John P Masciale MD, Minimally Invasive Orthopedic Spine Surgeon

The Spine Center
Orthopedic Associates of Corpus Christi




Back pain is a ubiquitous human experience which spans the globe and in all age ranges. Most of the time lower back pain is a benign consequence of tissue fatigue for a microscopic injury with short-lived stiffness, pain and even muscle spasm. There are other more significant underlying conditions which may be contributory discussed further below.


These can occur in all age groups when muscle ligament or tendon insertions begin to fail, tear or rip under unusual loads or forces. The symptoms include local pain which can then radiate toward the tailbone, the buttocks, the hips but usually not below the knees. Treatment includes rest, ice, use of over-the-counter analgesics such as Tylenol or NSAIDS as well as potential treatment from a physical therapist if the symptoms become more protracted or our chiropractic professionals. These problems are usually self-limiting. Caution is advised in older patients with osteoporosis who may have an underlying compression fracture and in that situation may warrant a visit to their family doctor for purposes of x-ray examination if the symptoms last for more than three days.


The human disc is a complex hydrostatic support mechanism meant to absorb and disperse stresses ongoing in the spine under a variety of conditions and postures. Young, healthy discs are succulent because of healthy cells maintaining a matrix which imbibes water, and this protects the outer edges of the disc, the annulus which is a more dense collagen ligamentous-type tissue. Sometimes under certain loads and stresses the retaining disc annulus wall will thin, and nuclear material will begin to occupy the space and push outward. When this occurs in the direction of the nerves, it can cause intense back pain especially with prolonged sitting, bending and stooping. Mediators of inflammation can irritate the nerves and cause radiating leg pain, typically burning or lancinating, and there is frequent numbness or tingling and even weakness in certain leg muscle groups. This is a symptomatic disc herniation. Disc herniations can become larger or extruded where the nuclear contents freely spit out from the disc space and cause more intense nerve compression and irritation resulting in severe and even incapacitating nerve-type sciatic leg pain. This process is frequently self-limiting but not always. Patients who are beginning to manifest these types of symptoms should consult their family doctor. They may benefit from certain exercises that can reduce the forces across the disc and alleviate symptoms. Rest, avoidance of repetitive bending and stooping, avoidance of heavy lifting and prolonged sitting in conjunction with the use of analgesic medications such as Tylenol and NSAIDS are appropriate. When symptoms become more severe or protracted especially when accompanied by leg numbness and weakness, an MRI is recommendable and consideration for more aggressive treatment such as lumbar epidural steroid injections. Patients who fail to respond or manifest progressive numbness or weakness in the legs or begin to manifest loss of bladder or bowel function require surgical evaluation by a spinal surgical specialist. Degenerative disc disease is ubiquitous in society and is not always symptomatic. Sometimes small fissures will present in the back or sides of the disc which can cause local pain for which analgesic medications, muscle relaxers and physical therapy are typically very helpful. In some individuals with more incapacitating attacks of back pain, there may be a place for epidural steroid injections or even spinal operative treatment.


This is a condition which can present in young patients and old. About 8% of the population have a bony defect, a spondylolysis which in time can result in a shift of the whole vertebral body, a spondylolisthesis. Some people know this is as a “slipped disc”. Treatment is usually non-operative with supportive medication as stated above and back strengthening exercise. With some individuals with more severe or incapacitating pain or functional limitations requiring injection therapies such as epidural steroid injections. When the condition results in concomitant nerve pain, sciatica with or without leg numbness or weakness, the condition is frequently treated by operative intervention by a spinal surgical specialist.


The spine bones may fracture after severe high-energy trauma such as from falls from heights, motor vehicle accidents or other types of direct or indirect trauma. However, some elderly individuals and even some younger individuals with metabolic disease or who are taking corticosteroids for chronic illness can develop vertebral body compression fractures under low trauma conditions or even with virtually no trauma at all. There should be a high index of suspicion in patients who already have been diagnosed with osteoporosis. The diagnosis is typically by x-ray examination in condition with a structural study such as an MRI. Treatment for this condition has become much more effective/satisfactory with vertebral augmentation procedures such as kyphoplasty which is typically offered


Spinal stenosis is a condition where the space available in the spinal canal behind the vertebral bodies is gradually encroached upon from local anatomic structures whether they be a bulging disc, enlarged arthritic facet joints, thickened ligamentum flavum or lamina and especially if there is a vertebral shift (spondylolisthesis or retrolisthesis). The patients typically will complain of increasing back pain and leg weakness and fatigue with standing and walking. They typically do better leaning forward, for instance, while walking behind a shopping cart. The treatment is initially with therapeutic exercise. Epidural steroid injections can favorably impact on this problem. Some individuals have stenosis so severe that they require operative management. Options available for such management include the new X-STOP implant as well as more traditional and frequently necessary lumbar laminectomy (decompressive) spinal surgical procedures. X-rays and lumbar spine MRI examinations are frequently required to make the diagnosis.


Some individuals unfortunately have back pain for reasons which are not benign. There are a variety of structures or conditions which can cause this. One such condition is a tumor of one of the bones of the spine or one of the nerve structures. Some tumors themselves are benign but most frequently tumors of the spine are the result of metastases from breast cancer, prostatic cancer alike. Individuals who are likely undergoing such treatment should have a high index of suspicion if they are experiencing pain, severe in nature, even at rest. Infections can also cause such intractable severe pain at rest, such as spondylodiscitis; frequently the result of urinary tract infections and other types of skin infections in individuals who have compromised immune status or have chronic corticosteroid therapies. Other conditions which can potentially cause non-mechanical back pain include kidney-related conditions such as kidney stones, pancreatic conditions such as pancreatitis and pancreatic cancers and even some vascular conditions such as a dissecting aortic aneurysm. These are all very serious problems which require urgent workup and appropriate and aggressive medical intervention.