Lower Back and Cervical Pain:
Low Back Pain:
Many of Dr. Berti's patients come to him due to lower back pain. Back
pain is the second most common neurological ailment in the United
States after headaches. While most of these occurrences of low back
pain get resolved on their own, some may lead to more serious
The back is made up of the spinal column, which includes nerves,
tissue, and cartilage, and muscles to hold it up. The spinal cord
carries all the signals and nerve impulses from the body to the brain
and vice versa.
Low back pain can be caused by the natural weakening that comes from
aging, arthritis, and osteoporosis. One's lifestyle may also result in
back pain, whether from smoking, obesity, poor posture, or poor
sleeping position. Those who perform certain physical activities like
lifting heavy objects improperly or over-stretching may also cause a
disc to rupture or bulge, which may compress one of 50 nerve roots
along the spinal cord. This irritation results in back pain.
Dr. Berti will perform a thorough examination of your medical history
and symptoms, as well as a physical examination. Further diagnostic
testing, such as CT or CAT scans, MRIs, X-Rays, and diagnostic nerve
root blocks may also be used if necessary.
Most treatments for lower back pain are conservative in nature. These
include physical therapy, back exercise, short bed rest, heat and ice
treatment, weight loss, epidural steroid injections, anti-inflammatory
medications, and rehabilitation. Dr. Berti and your primary care
physician will try to treat you conservatively and will educate you on
proper body mechanics.
If your lower back pain gets worse or does not improve after two to
three days you should contact your primary care physician for further
evaluation on which nerve root is being compressed. Surgery may be
opted on if these treatment options do not provide relief within two
When applicable, Dr. Berti may recommend minimally-invasive,
outpatient procedures like kyphoplasty or vertebroplasty. Invasive
back surgery is reserved for those with highly progressed neurologic
disease or extensive peripheral nerve damage, as it is a major
operation which may require hospitalization and a long recovery
period. These procedures include laminectomies, discectomies, spinal
fusion, and foraminotomies, to name a few. (Link to these)
Cervical Pain, Degenerative Disc Disease:
Many of Dr. Berti's patients come to him for severe neck and shoulder
pain, stiffness, or tingling and numbness in their arms. This neck
pain may have many sources. Your cervical spine is made up of seven
vertebrae or bones, which are separated by discs filled with a
cushioning, gel-like substance. These cervical discs both stabilize
your neck and allow you to move your head from side to side and back
and forth. They can wear down gradually over time and degenerate,
causing neck pain.
Other sources of pain may include arthritis and your lifestyle-
including smoking and poor posture. These cause disc herniation and
bone spurs to form as well. As disc disease progresses, the neck will
become less flexible, and you will feel pain towards the end of the
day, or a stiffness in your neck. When one of these discs presses on
one or more of the many nerves running through the spinal cord, you
may also develop pain, numbness, or weakness radiating down your
shoulder, arm, and hand. Pressure on the spinal cord in the cervical
spine can cause problems throughout your whole body. Almost all the
nerves that reach throughout the rest of the body pass through the
neck on their way to the extremities, abdomen, and chest.
Dr. Berti will perform a thorough review of the patient's medical
history, symptoms, and will also perform a physical examination that
will include testing the neck's flexibility and extension. Imaging
studies will also be performed where warranted, and will include
x-rays, MRIs, and CT scans. The doctor may opt for a diagnostic
selective nerve root block in some cases, as well.
Dr. Berti will determine a treatment plan based on the cause of
the nerve irritation. His first recourse is, in most cases,
conservative treatment. He might suggest over-the-counter pain
medications, including acetaminophen (Tylenol), nonsteroidal
anti-inflammatory medications such as ibuprofen (Motrin, Advil) and
naproxen (Aleve). These medications can help reduce pain and
inflammation and allow time for healing. He might prescribe steroids
or narcotic painkillers if over-the-counter medications aren't
Dr. Berti may also prescribe rest or a cervical collar, and
potentially, physical therapy appropriate for cervical disc disease.
Your therapist may use cervical traction, or gently massage your
muscles and joints to reduce your pain and stiffness. The physical
therapist can also help you increase your range of motion and show you
exercises and correct postures to help improve your neck pain. Dr.
Berti may also recommend epidural steroid injections to temporarily
Surgery is also a treatment option, depending on whether you and Dr.
Berti decide on it. The most common surgery for degenerative disc
disease is a discectomy (link to this page). Spine fusion may also be
used (link to this page.)
Dr. Berti treats:
Herniated Disc: A herniated disk is a disk that slips out of place or
ruptures, potentially putting pressure on the spinal cord or nerves,
causing back pain or sciatica. It is also known as a "slipped disc",
and can occur quickly due to an injury or trauma to the neck or spine-
or gradually, from wear and tear on the disc. Herniated discs usually
occur in the lower spine, but sometimes occur in the cervical spine.
It is rare to have a herniated disc in your upper back.
When you have a herniated disc in your cervical spine, you may feel
pain in you rneck that radiates to the shoulders and upper arms. If
the herniated disc is in your lower back, you may feel pain that
begins in your back then spreads to your buttocks and legs (this is
also known as sciatica). You may feel tingling or numbness and have
muscle spasms or weakness.
Treatment for herniated discs follows treatment for degenerative
disc disease, including rest, over-the-counter pain medications,
anti-inflammatory medicine to help with pain and swelling, physical
therapy, losing weight, and potentially, surgery if conservative
treatments don't alleviate pain after at least six weeks. Surgeries
include discectomy, laminectomy, and spinal fusion. (link to
appropriate procedure on procedures page)
Spondylolisthesis is a disease which occurss when one's
vertebra (usually in the lower back) slips over the vertebra below it.
The most common cause in adults is arthritis, although it is
associated with those who partake in sports such as gymnastics,
football, and weight lifting. A stress fracture from one of those
sports can cause the vertebra to crack and shift out of place.
A person with spondylolisthesis may not exhibit any symptoms for
years, if ever. If one does have symptoms, they may include pain in
the lower back and buttocks, numbness, stiff hamstrings, a limp, and
tenderness in the area of the disc that slipped. If there is nerve
compression, then a patient might feel numbness, slow reflexese,
tingling, and weakness in the lower legs. The condition can produce
swayback (or lordosis), but in later stages may result in roundback
(or kyphosis) as the upper spine falls off the lower spine.
If Dr. Berti determines that a spondylolisthesis is causing your
pain, he will first employ nonsurgical treatments. These may include a
short period of rest, anti-inflammatory medications (orally or by
injection) to reduce the swelling, analgesic drugs to control the
pain, bracing for stabilization, and physical therapy and exercise to
improve your strength and flexibility so you can return to a more
normal lifestyle. You will also be educated in how to perform daily
activities without adding stress to your lower back.
Depending on your grade of spondylolisthesis, Dr. Berti may determine
that spine fusion or a laminectomy are needed for either stabilization
or to relieve. .
Spinal stenosis refers to a narrowing of the canal surrounding
the spinal cord. The condition may occur naturally with aging as the
discs become drier and start to shrink. It is associated with
middle-aged or elderly people; their arthritis may cause bones and
ligaments of the spine to become inflamed or swell. Other possible
causes include spine tumors, infections, injuries that cause pressur
on the nerves or spinal cord, and birth defects.
Patients may experience weakness in the legs and leg pain while
standing up; this pain is often relieved simply by sitting down. They
may also experience numbness, cramping, and pain in corresponding
parts of their bodies. For example, if you have spinal stenosis in
your lower back, you will feel cramping in the back, buttocks, thighs,
etc...More serious symptoms can include difficulty or imbalance when
walking, incontinence, and constipation. Interestingly, patients with
spinal stenosis may be able to ride a bicycle with little or no pain.
Again, Dr. Berti stresses a conservative approach to treatment, which
will first include medication, physical therapy, and daily changes to
his patient's lifestyle routine. If these approaches don't work, he
may consider surgery of the neck or lower back to relieve the pain of
Osteoarthritis: Osteoarthritis, also known as degenerative
joint disease or osteoarthrosis, is the most common form of arthritis
caused by the slow, gradual wear and tear on one's joints. The cause
of osteoarthritis is often unknown, but it is thought to be mainly
related to aging, as the symptoms usually appear in middle age. Some
factors that can cause or lead to osteoarthritis include heredity,
obesity (especially for the hip, knee, ankle, and foot joints), joint
injury, and long-term overuse at work or sports. Various medical
disorders, such as bleeding disorders or rheumatoid arthritis, can
lead to osteoarthritis as well. Symptoms include pain (especially
after exercise or any pressure on the joint), swelling, tenderness,
joint stiffness, bone spurs, and inflexibility.
Dr. Berti will recommend various treatments, such as lifestyle
changes, physical therapy, over-the-counter medication such as
acetaminophen or topical analgesics, non-steroidal anti-inflammatory
drugs (NSAIDs), braces, steroid injections in the joint and, if all
else fails, surgery. Lifestyle changes include getting proper rest,
water exercises, changes in diet, losing weight, and rearranging your
home. Dr. Berti will consult with you to determine whether surgery is
the correct route for your improvement.