Common Causes of Back Pain

Christopher Heck, MD, an orthopedic spine surgeon at Southlake Orthopaedics, treats a large of number of back pain sufferers.

“The most common cause of back pain I see in these groups is usually a simple pinched nerve from stenosis,” Heck says. “As we age, some of our discs collapse in height and wear out over time—much like the brakes in your car, they don’t last forever. As the disc collapses, the nerve roots in the spine get pinched, and that causes issues like sciatica, or pain down your arm and neck.”

Disc Herniation: A Common Culprit

“The second most common issue we see is disc herniation,” he says. “I like to tell patients that the disc, that soft tissue between each bone, is like a jelly doughnut. It has a firm outer covering and a jelly center, and when that outer covering gets torn, some of that jelly can spill out through that tear, and that can push on a nerve and cause sciatica.”

Spinal Instability and Its Effects

Finally, the third most common issue is spinal instability. “This is where one spine bone slips out of place of another, and much like a child’s building blocks, when you push one of those blocks a little, it usually stays put and doesn’t completely fall off, but you can have a slip that’s 25 to 30 percent, and the higher percentage you get, the more instability and the more likely it is that bone will want to fall off,” Heck says. “Of course, it doesn’t completely fall off from the body like a block would because there are other restraining elements like ligaments and muscles that hold it in place, but because it shifts from moving around, it can cause intense pain and even cause pinched nerves and pain down the legs. That is a very common problem that occurs due to arthritis in the joints of the back, which is simply a part of aging.”

Treatment Approaches for Back Pain

Heck takes his patients’ needs into consideration when initiating a treatment plan. He notes that the first step in treatment is usually over-the-counter treatment options like anti-inflammatory medicine, and patients usually start there on their own. The second line of treatment is physical therapy.

The Importance of Physical Therapy

Many patients assume they don’t need physical therapy because they can simply exercise on their own. However, there’s a crucial difference between general exercise and structured rehabilitation. “Physical therapists go through specialized training,” Heck says. “They are highly skilled in what they do. While we may use some overlapping techniques, I am not trained to be a physical therapist, and they are not trained to be a surgeon.

“Imagine you have a ’69 Chevy with bald tires, a rusty exterior, and beat-up shocks. If you drive down a road full of potholes, that ride is going to be extremely bumpy. But if you take that same car to the shop and put new shocks on it, it may still look the same, but the ride is going to be much smoother.

“Physical therapy works in a similar way. It strengthens and conditions the muscles that stabilize and support the body—acting as shock absorbers.”

When Further Intervention is Needed

“If physical therapy isn’t helping the problem, then some type of intervention is needed,” Heck says. “Intervention can be nerve blocks, which is the most common, and includes an epidural or steroid injections, which is steroid medicine and numbing medicine that is put around a nerve in the spine. And while the nerve is still pinched, and it doesn’t un-pinch it, the steroid is anti-inflammatory and it significantly calms down the inflammation present.”

Advancements in Spinal Surgery

If injections don’t provide sufficient pain relief, surgery may be the next step. One of the most significant advancements in spinal surgery over the past 20 years is the transpsoas fusion, a technique Heck has found particularly effective in his practice.

The Transpsoas Fusion Technique

“The psoas muscle runs along the side of the spine, with one on the left and one on the right,” Heck says. “In a cow, this muscle is known as the tenderloin. It plays a key role in hip flexion—engaging when you step up, lift your leg, or even put on a shoe. In the early 2000s, a new surgical approach was developed that allows surgeons to access the spine through the psoas muscle, rather than through the back.

“We actually enter through the side of the abdomen, which provides direct access to the spine. From there, we remove a damaged disc and insert a cinderblock-shaped cage. This spreads the bones apart, opening up space for the nerves and relieving pressure. Inside the cage, we place bone graft material, which eventually turns into solid bone, fusing the vertebrae together over about two months.”

The Benefits of Minimally Invasive Surgery

Before this innovation, spinal fusions required a much more invasive approach.

“In the past, surgeons had to go through the back, peeling muscles away from the spine,” Heck says. “This caused significant pain and led to longer recovery times. The transpsoas fusion offers a far less invasive alternative, making recovery easier for patients.”

Exploring Other Surgical Options

Heck stresses that while not every patient needs a spinal fusion, this surgery is especially helpful in patients with spinal instability, where a fusion is more necessary to keep pressure off of the nerves due to shifting from movement.

“There are other non-fusion techniques, such as a disc replacement,” he says. “In 2007, the FDA approved cervical disc replacements. These are especially useful for younger patients who herniate a disc since they are higher-demand people who are more active.”

Making an Informed Decision About Surgery

“Most of the time, I tell my patients that they don’t need spinal surgery,” Heck says. “Instead, it’s the last step in treatment—one that can fix the issue and relieve pain when other approaches haven’t worked.

Comprehensive Care at Southlake Orthopaedics

If you’re living with back pain and are interested in receiving specialized treatment to relieve your pain, the experts at Southlake Orthopaedics are here for you. Contact us today to get started on your path to a life with less back pain and more living.