How Your Spine Functions and Hurts
To understand why back or neck pain occurs—and how non-surgical interventional treatments work—it helps to first understand the anatomy of the human spine.
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The spine serves two main functions - it provides structural support and flexibility for the body while creating a protective bone conduit for the spinal cord and its delicate nerve roots. When any component of this complex system experiences mechanical wear, inflammation, or structural degradation, the result can range from a dull local ache to severe, radiating nerve pain.
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The spinal column is composed of 33 vertebrae stacked vertically, divided into key functional regions:
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Cervical Spine (Neck): Comprising 7 vertebrae, the cervical spine supports the head and provides a high range of motion, making it susceptible to strain, whiplash, and disc herniation.
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Thoracic Spine (Mid-Back): Comprises of 12 vertebrae attached to the rib cage, offering stability with relatively low mobility.
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Lumbar Spine (Lower Back): Consists of 5 large vertebrae that bear the majority of the body’s weight, making this the most frequent site of chronic mechanical pain and nerve compression.
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Sacrum and Coccyx: Fused bones at the base of the spine connecting to the pelvis via the Sacroiliac (SI) joints.
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Between each vertebral bone sits an intervertebral disc. The intervertebral disc is a shock-absorbing cushion consisting of a tough outer ring (annulus fibrosus) and a soft, gel-like center (nucleus pulposus).
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Posteriorly, adjacent vertebrae connect via paired facet joints (zygapophyseal joints), which guide and restrict movement. Branching out from the central spinal cord at every level are paired spinal nerve roots, passing through tiny bony exits called intervertebral foramina to travel down into the arms, trunk, and legs.
Intervertebral Disc Pathology (Herniated & Degenerative Discs)
The intervertebral disc consists of a central nucleus pulposis (gel-like material) and an annulus (fibrous material). A tear in the the annulus can cause shearing pain in the neck or back. In some cases, the nucleus pulposis can also herniate through an annular tear, causing disc herniation and pain in the limbs by causing chemical inflammation and mechanical traction against the exiting or traversing nerve roots.Â
Sacroiliac Joint Dysfunction
Connecting the sacrum to the pelvis, the SI joint acts as a primary shock absorber between the upper body and legs. Hyper-mobility, arthritis, or altered gait can inflame this joint, resulting in low back pain and sometimes buttock pain radiating to the back of the thigh.
Causes of Spine Pain
Facet Joint Arthrosis & Spinal Stenosis
Just like knee or hip joints, the facet joints are lined with cartilage and encased in a capsule. Over time, repetitive movement and disc height loss can lead to facet joint arthritis, causing localized inflammation, stiffness, and bone spur formation (osteophytes). This is a common cause of pain in those aged over 45 years old. With age, enlargement of the facet joints, coupled with thickening of the ligaments in the spinal canal can cause the nerves in the spinal canal to be compressed. This is called spinal stenosis
Musculoskeletal & Ligamentous Strain
Postural stress, prolonged sitting, or sudden physical strain can cause micro-tears in the paraspinal muscles and supporting ligaments, triggering acute muscle spasms and pain.Â
Common Causes of Neck and Lower Back Pain
Intervertebral Disc Pathology
The intervertebral disc is made up of a central gel-like core called the Nucleus Pulposus and an outer ring called the annulus. Tears in the annulus may be associated with severe back pain (annular tear). In some cases, the nucleus pulposis can herniate out of the annular tear, causing chemical and mechanical irritation of the nerves that run behind the disc, resulting in pain shooting down the arms or legs.Â
Facet Joint Arthrosis & Spinal Stenosis
The facet joints are lined with cartilage and each joint is encased by a capsule. Degeneration over time and trauma can result in facet joint arthritis. This is a common cause of axial neck and back pain. This arthritic change can result in thickening of the joint. And together with thickening other ligaments of the spine, this can cause spinal canal narrowing and pain.Â
Sacroiliac (SI) Joint Dysfunction
The Sacroiliac joint is the articulation between the pelvis and spine. Patients with sacroiliac joint pain can present with low back pain or buttock pain that is worse with sitting for long periods. Risks factors for this include pregnancy, post-pregnancy, age and patients with previous spine fusion surgery. The diagnosis of this requires both a clinical examination and a diagnostic joint injection
Tissue Strain
Postural stress, prolonged sitting, or sudden physical strain can cause micro-tears in the paraspinal muscles and supporting ligaments, triggering acute muscle spasms and myofascial pain. This is a common cause of pain especially when radiological findings are normal.Â
Interventional Pain Management Targets the Root Cause
Unlike oral pain medications that temporarily mask symptoms site-wide, or invasive open spine surgeries that permanently alter spine mechanics, interventional pain management uses high-precision image guidance (Fluoroscopy / Ultrasound) to deliver targeted therapy directly to the source of pain.Â
Interventional Spine Procedures for Spine Pain & Sciatica treatment
This procedure delivers powerful anti-inflammatory medication directly into the space surrounding spinal nerves. This image-guided procedure reduces swelling of irritated nerves to provide rapid relief from leg or arm pain. It is indicated for patients suffering from disc herniations or mild-to-moderate spinal stenosis.
This advanced technique uses thermal energy to precisely target and quiet the specific nerves responsible for sending pain signals from your spinal joints to your brain. It is typically used for patients with chronic neck or lower back arthritis who are suspected to have facet joint arthritis or whiplash injury. The results can provide long-lasting relief, allowing one to return to his or her daily activities.
The disc is a common source of low back pain and radiculopathy. A small tear in the disc (annular tear) can cause severe back pain. This can be treated with an annuloplasty procedure, where the nerves that supply the disc are ablated with heat. This results in pain relief and in some cases, can result in sealing up of the annular tear by scarring. In patients with a disc bulge which is causing nerve compression and radiculopathy, nucleoplasty can be offered as well. By reducing the intradiscal pressure, this procedure reduces the mechanical compression of the nerves that lie behind the discs.Â
Spinal Cord Stimulation
Spinal Cord Stimulation is indicated for patients with persistent back pain or radiculopathy after spine surgery. In SCS, leads are placed behind the spinal cord and electrical signals are fed to these leds. This results in masking of the pain signals before they reach the brain, laeding to pain relief. For failed back surgery syndrome (or persistent pain despite spine surgery) in the absence of significant new pathology, SCS has been shown to be more effective than re-operation.Â
