MRI. Magnetic resonance imaging uses a magnetic field and radio frequency to create a picture of bones, soft tissues, and organs. It gives your doctor a picture of your spinal cord, the nerves, and the discs of the spine, which are the most commonly affected structures in cases of back pain. With an MRI, your doctor can see if there’s serious damage to a disk or a pinched nerve, says Figuereo. But using an MRI scan is somewhat controversial, since some experts believe they often show abnormalities that aren’t related to pain. Any neurologist is highly specialized in diagnosing back pain and neck pain, and in assessing risks and treatment options. Every back pain and neck pain patient is unique, with different degrees of problems associated with a bone or disc abnormality.
While pinched nerves in your neck may affect your shoulders, arms and/or hands, myelopathy can involve both your arms and legs. The sciatic nerve is the largest nerve in the body and runs down the back of your legs. When this nerve is injured, pain can radiate from the lower back to the buttocks, hips, and legs. Patients who suffer from sciatica may also feel numbness, weakness, or a tingling sensation.
An independent neurologist who has seen thousands of similar patients can find the best surgeon for your case. Unfortunately, some patients can’t be helped by even the best physical therapy. Disc herniation can be too extreme, bone can build up around nerves to the point where they no longer fit through, or the spine can become unstable on standing for many reasons.
Occasionally the cause of chronic lower back pain is difficult to determine even after a thorough examination. Stacked on top of one another are more than 30 bones, called vertebrae that form the spinal column. Each of these bones contains a round-shaped hole that when stacked on top of one another, creates a channel that surrounds the spinal cord. The cord descends from the base of the brain and extends to just below the rib cage.
Avoiding pillows under the neck when sleeping can help the cervical spine – if it fuses – to fuse in a less debilitating position. In patients with more severe disease, the drugs used are typically sulfasalazine and methotrexate. If the patient is not doing well despite trying these medications, TNF-alpha blockers, appear to provide benefit in such spondyloarthropathies as ankylosing spondylitis and psoriatic arthritis. Etanercept (Enbrel®), adalimumab (Humira®), infliximab (Remicade®), Golimumab (Simponi®) and certolizumab (Cimzia®) are the five anti-TNF agents presently approved by the FDA for use in this condition. These agents clearly improve the patient’s ability to move and function. More study is needed to see whether these medications can prevent fusion of the spine, over the long run.
Treatment of sciatica is usually multi-modal and includes anti-inflammatories, physical therapy, and often epidural steroid injections. Neurogenic sciatica is caused by compression of the sciatic nerve, caused by a number of things, such as bulging discs to tight muscles. The discs can bulge, herniate, or burst, and this causes pressure on the nerves along the spine.
If medications and other approaches do not offer sufficient relief, nerve block injections, spinal cord stimulation, and pain pumps may be considered for neuropathic pain. Neuropathic pain could spinal injury neurology expert witness be placed in the chronic pain category, but it has a different feel than chronic musculoskeletal pain. The pain is often described as severe, sharp, lightning-like, stabbing, burning, or cold.
Some people experience pain in both legs, though one leg can be worse than the other. The spinal nerves from the thoracic spine are involved with the function of the chest and abdomen. The exception is with the first thoracic nerve, which is also responsible for the ring and pinky fingers. A pinched nerve at the thoracic levels may cause pain and/or numbness in the back, chest, abdomen, and/or the ring and pinky finger.
The individual may also experience ongoing numbness, tingling, or weakness. Pain may be felt along the nerve path from the spine down to the arms/hands or legs/feet. If low back pain occurs after a recent injury — such as a car accident, a fall or sports injury — call your primary care physician immediately. If no neurologic problems are present, the patient may benefit by beginning conservative treatment at home for two to three weeks.