Extremity pain , usually radiating pain down the arm or leg typically occurs when there is nerve compression in the neck or the low back. This is often reffered to as radiculopathy. The nerve compression usually occurs from disc herniation or bone spurs, but there are other causes.

A Physician Assistant known as PA-C is certified by the (NCCPA) National Commission of Certification Physician Assistants. They are licensed health care professionals by the state and must keep up the licensing requirements of the state.
PA'S are trained under the same medical model as physicians, in addition, the curriculum emphasizes development of interpersonal skills to ensure better communication and care for the patients. PA'S interview, examine, diagnose, assist during operative procedures, see hospital patients, and take calls after office hours. PA'S are trained to perform all of these duties under the supervision of their sponsoring physicians.
In Dr. Lonstein's practice the P.A. may interview the patient during their initial or follow up visit, order imaging tests or other diagnostic tests, and assist with the physician's examination. The P.A. also assists with surgical procedures.

OA can cause back pain, also feelings of stiffness in the back, especially early in the morning when first getting out of bed.

Many pain episodes result from changes that occur in your back from the aging process which eventually become symtomatic. About 50% of patients report the onset of symptoms without any inciting event that they can recall.

X-rays give limited information, mainly showing the bony anatomy. MRI's give much more detailed information, including disc changes, bone marrow changes, soft tissue (muscle, ligament, tendon) evaluation and the spinal nerves and spinal cord. The MRI can also identify tumors and infections.

Balloon kyphoplasty is a minimally invasive treatment in which orthopaedic balloons are used to gently elevate the bone fragments in an attempt to return them to the correct position. Before the procedure, you will have diagnostic studies, such as X-rays and magnetic resonance imaging (MRI), to determine the exact location of the fracture.
Balloon kyphoplasty can be done under local or general anesthesia - your doctor will decide which option is appropriate for you. Typically, the procedure takes less than one hour per fracture treated and may require an overnight hospital stay.

The steps of the procedure are as follows:

Balloon placement
With a hollow instrument, the surgeon creates a small pathway into the fractured bone. A small, orthopaedic balloon is guided through the instrument into the vertebra. The incision site is approximately 1 cm in length.
Full inflation
Next, the balloon is carefully inflated in an attempt to raise the collapsed vertebra and return it to its normal position.
Void within vertebral body
Once the vertebra is in the correct position, the balloon is deflated and removed. This process creates a void (cavity) within the vertebral body
Filling the cavity with cement
The cavity is filled with a special cement to support the surrounding bone and prevent further collapse.
The internal cast
The cement forms an internal cast that holds the vertebra in place. Generally, the procedure is done on both sides of the vertebral body.

With a Disc herniation (ruptured disc, slipped disc) there is usually the onset of back and leg pain. Often with nonsurgical care such as: medications, physical therapy, steroid injections, the symptoms will improve or resolve over a 6-12 week period. The nerve root inflammation dissipates and the pain resolves. If the pain resolves, then surgery can be avoided. If severe, intolerable back and/or leg pain persists, then a surgical procedure can be considered for pain relief.

Hospitalization after fusion surgery is limited by patient's mobilization and symptoms. Once the patient can ambulate and his/her postoperative pain is manageable with oral medications, the patient is usually safe for discharge. The majority of patients who have undergone a one or two level fusion procedure are discharged on the day following the day of surgery. Those undergoing more extensive fusion procedures may require 1 to 2 additional hospital days.

Recovery is an ongoing process for several weeks after surgery, depending on the procedure performed. For the patient who has undergone diskectomy and/or laminectomy, there are no restrictions on walking, and driving can resume within a few to several days, usually limited only by the level of comfort of the individual patient. More strenuous activities such as golf, tennis and other sports are restricted during the first six weeks postoperatively, then usually can be resolved. The patient who has undergone a fusion procedure will have activity restriction for about a three month period, but walking and driving can begin early on as with the laminectomy patient.

We encourage patients to get up and walk on the day of the surgery. Early mobilization speeds up the recovery time, and shortens the hospital stay. In addition early mobilization lessens the risks of postoperative blood clots and postoperative pulmonary complications after the general anesthetic.

The ability to return to work at an early date after surgery is of course dependent on the type of work performed. Lifting is limited, depending on the procedure performed, to 10-15 pounds for a few to several weeks. Car driving is usually allowed as soon as the patient's comfort permits. Thus, if one performs a job that has limited physical demands, they may be able to return within a few to several days.

Spinal fusion is most beneficial for patients who have a slippage of a vertebrae forward on the vertebrae below (spondylolisthesis) and have not responded to nonsurgical treatments over a 3 to 6 month period. Fusions are utilized to stabilize "unstable" spines, including curvature of the spine, called scoliosis.