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The Degenerative Spine Cascade

The Degenerative Spine Cascade is the process by which the human spine changes and degenerates over time. A continuous process that can begin at any age, the degenerative spine cascade often takes 40-50 years or more to run its course and will affect 90% of the population to some degree during their lifetime.

The process of spinal degeneration usually starts at one level in the cervical, thoracic, or lumbar spine, and spreads to adjacent levels over a period of time. Commonly called spinal arthritis, spinal degeneration, and/or spondylosis, it is by far the most common cause of spinal conditions that individuals seek treatment for. Spinal degeneration can be a naturally occurring process brought on simply by wear and tear over time, or it can be initiated by acute or recurring injuries. Major trauma, sports related activities, occupational factors, genetic predisposition, diet and nutrition, weight, general health, exercise or activity level, smoking, and certain medication are all factors that can play a role in when and how quickly spinal degeneration develops and progresses.

The following flow chart attempts to explain the Degenerative Spine Cascade and the many conditions that may develop during the process. All of these conditions can occur alone or in conjunction with other conditions, and can occur at one or multiple levels/locations. The flow chart also lists commonly referred to acronyms (AKAs) for the conditions, the effects conditions may have on surrounding structures, typical symptoms, and the various treatment options available.

The Degenerative Spine Cascade Flow Chart

Sprains and Strains

Also Known As: Thrown Back, Pulled Muscle, Trigger Point, Segmental Dysfunction, Joint Out of Place
Age: 
Location and Severity of Pain: 

Type of pain:

  • Burning, Localized, Feels Warm to Touch, Non-Radiating, Swelling
  • Generalized Pain, Superficial, Hurts to Touch, Sore
  • Point Tenderness, Trigger Point, Pressure Point, Very Localized

Treating Back Sprains and Strains

Non-Surgical

Pain Procedure Surgery
Trigger Point Injection, Prolo or Sclero Facet Injection, Facet Block Radio Frequency Nerve Ablation, Laser Facet Ablation (Laser Spine Surgery)

 

Herniated Disc

Also Known As: Herniated Disc, Slipped Disc, Ruptured Disc, Bulging Disc, Pinched Nerve, Sciatica, Radiculopathy, Acute Disc Injury, Annulear Tear, Torn Disc
Age: 
Location and Severity of Pain: 

Type of pain:

  • Throbbing, Thumping, Fairly Localized
  • Severe Electric Shock Pain, Shooting Into Arm(s) or Leg(s)
  • Tingling Pain, Burning, Numbness
  • Pain is Constant, Never Goes Away, Night Pain

 Treating Disc Herniation

Non-Surgical

Pain Procedure Surgery

OTC Medicine, Physical Therapy, Spinal Manipulation, Rx Medication, Decompresstion Traction Machines

Epidural, Caudal-Epidural, Transforaminal Epidural, Selective Nerve Block Percutaneous Laser Discectomy, Percutaneous Nucleoplasty Coblation, Laminotomy, Laminectomy, Transforaminal Micro Discectomy, Microdiscectomy, Nucleus Replacement/Disc Stabilization Arthroplasty, Epidural Endoscopic Laser

 

Degenerative Disc Disease

Also Known As: Black Disc Disease, Desiccated Disc, Inflamed Disc, Internal Disc Disruption, Isolated Disc Resorption
Age: 
Location and Severity of Pain: 

Type of pain:

  • Deep Aching Pain, Non Reproducible
  • Pain is Position/Activity Dependent
  • Morning Pain, Stiffness, Gets Better as Day Goes On

Treating Degenerative Disc Disease

Non-Surgical

Pain Procedure Surgery
Epidural, Caudal-Epidural, IDET (Intradiscal Electrothermic Therapy) Nucleus Replacement/Disc Stabilization Arthroplasty, Artificial Disc Replacement, Artificial Facet Replacement, Interbody Fusion, Epidural Endescopic Laser

 

Dynamic Lateral Recess Stenosis & Foraminal Narrowing

Also Known As: Collapsing Disc, Spinal Instability, Vertical Instability, Torn Facet Ligaments, Facet Arthritis
Age: 
Location and Severity of Pain: 

Type of pain:

  • Deep Aching Pain, Non Reproducible
  • Pain is Position/Activity Dependent
  • Morning Pain, Stiffness, Gets Better as Day Goes On

 Treating Dynamic Lateral Recess Stenosis

Non-Surgical

Pain Procedure Surgery

Decompression Traction Machines

Facet Block, Radio Frequency Nerve Ablation, Laser Facet Ablation (Laser Spine Surgery) Endoscopic Transforaminal Laser Decompression, Micro Transforaminal Decompression, Percutaneous Facet Fusion, Instrumented Fusion, Interbody Fusion,  Artificial Facets, Stabilization Bands

 

Degenerative Spondylolisthesis & Degenerative Scoliosis

Also Known As: Slipped Vertebrae, Spinal Instability, Curvature of the Spine, Twisted Spine, Crooked Spine, Shifted Spine, Sway Back, Flat Back
Age: 
Location and Severity of Pain: 

Type of pain:

  • Burning, Localized, Feels Warm to Touch, Non-Radiating, Swelling
  • Deep Aching Pain, Non Reproducible
  • Severe Tooth Ache, Throbbing, Thumping, Fairly Localized
  • Severe Electric Shock Pain, Shooting Into Arm(s) or Leg(s)
  • Tingling Pain, Burning, Numbness

Treating Degenerative Spondylolisthesis & Degenerative Scoliosis

Non-Surgical

Pain Procedure Surgery
Epidural, Transforaminal Epidural, Selective Nerve Block Percutaneous Spinal Fusion/Sextant, Spinal Fusion without Instrumentation and Implants, Spinal Fusion with Instrumentation and Implants, Major Spine Reconstruction, Laminectomy, Microdecompression Laminaplasty

 

Fixed Lateral Recess Stenosis

Also Known As: Bone Spurs, Arthritis of Spine, Facet Degeneration
Age: 
Location and Severity of Pain: 

Type of pain:

  • Deep Aching Pain, Non Reproducible
  • Pain is Position/Activity Dependent

 Treating Fixed Lateral Recess Stenosis

Non-Surgical

Pain Procedure Surgery

OTC Medicine, Traction, Water Exercises, Rx Medication, Decompression Traction Machines

Epidural, Caudal-Epidural, Transforaminal Epidural, Radio Frequency Nerve Ablation, Laser Facet Ablation (Laser Spine Surgery) Percutaneous Spinal Fusion/Sextant, Spinal Fusion without Instrumentation and Implants, Spinal Fusion with Instrumentation and Implants, Microdecompression Laminaplasty

 

Central Spine Stenosis

Also Known As: Spinal Stenosis, Neurogenic Claudication, Pinched Nerve, Sciatica, Radiculopathy, Myelopathy, Spondylosis, Stiff Back
Age: 
Location and Severity of Pain: 

Type of pain:

  • Burning, Localized, Feels Warm to Touch, Non-Radiating, Swelling
  • Deep Aching Pain, Non Reproducible
  • Severe Electric Shock Pain, Shooting Into Arm(s) or Leg(s)
  • Pain is Position/Activity Dependent

Treating Central Spine Stenosis

Non-Surgical

Pain Procedure Surgery
Epidural, Caudal-Epidural, Transforaminal Epidural, Selective Nerve Block, Radio Frequency Nerve Ablation, Laser Facet Ablation (Laser Spine Surgery) Transforaminal Micro Decompression, Microdecompression Laminaplasty, MED (Micro Endoscopic Decompression), Laminotomy, Laminectomy, Laminaplasty (Lumbar), Indirect Spinal Distraction Decompression (X-Stop), Spinal Fusion with Instrumentation and Implants

 

Multi Level Spondylosis

Also Known As: Spinal Stenosis, Neurogenic Claudication, Pinched Nerve, Sciatica, Radiculopathy, Myelopathy, Spondylosis, Stiff Back
Age: 
Location and Severity of Pain: 

Type of pain:

  • Burning, Localized, Feels Warm to Touch, Non-Radiating, Swelling
  • Deep Aching Pain, Non Reproducible
  • Severe Electric Shock Pain, Shooting Into Arm(s) or Leg(s)
  • Pain is Position/Activity Dependent

 Treating Multi Level Spondylosis

Non-Surgical

Pain Procedure Surgery
Epidural, Caudal-Epidural, Transforaminal Epidural, Selective Nerve Block, Radio Frequency Nerve Ablation, Laser Facet Ablation (Laser Spine Surgery) Transforaminal Micro Decompression, Microdecompression Laminaplasty, MED (Micro Endoscopic Decompression), Laminotomy, Laminectomy, Laminaplasty (Lumbar), Indirect Spinal Distraction Decompression (X-Stop), Spinal Fusion with Instrumentation and Implants