Understanding the Spine
The spine is composed of 33 vertebrae divided into five regions: the cervical spine (neck — 7 vertebrae), thoracic spine (mid-back — 12 vertebrae), lumbar spine (low back — 5 vertebrae), sacrum (5 fused vertebrae), and coccyx (tailbone — 4 fused vertebrae). Between each pair of moveable vertebrae sits an intervertebral disc — a tough, gel-filled cushion that absorbs shock and allows the spine to bend and twist. Spinal nerves exit through small openings (foramina) on either side of the spine at each level, branching out to supply sensation and motor function to the body.
Spine pain can arise from virtually any of these structures — the vertebral bones, intervertebral discs, facet joints (the small joints that connect adjacent vertebrae), ligaments, muscles, and the spinal nerves themselves. An accurate diagnosis requires determining which specific structure or structures are responsible for the patient’s symptoms.
Common Spine Conditions
Herniated Disc (Disc Herniation)
A herniated disc occurs when the soft, gel-like center (nucleus pulposus) of an intervertebral disc pushes through a tear in the tough outer layer (annulus fibrosus). The herniated material can compress an adjacent nerve root, causing pain, numbness, tingling, or weakness that radiates into the arm (if in the cervical spine) or leg (if in the lumbar spine). Herniated discs are among the most common causes of radiculopathy and sciatica.
Degenerative Disc Disease
Despite its name, degenerative disc disease is not truly a “disease” but rather a description of the normal age-related changes that occur in the intervertebral discs over time. As discs lose water content and height, they become less effective as shock absorbers. In some patients, these changes produce chronic low back or neck pain, particularly with bending, lifting, or prolonged sitting. Not all disc degeneration causes symptoms — the clinical significance depends on the individual patient.
Spinal Stenosis
Spinal stenosis refers to narrowing of the spinal canal or the neural foramina (the openings through which nerves exit the spine). This narrowing can compress the spinal cord or nerve roots, producing pain, numbness, weakness, and difficulty walking. Lumbar spinal stenosis is the most common form and often produces a characteristic symptom pattern called neurogenic claudication — leg heaviness or pain that worsens with standing or walking and improves with sitting or leaning forward.
Facet Joint Syndrome (Facet Arthropathy)
The facet joints are paired joints located at the back of the spine at each vertebral level. Like any joint, they are lined with cartilage and can develop osteoarthritis over time. Facet joint pain is typically experienced as an aching or stiff pain in the neck or low back that worsens with extension (arching backward) and twisting. It is a common and often underdiagnosed contributor to chronic spinal pain.
Spondylolisthesis
Spondylolisthesis occurs when one vertebra slips forward over the vertebra below it. This may result from a stress fracture (spondylolysis), degenerative changes, or congenital abnormalities. Depending on the degree of slippage and nerve involvement, symptoms can range from mild low back pain to significant radiculopathy or neurogenic claudication.
Sacroiliac (SI) Joint Dysfunction
While technically a pelvic joint, the sacroiliac joint is a frequent source of low back and buttock pain that is often attributed to the lumbar spine. SI joint dysfunction can result from injury, arthritis, pregnancy, or altered mechanics following lumbar spine surgery. Accurate diagnosis typically requires a combination of physical examination findings and diagnostic injections.
Failed Back Surgery Syndrome (FBSS)
Also known as post-laminectomy syndrome, FBSS refers to persistent or recurrent pain following one or more spinal surgeries. Causes may include residual or recurrent disc herniation, epidural fibrosis (scar tissue), facet joint arthropathy, sacroiliac joint dysfunction, or neuropathic pain from nerve injury. Patients with FBSS often benefit from a comprehensive interventional pain management evaluation to identify treatable pain generators.
Compression Fractures
Vertebral compression fractures occur when a vertebral body collapses, most commonly due to osteoporosis. They typically affect the thoracic and lumbar spine and present as sudden-onset, localized back pain that worsens with standing and weight-bearing. Conservative management includes pain control and bracing, while interventional options such as kyphoplasty or vertebroplasty may be appropriate for fractures that fail to heal.
How Are Spine Conditions Diagnosed?
A thorough evaluation at Coastal Spine & Pain begins with a comprehensive history and physical examination, including a detailed neurological assessment. We pay close attention to the character, location, and radiation pattern of your pain, as well as any associated neurological symptoms such as numbness, tingling, or weakness.
Advanced imaging — including MRI, CT, and X-ray — plays an important role in visualizing the structural anatomy of the spine and identifying potential pain generators. However, imaging findings must always be interpreted in the context of the patient’s clinical presentation. Many people have disc bulges, disc degeneration, or other imaging findings that are completely asymptomatic. Treating imaging findings rather than patients is a common pitfall that Coastal Spine & Pain is committed to avoiding.
Diagnostic injections are a cornerstone of interventional spine evaluation. By selectively blocking specific structures — such as a facet joint, nerve root, or sacroiliac joint — and monitoring the patient’s pain response, we can confirm or exclude suspected pain generators with a high degree of confidence. This diagnostic precision is what allows us to develop targeted treatment plans rather than relying on a “trial and error” approach.
Treatment Options
Coastal Spine & Pain offers comprehensive interventional treatment for spine conditions:
Epidural Steroid Injections
These injections deliver corticosteroid medication into the epidural space surrounding the spinal nerves to reduce inflammation and relieve pain caused by herniated discs, spinal stenosis, and radiculopathy. Approaches include interlaminar, transforaminal, and caudal epidural injections, selected based on the patient’s anatomy and diagnosis.
Facet Joint Injections & Medial Branch Blocks
Diagnostic medial branch blocks identify whether the facet joints are contributing to spinal pain. If confirmed, therapeutic facet joint injections can provide temporary relief, and radiofrequency ablation of the medial branch nerves can deliver longer-lasting results.
Radiofrequency Ablation (RFA)
Also called radiofrequency neurotomy, this procedure uses heat generated by radiofrequency energy to disrupt the function of specific nerves carrying pain signals from the facet joints or sacroiliac joint. Pain relief from RFA typically lasts six to twelve months and the procedure can be repeated when pain recurs.
Sacroiliac Joint Injections
Both diagnostic and therapeutic SI joint injections are performed to evaluate and treat sacroiliac joint-mediated pain. Patients who demonstrate consistent diagnostic responses may be candidates for SI joint radiofrequency ablation or other advanced interventions.
Spinal Cord Stimulation (SCS)
For patients with chronic, refractory spine-related pain — particularly those with failed back surgery syndrome, persistent radiculopathy, or CRPS — spinal cord stimulation offers a well-established, evidence-based treatment option. A trial period allows patients to assess the therapy before a permanent implant is placed.
Selective Nerve Root Blocks
These targeted injections isolate a specific nerve root to both diagnose and treat radicular pain. They are particularly useful when imaging shows pathology at multiple spinal levels and the clinical question is which level is producing the patient’s symptoms.
Medication Management
When appropriate, medications including NSAIDs, muscle relaxants, neuropathic pain agents, and short-term corticosteroids may be incorporated into the treatment plan. Our practice emphasizes multimodal pain management strategies that minimize reliance on opioid medications.
Physical Therapy Coordination
Spine rehabilitation is a critical component of long-term spine health. We work closely with physical therapists to develop individualized programs that strengthen the core musculature, improve spinal mechanics, and reduce the risk of pain recurrence.
When to Seek Care
Spine-related pain warrants evaluation by a specialist if it persists beyond four to six weeks, radiates into the arms or legs, is accompanied by numbness, tingling, or weakness, affects bowel or bladder function (which requires urgent evaluation), or is progressively worsening despite conservative treatment. Many spine conditions respond well to non-surgical interventional treatment when addressed in a timely manner.