Low Back Pain

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 conditions.

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.

Diagnosis:
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.

Treatment:

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 weeks.

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.

Diagnosis:

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.

Treatment:
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 working.

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 relieve pain.

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:
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.

Treatment:
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.

Treatment:
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 nerve compression.


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.

Treatment:
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.