Neck and Low Back Pain FAQs

How common is neck or back pain?
Back pain is the second most common reason for visit to the doctor’s office. In the United States, approximately 90% of adults will experience back pain at some time in their life. Up to 47% of the working population reports a history of back pain. Most neck or back pain usually resolves within a few weeks without any intervention.
What can cause chronic (longstanding) neck or back pain?

Disc herniation
Bone degeneration (bone spurs and/or narrowing of small joints) in the spine
Pain from the soft tissues and ligaments
Other processes: spinal tumor, fractures, infections
Other neighboring structures may also be the source of pain. This is known as referred pain. An example will be: back pain due to kidney stone or ruptured abdominal aortic aneurysm.

What are the common tests my doctor can order to evaluate back pain?

After a thorough history and physical examination, your doctor may order one or more diagnostic tests. Keep in mind that, in the majority of cases, there may be no diagnostic evidence of anatomical abnormality. In other cases, diagnostic tests such as X-ray, CT scan, MRI, bone scan, EMG may reveal apparent causes of back pain such as herniated disk, degenerative disc disease, spinal stenosis, facet arthropathy and spondylolisthesis.
X-ray: This test looks at the alignment and integrity of the bony aspects of the spine. It does not give information about the spinal cord, nerve, or muscle.
CT scan: This test is a computer-assisted X-ray that looks at the cross-sectional anatomy of the spine to reveal the various elements of the spine: bone, disks, nerves, ligaments, tendons, and muscles.
MRI: This test is similar to the CT scan in that it gives a three-dimensional view of the various elements of the spine. Unlike the CT scan, this test uses a very strong magnet to generate the images and does not expose the patient to any radiation. While the test is safe for most people, those with metal parts (pacemaker, defibrillator, certain metal implants, ear/cochlear implants, shrapnel penetration) in their body may not have the test due to dangerous effect of exposure of metal to the magnetic field.
EMG/NCS (Electromyography/Nerve Conduction Study): This test is a study of the nerves and muscles of the arm(s) or leg(s) to determine if there is any pinching of the nerve root originating from the spine at the neck or back, respectively.
Bone scan: This test involves an injection of a small amount of radioactive dye to see if there has been bony damage caused by fracture, infection, tumor, or arthritis.

What treatments can my physician prescribe?

Treatment

Physical therapy for stretching, training proper posture, strengthening exercises of neck, abdomen and back muscles

Exercise program in the water (aquatic exercises)

Medication to decrease inflammatory and pain
Interventional spine procedures
Surgery in selected, appropriate cases

What procedures are done at Stanford Interventional Spine Center?

Epidural steroid injection
Selective nerve root block
- Facet joint (small joint in the spine) injection
- Medial branch neurolysis - temporary destroy nerves to selective facet joints
IDET
- Nucleoplasty
- Discography - diagnostic procedure to determine which disc level is causing neck or back pain

How do I know which treatment or procedure is right for me?

There is usually no one "right" treatment or procedure for chronic neck and back pain.
With a thorough work-up, including history taking, physical examination, and diagnostic tests, the physician attempts to identify possible sources of pain. Management of the condition may be a combination of different treatment.

Do I need surgery for my neck or back pain?

Surgery may be indicated for progressive neurological deficits or intractable pain. Signs of neurological deficits include progressive weakness, loss of fine motor control, loss of bowel or bladder control, inability to have urination.
Surgery for intractable pain is often the last resort. Spinal fusion aims at decreasing pain by limiting the motion of a particular spinal segment. With time, however, the segment of the spine above and below the fusion may experience accelerated bony degeneration as they have to withstand more workload. This can then become another source of pain.

How do I schedule an appointment at the Stanford Interventional Spine Center?

Contact (650) 725-8823.

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