FAQ

You can book online through our appointment page or call the office at (424) 217-7463. If you already have an MRI or CT scan, upload it first — Dr. Melamed reviews your imaging before the visit so your time together is spent on a plan, not paperwork.

Bring any recent imaging (MRI, CT, or X-ray) on a disc or uploaded ahead of time, a list of treatments you have already tried, your current medications, and your insurance card. If your imaging is older than a year, we will let you know whether a new study is worth getting.

Yes, and many patients come to us for exactly that. A recommendation for fusion is not always the only option. Dr. Melamed will review your imaging and tell you honestly whether a smaller, muscle-sparing procedure — or no surgery at all — is realistic for your case.

Yes. Dr. Melamed works with many major insurance plans and also sees out-of-network and self-pay patients. Our team verifies your benefits before any procedure so you know what to expect ahead of time.

We do. If we are out of network with your plan, our team will walk you through your out-of-network benefits and provide clear, itemized pricing for self-pay care so there are no surprises.

For patients who need it, we can point you to third-party medical financing options that spread the cost over time. Ask our team during your benefits review and we will share what is available.

Cost depends on the specific procedure, the facility, and your coverage, so there is no single number. Once Dr. Melamed has reviewed your imaging and recommended an approach, our team gives you a clear estimate based on your plan before you commit to anything.

Most patients with sciatica, a herniated or bulging disc, stenosis, or nerve compression are candidates. The fastest way to know for certain is to upload your MRI or CT scan for a personal review by Dr. Melamed.

Progressive, severe, and disabling pain as well as numbness, tingling, and weakness all indicate a need for surgery. Moreover progressive nerve damage or deformities of the spine suggest that surgery may be needed.

If nerve or spinal cord pressure lasts for an extended period of time the changes could be permanent which would typically occur with a patient who had considerable clumsiness or weakness which is termed spinal degeneration symptoms. If surgery is delayed, patients that mainly have neck pain, probably have a small chance of permanent damage, provided that their problem is associated to simple degeneration. However, surgery should not be delayed for patients with cancer, infections, fractures, or instability involving the spine. Overall, the length of existence of nerve or spinal cord compression is inversely proportional with a chance of complete recovery.

The decision to perform cervical fusion depends upon a couple of factors such as the shape of your spine, the nature of the disc disease, and your symptoms. It is not the case that every individual who has a cervical discectomy must get a fusion. There are two different ways to take pressure off nerves, anterior and posterior approaches that do not require a fusion. Nevertheless, a fusion is a common procedure and is tremendously useful in patients with noteworthy loss of disc space height, deformity of the neck and significant neck pain as well as arm symptoms.

One reason is the location of the problem, which is usually from the front where the pressure is on the nerves and spinal cord. Conducting surgery from the back of the neck would mean that the spinal cord would have to be moved out of the way. Coming from the front is less invasive than coming from the back. Hardly any muscles are cut when the procedure is done from the front. Also, there is little blood involved when operating from the front.

The effect depends on a couple of things such as what level of the spine is fused and how many levels are fused. The majority of the nodding and turning of the head happen at the highest cervical levels, which are hardly ever involved in cervical fusion operations. Fusions performed in the middle of the cervical spine are the most common. By having the bones grow together at one or more levels, some of the stress of head motion will be moved to neighboring cervical spinal levels. Although it has not been proven yet, there is the thought that this might cause accelerated breakdown at the neighboring spinal levels. Once more, however, an individual should not have a cervical fusion except for when it is considered completely necessary, if that is the case, the risk of degeneration at neighboring segment levels is worth taking.

It varies by procedure and patient, but because the muscle is spared rather than cut, most people are up and walking the same day and return to light activity in a matter of weeks rather than months. Dr. Melamed will give you a realistic timeline for your specific case.

Typical timelines by procedure:

Microdecompression/microlaminotomy/microforaminotomy – The typical recovery time for microdecompression is usually up to 6-12 weeks depending on the patient and how the patient is feeling after surgery. The first six weeks after surgery will have many ups and downs. The patient will have some good days and some bad days. You may experience arm pain or leg pain if you had neck or low back surgery respectively. As the weeks progress, the good days will outweigh the bad days. The patient will typically be asked to take it easy for the first 4 weeks. The surgical pain itself typically takes about 6 weeks to get better. This means no bending, twisting, or lifting greater than 10 pounds for the first 4 weeks. The patient can, and is encouraged, to walk around the house/neighborhood as tolerated immediately post-surgery. Around the four week mark, it is ok to remove the brace if you had lumbar surgery. If you had neck surgery, the brace is typically removed few days after surgery and you may move your neck as tolerated. We usually begin PT around 6 weeks. At 8-12 weeks the patient should be ready to go back to full activity as tolerated.

Microdiscectomy – The risk of re-herniation of the disc in a microdiscectomy is greatest in the first 3 months. Therefore, we typically have the patient stay in the brace for the first 4 weeks. The first six weeks after surgery will have many ups and downs (if you have had the nerve pain for many months prior to surgery then nerve pain relief from surgery can last few months). The patient will have some good days and some bad days. You may experience arm pain or leg pain if you had neck or low back surgery respectively. As the weeks progress, the good days will outweigh the bad days. The patient will typically be asked to take it easy for the first 4 weeks. The surgical pain itself typically takes about 6 weeks to get better. This means no bending, twisting, or lifting greater than 10 pounds for the first 4 weeks. The patient can, and is encouraged, to walk around the house/neighborhood as tolerated immediately post-surgery. Around the four week mark, it is ok to remove the brace if you had lumbar surgery. If you had neck surgery, the brace is typically removed few days after surgery and you may move your neck as tolerated. We usually begin PT around 6 weeks. The patient usually returns to full activity in 5-6 months.

Lumbar Fusion – Ordinarily, the recovery time for a lumbar fusion is longer than a microdecompression because we must allow time for the fusion to begin the healing process. Patients will be required to wear the brace for 6-12 weeks following surgery. The patient also should not push, pull or lift anything exceeding ten pounds for the first 2 months as well. The first six weeks after surgery will have many ups and downs. The patient will have some good days and some bad days. You may experience arm pain or leg pain if you had neck or low back surgery respectively. As the weeks progress, the good days will outweigh the bad days. The patient can, and is encouraged, to walk around the house/neighborhood as tolerated immediately post-surgery once discharged home. At three months we begin PT. The weight restriction is also increased by 5 pounds every two weeks at this 2 months mark. The patient can usually return to full activity by 6 months.

Cervical Fusion – Ordinarily, the recovery time for a cervical fusion is longer than a microdecompression because we must allow time for the fusion to begin the healing process. A soft collar typically is used for few days after surgery but should not be worn for longer. The reason for this is to keep the neck muscles strong and to help decrease recovery time. The patient also should not push, pull or lift anything exceeding ten pounds for the first 2 months as well. The patient can, and is encouraged, to walk around the house/neighborhood as tolerated immediately post-surgery. The first six weeks after surgery will have many ups and downs. The patient will have some good days and some bad days. You may experience arm pain or leg pain if you had neck or low back surgery respectively. As the weeks progress, the good days will outweigh the bad days. The patient will typically be asked to take it easy for the first 4 weeks. The surgical pain itself typically takes about 6 weeks to get better. The weight restriction is also increased by 5 pounds every two weeks at this 2-month mark. The patient can usually return to full activity by 3-6 months depending on fusion status which is determined by x-rays at follow-up appointments.

Artificial disc replacement – The typical recovery time for microdecompression is usually up to 6-12 weeks depending on the patient and how the patient is feeling after surgery. The first six weeks after surgery will have many ups and downs. The patient will have some good days and some bad days. You may experience arm pain or leg pain if you had neck or low back surgery respectively. As the weeks progress, the good days will outweigh the bad days. The patient will typically be asked to take it easy for the first 4 weeks. The surgical pain itself typically takes about 6 weeks to get better. At 6 weeks, the patient is encouraged to start PT and increase activities as tolerated and back to full activities by 3 months.

Dr. Melamed's approach is designed to minimize narcotics. The muscle-sparing technique and outpatient recovery mean most patients need far less pain medication than with traditional open surgery.

For most cases, yes. Many biportal endoscopic and minimally invasive procedures are performed same-day, so you recover at home rather than in a hospital. Whether that is right for you depends on your specific condition and health.

It is of paramount importance to quit smoking before any surgery, especially spine surgery. There are many reasons. Smoking has been shown to have very negative impact on wound/incision healing. The chance of infection goes much higher since the soft tissues (muscles/ligaments/tendons/skin) do not heal as well. It diminishes one’s immune system. It also has been shown to interfere with nerve recovery and nerve regeneration. Simply put, if you have nerve damage going into surgery, there is much less chance of nerve recovery. If you are having surgery to remove a herniated disc, it highly increases risk of reherniation and not to mention that the disc just doesn’t heal as well. I personally, unless absolutely urgent or emergent, will not operate on patients who smoke and will always have a discussion with them about quitting smoking.

Medications that need to be stopped at least 2 weeks prior to surgery include aspirin, aspirin containing medications, anti-inflammatories which include: ibuprofen, naproxen, Motrin, Advil, Aleve, and Celebrex among others, and any Chinese herbs or plant extracts especially: ginkgo biloba, ma huang, kava-kava root, St. John’s wort, MSM, glucosamine, Sam-E, ginger, ginseng, fish oil, multi-vitamins, and garlic tablets. Plavix should be stopped 2.5 weeks prior, Coumadin 5 days before, and heparin/lovenox 48 hours before.

The patient is allowed to eat/drink up to 8 hours before the procedure. Please do not eat or drink anything 8 hours before your anticipated surgical time.

No, you do not need to bring your medications with you to the hospital. The hospital will provide you with any regular medications that you were taking at home for the duration of your stay. A list of medications along with dosages may be appropriate to bring so that the hospital knows exactly what meds you are taking at home.

Microdecompression/microdiscectomy/posterior lumbar or cervical fusion – It is okay to shower after surgery as long as the bandages are covered in plastic wrap and they do not get wet. At 7 days post-op the bandage is removed and if the wound is healing as expected then the patient can shower without the bandage or plastic wrap and allow the water to run over the wound. The steri-strips should NOT be removed. They should be allowed to fall off on their own. This usually occurs 2-3 weeks after surgery.

Anterior Cervical Fusion/artificial disc replacement – It is okay to shower after surgery as long as the bandages are covered in plastic wrap and they do not get wet. At 3 days post-op the bandage is removed and if the wound is healing as expected then the patient can shower without the bandage or plastic wrap and allow the water to run over the wound. The steri-strips should NOT be removed. They should be allowed to fall off on their own. This usually occurs 2-3 weeks after surgery.

Anterior Lumbar fusion/artificial disc replacement – It is okay to shower after surgery as long as the bandages are covered in plastic wrap and they do not get wet. At 3 days post-op the bandage is removed and if the wound is healing as expected then the patient can shower without the bandage or plastic wrap and allow the water to run over the wound. The steri-strips should NOT be removed. They should be allowed to fall off on their own. This usually occurs 2-3 weeks after surgery.

No, the steri-strips should be allowed to fall off on their own. This process can usually take 2-3 weeks after surgery.

While stitches are placed in the incision there will be no need to remove any stitches after surgery. There are no stitches that are used on the outer part of the wound. Instead, steri-strips are used to keep the wound closed. These steri-strips will eventually fall off on their own. Once the incision site has healed and the steri-strips have fallen off no stitches will be seen.

The more ice you use the better it is to keep the swelling and inflammation down. Just like professional athletes use ice after the game to cool down their joints, the same concept is applied for your incision. By keeping the inflammation and swelling down, this helps to minimize pain and even more important maximize faster and speedier recovery.

Cervical Surgery – The meds that will be ordered include: Norco 10/325 mg which is a narcotic that is used as needed for pain, Robaxin 750mg which is a muscle relaxant that is used as needed for muscle spasms, and Ultram 50 mg which is also a pain medication that can be used as needed. We encourage patients to only use narcotics if necessary. The patient should try to decrease the narcotic usage as much as possible over the first several weeks.

Lumbar Surgery – The meds that will be ordered include: Norco 10/325 mg which is a narcotic that is used as needed for pain, Robaxin 750mg which is a muscle relaxant that is used as needed for muscle spasms, and Relafen 750 mg which is an anti-inflammatory that is used as needed for inflammation and pain. You may take the Norco and the Relafen together as needed if your pain is uncontrolled. We encourage patients to only use narcotics if necessary. The patient should try to decrease the narcotic usage as much as possible over the first several weeks.

It is normal for the patient to not have a bowel movement for 2-3 days after surgery. However, sometimes constipation can last longer. This can be due to the medications that have been prescribed for pain or decreased fluid and food intake. Some at home remedies for constipation include increased fluid intake, fiber supplements, and prune juice. If these do not help then a prescription medication can be called in by the Physician to help with the constipation.

The typical time-frame for post-op appointments includes a one-week follow-up with Dr. Melamed or his Physician Assistant to perform a wound check and to go over any questions following surgery. Then the patient is seen back in 4-5 weeks for the next follow-up appointment with Dr. Melamed. If the patient had a fusion then there will be X-rays taken at this appointment to evaluate the fusion and any hardware that may have been placed during surgery. There is a 3-month post-operative appointment with X-rays as well if you had fusion or artificial disc replacement. Any appointments after 3 months are determined by Dr. Melamed and his staff.

It is okay to begin driving at 7 days post-operatively. The patient should start off driving only short distances around town. The distance can be increased gradually as tolerated over time. The patient should never drive if still taking narcotics for pain post-surgery.

Microdecompression – Physical therapy is usually started at about 4-6 weeks depending on how well the patient is recovering. Once the patient is ready to begin physical therapy he/she will be given a prescription. The physical therapist is chosen by the patient and a list of PT practices may be provided.

Microdiscectomy – Physical therapy after these surgeries is typically started at around 6-8 weeks depending on how well the patient is doing. This is longer than a microdecompression because of the risk of re-herniation in a microdiscectomy.

Lumbar Fusion/Cervical Fusion – Physical therapy after these surgeries is typically started at around 3 months depending on how well the patient is doing. This is longer than a microdecompression because of the amount of time needed to ensure healing for a fusion. Once the patient is ready to begin physical therapy he/she will be given a prescription. The physical therapist is chosen by the patient and a list of PT practices may be provided.

Microdiscectomy/Microdecompression lumbar – The brace is typically worn for 4 weeks.

Microdiscectomy/Microdecompression cervical – soft collar for few days only.

Lumbar Fusion – The brace is typically worn for 6-12 weeks.

Cervical Fusion – A soft collar may be placed for few days but is not to be worn after that period of time.

Bone stimulators are sometimes given to patients after a lumbar or cervical fusion. They help to stimulate fusion growth and healing. The bone stimulator is used every day after surgery for 30 minutes per day. The stimulator will be used for at least 6 months after surgery and possibly longer if deemed necessary.

Disability forms can be mailed to Dr. Hooman Melamed at 9777 Wilshire Blvd, Suite 808, Beverly Hills, CA 90212.

Absolutely. A large share of our patients travel to Beverly Hills. We coordinate telehealth consultations, remote MRI review, and travel logistics so your visit is efficient and most of the process happens before you ever get on a plane.

After you upload your imaging, we schedule a video visit with Dr. Melamed. He reviews your scans with you, explains your options, and outlines a plan. If surgery makes sense, we coordinate a single focused trip so you are not making repeated visits.

Use the upload page to send your imaging securely, or bring it on a disc. Dr. Melamed personally reviews it — not a coordinator — and tells you whether a muscle-sparing option is realistic before you travel or commit to anything.

It uses two incisions under a centimeter and a high-definition endoscope instead of a large open wound. Muscle is spared rather than cut, so most patients go home the same day with far less pain and narcotic use.

Sciatica, herniated and bulging discs, spinal and foraminal stenosis, pinched nerves, and select cases of instability and deformity can often be addressed with minimally invasive technique. Your imaging determines what is appropriate for you.

Yes. Dr. Hooman Melamed is a board-certified orthopedic spine surgeon with two decades in practice, fellowship-trained at the Cedars-Sinai Institute for Spinal Disorders, and a member of the American Academy of Orthopaedic Surgeons and the Scoliosis Research Society.

We treat nearly all conditions related to the spine, including injuries, arthritis, and degenerative diseases. We specialize in treating back pain and radicular or radiating pain. We understand that pain felt in the arms, hips or legs can often be the result of a spinal injury or pinched nerve in the spinal region. A full list of conditions we treat includes:

• Arthritis of the spine
• Bulging discs
• Degenerative disc disease (DDD)
• Failed back surgery syndrome (FBSS)
• Foraminal stenosis
• Herniated discs
• Sciatica
• Scoliosis
• Spinal stenosis
• Annular tear
• Bone spurs
• Collapsed disc
• Disc extrusion
• Canal stenosis
• Degenerative joint disease
• Disc protrusion
• Facet joint disease
• Pinched nerve
• SI joint pain (Sacroiliac)
• Spondylitis
• Spondylolisthesis
• Spondylosis
• Torn disc

We specialize in treating the bones, ligaments and nerves in the spinal region, including the neck, cervical spine and lumbar spine. Oftentimes, pain felt in the arms, hips or legs are the result of radicular pain from a spinal injury or pinched nerve in the spinal region. In these cases, we treat the disc herniation that is causing pain to radiate to the limbs.

We believe in a holistic and integrative approach to spinal care. Only once a patient has exhausted all conservative treatments will we consider surgery as an option. There are a variety of minimally invasive treatment options for spinal wellness that we may consider. A complete list of treatments includes:

• Minimally invasive spinal surgery
• Artificial disc replacement
• Microdecompression treatments
• PRP and cell therapy
• Cervical and lumbar surgery
• Scoliosis and spinal deformity surgery
• Degenerative disc disease surgery
• Outpatient fusion surgery

A ligamentous structure that is located between juxtaposing vertebrae that enables motion in the spine. One purpose of a disc is to act as a shock absorber but the main purpose is to allow movement to be possible in the spine. The spine can move in many directions due to the discs such as side-bending to the right or left, rotation to the right or left, flexion, extension, and distraction and compression along the axis of the spine. The center of a healthy disc is soft, the other portion is hard consisting of very tough ligaments. It is this tough outer portion that allows the movement of the spine in different directions. There are no specific nerves or blood supply within the disc but the outside is vastly innervated with nerve fibers. Severe back pain occurs when these outside nerve fibers are irritated. The nerves that supply pain sensation to the outside of the disc are not the same as the nerves that go behind the disc and down into the limbs. When the nerves that go down into the limbs get tightened, pain radiates into the limbs. This type of pain is called radicular pain. If the disc in question is located in the low back, central or back pain is produced when irritation of the nerves that innervate the outside of the disc occur. Neck pain is produced when the disc is in the neck.

Discs are located between vertebrae in juxtaposition acting as shock absorbers. When these “shock absorbers” weaken they may “bulge,” “slip,” “rupture,” or “herniate” and in turn press on the nerve roots or spinal cord. When a piece of disc is not in the correct place it is called herniation.

There is a typical height and shape for a normal healthy disc. As a disc loses its normal water content and begins to deteriorate, its ligamentous strength weakens. The loss of water content is usually accompanied by loss of height, which then causes the periphery of the disc to stick out beyond the edges of the bone. This can be compared to letting air out of a bicycle tire. As a bicycle tire loses air, the tire broadens outwards as height decreases. This compares to a disc that goes beyond the normal edge of the bone by more than 50% of the circumference, and is called a disc bulge. In comparison, when a portion of the disc goes out beyond the periphery of the normal adjacent bony edges and measures less than 50% of the circumference of the disc, a herniated disc occurs. This usually occurs when the outer lining of the disc becomes torn, letting a fragment of the disc material be pushed out of the normal boundaries of the disc itself. If this disc fragment herniates enough and compresses one of the surrounding nerves as it goes to a limb, it usually creates radicular pain into that specific limb. For example, if the disc herniation or fragment is in the neck and is compressing one of the nerves going into the arm, then pain will be generated from the neck down into the arm along the distribution of the nerve. Besides pain, other sensations such as burning, numbness, and tingling and any combination could be experienced as well. Sometimes, a patient might experience only neck pain. In most situations, a bulging disc is linked with neck or back pain.

They are very common. The age of the patient and significant disc changes on MRI are directly proportional. It is the result of the normal aging process therefore very common in older people.

A disc herniates when the outer lining is torn, and the inner soft jelly-like portion has pushed out of the tear and is compressing the adjacent nerve roots. This pressure on the nerve roots causes low back pain as well as leg pain. This can lead to many different sensations such as tingling, burning, numbness and weakness. In its more severe form can be progressive and even affect bowel and bladder function. This is called cauda equina syndrome and is a very infrequent complication of disc herniation.

In the instance where a herniation occurs due to an extreme injury such as heavy lifting or motor vehicle accident, the cause of the herniation is obvious due to the fact that pain will develop shortly after the event. However, there are instances where a herniation occurs without known trauma. When this occurs it is usually thought that the herniation may have developed due to one of several etiologies. For instance, a significant trauma might have a cumulative effect on the disc, but was not noticed at that time. Another etiology could be a series of minor injuries that may have had a cumulative effect on the disc. Moreover, simple gradual degeneration, “wear and tear”, can contribute to destabilizing the disc until it herniates.

Disc injury can cause pain in a number of ways. One way the injured disc can be painful is just by tearing the outer portion of the disc and aggravating the nerves that innervate the outer edge of the disc. Another way is the injured disc may start to degenerate, thereby causing enzymes to be created. These enzymes can leak out of the disc and additionally aggravate the nerves on the outside of the disc which is a common cause of chronic back pain. Another way is that the injured disc is frequently weakened and does not work correctly. In particular, it does not inhibit irregular motion of one vertebra in comparison to the next. For instance, if a knee ligament were injured and stretched, the person would lose support in that knee. At a microscopic level, the same occurs when a disc is injured causing back pain. This allows for micro-translation movements of the disc, which causes inflammation of the surrounding soft tissue and the nerves that innervate the disc. The degenerative process is furthered by micro-instability and causes more production of degenerative enzymes in the disc, thereby aggravating the back pain. This scenario is quite frequent in patients with chronic low back pain.

A piece of a disc can break away from the injured disc and compress the surrounding nerves that innervate the leg or arm. If there is enough pressure on these nerves, then the patient will experience leg or arm pain. Depending on the position of compression, central pain can also occur in the low back or neck.

The muscular or ligamentous structures of the spine can be damaged with whiplash injury to the cervical spine. Exacerbation of a herniated disc of the neck can result if the whiplash injures the annulus of the disc. It is very unlikely that a normal disc would become a herniated disc with whiplash. The former is a more common occurrence.

Initially, the symptoms of pain, weakness, and numbness may be quite uncomfortable when a disc herniates. Within a few weeks, as healing occurs, the pain will diminish in intensity. Weakness might take longer. Numbness may or may not get better even after surgery. The first treatment modality consists of alleviating the inflammatory pain with non-narcotic anti-inflammatory medications such as a short course of steroids or NSAIDs. Acupuncture can be helpful as well. If pain is severe enough, sometimes a short course of narcotics may be indicated. As the pain lessens, a good physical therapy program emphasizing core conditioning can help in the healing process and prevent deconditioning. A good chiropractic program can also be quite helpful. If all else fails then microsurgery and microdecompression may be needed.

One of the most common ailments known to man is back pain. Nearly 80% of the adult population will develop a significant episode of back pain sometime in their life. Luckily, most of this pain will subside on its own. However, approximately 10% to 20 % will develop into substantial chronic and/or recurrent episodes of back pain. Degenerative arthritis and degenerative disc disease are two of the most common causes of this type of pain. Although uncommon, infection, trauma, tumor, internal organs and aneurysms can cause back pain. Muscular etiologies such as strain or tear can cause acute low back pain but these are short-lived and will resolve with time. Lack of appropriate posture, flexibility, and condition can aggravate symptoms.

Between the ages of 30 and 50 years old disabling low back pain can develop. Probably the reason for this is that the degenerative process has begun by the age of 30 to 50, and people in that age group are usually active enough to be putting their bodies and the already degenerative disc disease at risk for injury. In this age group, it is not uncommon for people to be very busy with their lives and career so that they do not put as much emphasis in taking good care of themselves physically as opposed to when they were younger. This can lead to higher wear and tear on the disc and thereby increasing the risk of significant pain and injury. Men and women both equally experience low back pain.

Adolescents also experience low back pain, which is not uncommon. This used to be viewed as possibly an underlying potential problem but now most of them are self-limited and benign. Just like adults, adolescents need to be wary of proper preventive procedures such as learning good body mechanics and participating in a proper strengthening and conditioning program for their spine and overall body.

Most patients improve within the first few weeks. In fact, most patients get better in two to three months without any intervention. However, within 6 months, 20-30% of patients will get a recurrence of their symptoms. Luckily, the majority of these recurrences are not disabling but can lead to unremitting problems with alternating episodes of discomfort. Unfortunately, 5%-15% of patients will tend to develop chronic low back pain which can become disabling.

Historically, the recommended treatment for back pain was prolonged bed rest. However, recent literature has shown that bed rest more than 2-3 days can actually be detrimental and make the patient worse in the long term. Bed rest leads to loss of muscle tone and overall de-conditions the patient. The patient can gradually increase activities and modify his/her activities which do not aggravate the back pain. When the case is severe back pain and the individual cannot even tolerate simple activities such as standing, walking, or sitting then bed rest is the best remedy. A short course of bed rest combined with proper medication can be quite helpful in these cases. Once the patient can tolerate the pain after a limited period of bed rest, the individual should be placed into a rehabilitation program consisting of strengthening and flexibility.

Accelerated disc degeneration has been positively correlated with smoking as well as increased pain perception amongst people who go through treatment. In addition, it has been connected with increased use of narcotics in order to control pain and increased discontent and less than satisfactory results with non-operative and operative treatment of spine problems as well as other musculoskeletal issues. All else being equal, a patient who smokes has a higher risk factor for spine and orthopedic problems than a patient who does not. Rates of fusion and overall success of spine surgery are significantly less in patients who smoke.

DDD is essentially arthritis of the disc. The disc acts as a shock absorber between the bones of the spine. These discs can become arthritic and deteriorate with stress, age, and strain. When this occurs this is called degenerative. This is similar to what happens when the cartilage wears out in hip or knee. The first step would be a conservative treatment, which consists of anti-inflammatory medications, physical therapy and a back school program with emphasis on core strengthening and trunk stability. Patients will learn to keep his/her body in optimum aerobic condition with good core program. Patients will also learn proper body mechanics and preventive measures to protect themselves from injury. Ultimately, when conservative measures fail, the patient can be a candidate for fusion or non-fusion technology such as artificial disc replacement or dynamic stabilization. This helps to relieve the stress on the arthritic motion segment and help with pain.

The most common reason for patients over 65 years of age, to have spine surgery is spinal stenosis. This is when the space available for the spinal cord and nerve roots becomes quite narrow. There are multiple reasons for this narrowing. The most common reasons are bone spurs, thickening of the ligamentum flavum (yellow ligament), overgrowth of facet joints due to wear and tear, disc space collapse and disc bulges. When this happens in the lumbar spine or lower back, this can lead to neurogenic claudication. This is when the patient experiences weakness, pain, numbness, and/or cramping in his/her legs when standing and walking. Sitting and laying down alleviates the pain. Pushing on the grocery cart relieves the pain as well.

When stenosis and narrowing is in the cervical or thoracic spine, then myelopathy can develop. This is when the spinal cord is getting compressed. Pain is typically not associated with this. The patient usually develops difficulty with balance, gait, and coordination. Hand-writing and fine-finger movement will deteriorate with time. Patient can experience burning sensation in fingertips and toes.

When the ligaments, discs and joints that support the bones of the spine are damaged to the end point meaning they can no longer hold the bones together and function as an effective unit, this is defined as lumbar instability which causes back pain. When the bones are out of position with respect to one another, they can compress the neighboring nerves and cause leg weakness and pain. Other terms for lumbar instability are also Internal Disc Derangement.

Mechanical, coming from the joint or the disc; radicular, coming from a nerve or nerve root; are two categories that neck pain can be divided into. Each part of the spine has basically three joints, the disc in the front and two facet joints in the back. Same as the lumbar spine or lower back these are also subject to mechanical wear and tear with time and these changes are usually seen after the age of 30. Just as in lumbar spine, degenerative disc disease can develop and lead to neck pain. When a specific nerve is affected, the patient experiences pain down the arm or around the neck in the distribution of the nerve. This is coined radiculopathy. If the spinal cord is affected then this is called myelopathy. This is when the spinal cord is getting compressed. Pain is typically not associated with this. The patient usually develops difficulty with balance, gait, and coordination. Hand-writing and fine-finger movement will deteriorate with time. Patient can experience burning sensation in fingertips and toes. A detailed history and physical exam of the entire spine can discern the exact problem.

After a careful history and physical examination, the physician will decide if an MRI scan is needed. Allowing some time to pass before obtaining an MRI is desirable because sometimes patients will improve with time, unless there is evidence of a significant neurological deficit. As a result, the MRI scan and the findings found in the MRI scan can, in fact, lead to significant confusion in terms of patient diagnosis. However, the MRI is essential if the individual is suffering significant weakness, problems walking, or bladder trouble.

Depending on the patient the proper therapy will be prescribed such as anti-inflammatory agents, oral steroids, physical therapy, injections, and electrical stimulation.

Rest, medication, and occasionally physical therapy often resolves neck and arm pain. A spine specialist would be able to give the best evaluation in regards to cervical disc disease, neck and arm pain are the case. When all more serious conditions have not been diagnosed the patient can start a program of neck rehabilitation which includes a workplace assessment to utilize office ergonomics. In addition, essential rest and sleep habits must be included. Finally, changes in work around the home or recreational activities can ameliorate a great deal of the problem.