There has been a significant shift in the medical understanding of spinal pain in recent years. I am writing this advisory article because outdated treatment standards are still widely practiced.
Spinal pain, whether in the lower back or neck, can be broadly divided into two main types: 1. The first type is pain caused by a soft disc herniation. This usually starts with localized back or neck pain and then radiates to the limbs. 2. The second type is chronic, recurrent pain that patients often describe as lower back pain that worsens with prolonged standing or sitting, sometimes with muscle spasms and stiffness after sleep. It typically improves with normal movement but may return after extended walking.
While treatment approaches for the first type are clear and almost universally agreed upon scientifically, the second type—which I believe is more common in our region (Egypt and the Arab Levant)—is still being diagnosed and treated using outdated approaches meant for the first type.
To clarify: the second type is multifactorial. Even when disc herniations are present on imaging, they often do not represent the true source of pain. From my experience in the Levant, the Gulf, and Iraq, the causes of this second type are clearly identifiable in only about 15% of cases. The rest require additional diagnostic tools, such as diagnostic injections.
This second type also requires a multimodal treatment approach, since pain may originate from multiple sources: vertebrae, facet joints, ligaments, or muscles. In recent years, minimally invasive interventions have been developed to target these sources, helping to avoid spinal fusion surgeries. However, due to the variety of these procedures and their costs, their adoption remains limited despite their proven effectiveness.
One barrier is the lack of alignment between scientific advances and insurance coverage. I believe the solution is for local insurance companies to follow the same standards used in the United States, which would be better for patients, while also creating mechanisms to distribute the additional costs of modern procedures.
This is a public awareness article, so I will not detail all the advanced procedures, as their terminology may be difficult for general readers. The key message is: the most common type of spinal pain in our region is the second type, and its diagnosis and treatment—through minimally invasive approaches—have evolved significantly. These differ from the first type, even though both may show disc changes on MRI. Their diagnostic and treatment pathways, whether conservative or surgical, are not the same.
For specialists, let me expand briefly: In the second type, pain often results from repeated inflammation detected by pain receptors, which transmit signals via two branches: • The anterior branch (from vertebrae and degenerated disc) through the sinuvertebral nerve (SVN). • The posterior branch via the medial branch (MB).
These signals travel to the spinal cord and then to the brain. To stop pain transmission without major surgery, both branches must be interrupted, or the primary pain pathway identified through diagnostic injections. Interruption techniques range from injections to ablation, radiofrequency, and laser, depending on the case. These methods can improve symptoms by 80–90%, and compared with spinal fusion and screw-plate surgeries, the results are generally very acceptable.
In conclusion: In my opinion, the second type is the most common in our region. It typically presents as pain worsened by prolonged sitting or standing, relieved by normal movement, and aggravated by stress, fatigue, cold drafts, or certain work postures. Both types show disc changes on MRI, but applying treatment standards of the first type to the second only leads to temporary relief, with symptoms recurring. Advances in minimally invasive diagnosis and treatment of the second type provide better long-term outcomes with minimal complications.
There has been a significant shift in the medical understanding of spinal pain in recent years. I am writing this advisory article because outdated treatment standards are still widely practiced.
Spinal pain, whether in the lower back or neck, can be broadly divided into two main types: 1. The first type is pain caused by a soft disc herniation. This usually starts with localized back or neck pain and then radiates to the limbs. 2. The second type is chronic, recurrent pain that patients often describe as lower back pain that worsens with prolonged standing or sitting, sometimes with muscle spasms and stiffness after sleep. It typically improves with normal movement but may return after extended walking.
While treatment approaches for the first type are clear and almost universally agreed upon scientifically, the second type—which I believe is more common in our region (Egypt and the Arab Levant)—is still being diagnosed and treated using outdated approaches meant for the first type.
To clarify: the second type is multifactorial. Even when disc herniations are present on imaging, they often do not represent the true source of pain. From my experience in the Levant, the Gulf, and Iraq, the causes of this second type are clearly identifiable in only about 15% of cases. The rest require additional diagnostic tools, such as diagnostic injections.
This second type also requires a multimodal treatment approach, since pain may originate from multiple sources: vertebrae, facet joints, ligaments, or muscles. In recent years, minimally invasive interventions have been developed to target these sources, helping to avoid spinal fusion surgeries. However, due to the variety of these procedures and their costs, their adoption remains limited despite their proven effectiveness.
One barrier is the lack of alignment between scientific advances and insurance coverage. I believe the solution is for local insurance companies to follow the same standards used in the United States, which would be better for patients, while also creating mechanisms to distribute the additional costs of modern procedures.
This is a public awareness article, so I will not detail all the advanced procedures, as their terminology may be difficult for general readers. The key message is: the most common type of spinal pain in our region is the second type, and its diagnosis and treatment—through minimally invasive approaches—have evolved significantly. These differ from the first type, even though both may show disc changes on MRI. Their diagnostic and treatment pathways, whether conservative or surgical, are not the same.
For specialists, let me expand briefly: In the second type, pain often results from repeated inflammation detected by pain receptors, which transmit signals via two branches: • The anterior branch (from vertebrae and degenerated disc) through the sinuvertebral nerve (SVN). • The posterior branch via the medial branch (MB).
These signals travel to the spinal cord and then to the brain. To stop pain transmission without major surgery, both branches must be interrupted, or the primary pain pathway identified through diagnostic injections. Interruption techniques range from injections to ablation, radiofrequency, and laser, depending on the case. These methods can improve symptoms by 80–90%, and compared with spinal fusion and screw-plate surgeries, the results are generally very acceptable.
In conclusion: In my opinion, the second type is the most common in our region. It typically presents as pain worsened by prolonged sitting or standing, relieved by normal movement, and aggravated by stress, fatigue, cold drafts, or certain work postures. Both types show disc changes on MRI, but applying treatment standards of the first type to the second only leads to temporary relief, with symptoms recurring. Advances in minimally invasive diagnosis and treatment of the second type provide better long-term outcomes with minimal complications.
There has been a significant shift in the medical understanding of spinal pain in recent years. I am writing this advisory article because outdated treatment standards are still widely practiced.
Spinal pain, whether in the lower back or neck, can be broadly divided into two main types: 1. The first type is pain caused by a soft disc herniation. This usually starts with localized back or neck pain and then radiates to the limbs. 2. The second type is chronic, recurrent pain that patients often describe as lower back pain that worsens with prolonged standing or sitting, sometimes with muscle spasms and stiffness after sleep. It typically improves with normal movement but may return after extended walking.
While treatment approaches for the first type are clear and almost universally agreed upon scientifically, the second type—which I believe is more common in our region (Egypt and the Arab Levant)—is still being diagnosed and treated using outdated approaches meant for the first type.
To clarify: the second type is multifactorial. Even when disc herniations are present on imaging, they often do not represent the true source of pain. From my experience in the Levant, the Gulf, and Iraq, the causes of this second type are clearly identifiable in only about 15% of cases. The rest require additional diagnostic tools, such as diagnostic injections.
This second type also requires a multimodal treatment approach, since pain may originate from multiple sources: vertebrae, facet joints, ligaments, or muscles. In recent years, minimally invasive interventions have been developed to target these sources, helping to avoid spinal fusion surgeries. However, due to the variety of these procedures and their costs, their adoption remains limited despite their proven effectiveness.
One barrier is the lack of alignment between scientific advances and insurance coverage. I believe the solution is for local insurance companies to follow the same standards used in the United States, which would be better for patients, while also creating mechanisms to distribute the additional costs of modern procedures.
This is a public awareness article, so I will not detail all the advanced procedures, as their terminology may be difficult for general readers. The key message is: the most common type of spinal pain in our region is the second type, and its diagnosis and treatment—through minimally invasive approaches—have evolved significantly. These differ from the first type, even though both may show disc changes on MRI. Their diagnostic and treatment pathways, whether conservative or surgical, are not the same.
For specialists, let me expand briefly: In the second type, pain often results from repeated inflammation detected by pain receptors, which transmit signals via two branches: • The anterior branch (from vertebrae and degenerated disc) through the sinuvertebral nerve (SVN). • The posterior branch via the medial branch (MB).
These signals travel to the spinal cord and then to the brain. To stop pain transmission without major surgery, both branches must be interrupted, or the primary pain pathway identified through diagnostic injections. Interruption techniques range from injections to ablation, radiofrequency, and laser, depending on the case. These methods can improve symptoms by 80–90%, and compared with spinal fusion and screw-plate surgeries, the results are generally very acceptable.
In conclusion: In my opinion, the second type is the most common in our region. It typically presents as pain worsened by prolonged sitting or standing, relieved by normal movement, and aggravated by stress, fatigue, cold drafts, or certain work postures. Both types show disc changes on MRI, but applying treatment standards of the first type to the second only leads to temporary relief, with symptoms recurring. Advances in minimally invasive diagnosis and treatment of the second type provide better long-term outcomes with minimal complications.
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