• What are the symptoms of back pain?

• What causes back pain?

• How is back pain evaluated?

• How is back pain treated?

What are the symptoms of back pain?

Patients will typically experience pain across the back, sometimes radiating to the hip or buttocks. Specific symptoms depend on what structures or combination of structures in the spine is causing the back pain.  Degeneration of the facet joints can result in pain with sitting or standing. Degeneration of the lumbar disc may result in herniation. Pain occurring from the disc can be felt as constant pain across the back. When disc is herniated back pain may radiate to the leg. Pain from sacroiliac joint is felt at the low back, buttocks or hip. Pain can be worse sitting, standing or climbing stairs.

What causes back pain?

Back pain is usually caused by degenerative conditions of the spine, or wear and tear. The most common causes of back pain vary with age. The usual sources are the back joints, called facets, the intervertebral disc or the sacroiliac joint. The facet joints are the joints that hold the back of the spine together. The disc is a cushion between the vertebrae.  The sacroiliac joint is the joint between the spine and the pelvis.

How is back pain evaluated?

The first step in the evaluation of back pain is a careful history and physical examination.  Often, a history will give many clues as to what part of the back is causing the pain; the joints or the disc. When conservative care with medications and therapy fails to bring relief, an MRI gives doctors a look inside the back.

How is back pain treated?

Medications and therapy are the first line in the treatment of back pain. In patients that don’t respond a spinal pain management evaluation can be performed.  In this highly specialized evaluation, we determine which of the structures in the back the pain is emanating from. Spinal injections can bring relief and confirm the source of pain.  Minimally invasive surgery is reserved only for cases that do not improve with spinal injections.

Back pain treatments

The following spinal injections can be used to treat back pain:

• Epidural steroid injection

• Facet block

• Median branch nerve injection

• Sacroiliac joint injection

The following minimally invasive surgical procedures can be used to treat back pain:

• Percutaneous endoscopic thoracic discectomy

• Percutaneous endoscopic lumbar discectomy

• Percutaneous endoscopic median branch avulsion

• Axial lumbar interbody fusion

• Percutaneous transforaminal lumbar fusion

• Lumbar Rhizotomy

Who is Dr. George Rappard?

George Rappard, MD is the director and founder of Los Angeles’ Minimally Invasive Spine Institute, located in the Miracle Mile area of the Wilshire Corridor. Dr. Rappard is a board certified neurointerventional surgeon specializing in spinal pain management, spinal injections and minimally invasive surgery for neck and back pain. Dr. Rappard performs a spectrum of “band aid” procedures of the spine, commonly employing x-ray and endoscopic guidance, designed to relieve back and neck pain as well as repairing damage caused by wear and tear of the spine. The use of x-rays and an endoscope mounted camera allows proven procedures to be performed through small tubes, allowing tiny incisions while still getting the job done. These procedures are typically associated with lower costs and quicker recovery times than conventional spine surgery techniques. In addition to seeing and treating patients, Dr. Rappard and the Institute are involved in several spine research trials. By offering advanced minimally invasive procedures and groundbreaking spine research, Dr. Rappard’s Minimally Invasive Spine Institute delivers leading edge spine care in Los Angeles