A patient may have a car accident and sustain an injury to his low back. He would come in for an evaluation because of intractable low back pain. We would then examine the patient. We would obtain x-rays, MRIs, nerve testing, or other such studies to better evaluate the reasons for why his back pain has not subsided. If all the studies came back negative, we would treat him with physical therapy, possibly anti-inflammatory or pain medication, and follow him in a fashion that would be suitable to make sure that his symptoms are improving with the course of treatment. There are times that the cause of the low back pain might be different than just a musculoskeletal strain or sprain. An MRI finding may come back with a significant herniated disc that is pushing on a nerve root, causing shooting pain down the leg or Sciatica and the back pain is not getting better with conservative management. Those types of patients, we might then go into more invasive management with injection therapy such as epidural injections or facet injections. If patients are getting worse in that type of a situation and all conservative management fails, they may have to undergo a microdiscectomy where we make a very small half an inch incision and their back and move away all the nerves and come down to the disc and take out the piece of disc that's pushing on the nerve. It's a relatively small procedure. It takes about 45 minutes and the patient goes home usually the same day or the following morning.
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