented typically. Meaning he seemed to be a mystery in need of a…read more

Alternatives to Back Surgery for Herniated and Bulging Discs

There are quite a few alternatives to back surgery for patients with bulging or herniated discs. Back surgery, in general, is one of those procedures where everyone seems to know someone who had a bad experience. Newer techniques aim to try to heal the damage to the disc rather than cutting parts of it out.…read more

Treating the Functional Spinal Unit: Time to Get Rid of the Pain Generator

Interventional pain medicine teaches us that we need to find what I call “the magic pain generator.” Meaning we have a whole specialty of physicians (which used to include me) whose focus is trying to find one structure in the spine that’s causing most of the patient’s spinal pain. However, while sometimes this can be done,…read more

Fusion Surgery No Better than No Surgery

Does fusion surgery work? I have blogged before about the research showing that this surgery is often no better in the long-run than no surgery. However, I’ve also pointed out that surgeons have a way of interpreting data in studies that benefit their preconceived notions of efficacy. Today’s blog is about one such study which…read more

An Update on Our Novel Alar and Transverse Ligament Injection Procedure

Way back when my career was just starting, I got a job with a physician who was involved in auto-accident managed care. This meant that there was a steady stream of neck-injured patients. While many of these patients could be helped, some couldn’t. While it would be attractive to say that these few had psychological…read more

How to Avoid Discography Side Effects: Biologic Discography

Frankly, until we became the first in the world to inject stem cells into discs, discography never made much sense to me. I would tell patients, “I’m going to poke a hole in your disc to see if there’s a hole in your disc.” However, when we began to see that platelet rich plasma and…read more

Pain After Back Surgery? Did the Surgeon Leave a Big Hole in Your Fascia?

In the world of human anatomy, there is a part of the body that doesn’t get a whole lot of attention despite the fact it has a huge job. This structure is the thoracodorsal fascia. If you’ve had low-back surgery, your surgeon cut through your thoracodorsal fascia to access your spine, but is it possible…read more

Stem Cell Disc Injection: The Hammer and the Nail

There’s a saying in medicine, “When all you have is a hammer, everything looks like a nail”. Meaning that if all the doctor knows how to do for a given problem is one treatment, then he or she tends to use that treatment when it’s not appropriate. This morning I’d like to highlight a stem…read more