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409-833-BACK (2225)

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4141 Southwest Freeway, Ste 490, Houston, TX 77027

The Woodlands: 25440 I-45 N., Suite 300, Spring, TX 77386
Pasadena: 4802 East Sam Houston Pkwy S, Pasadena, TX 77505
Nederland: 2300 FM 365 Suite 430, Nederland, TX 77627

Patient's Guide for Lower Back Pain

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Anatomy of the Spine

The spine is composed of bone, discs, ligaments, muscles, nerves, and blood vessels. The spine comprises 33 vertebrae, each lined up one atop another and divided into 5 areas: cervical (neck), thoracic (chest), lumbar (low back), sacral (pelvis), and coccygeal (tail bone). Cervical vertebrae aid with neck movements. Thoracic vertebrae support the ribs and permit rotation of the body. Lumbar vertebrae support the upper part of the body and enable forward and backward motion. The sacrum plays the role of anchor of the spine and fits between the pelvic bones.
The spine has a natural curvature. The neck and low back present forward -facing curves, and the thoracic and sacral spine have backward-facing curves. Each section of the spine serves a different function and motion so the curvatures keep a balance between the sections. The vertebrae in each portion of the spine have different shapes. The lumbar spine is composed of five vertebrae numbered one through five.


The sacrum is a large bone shaped like an upside down curved pyramid and composed of five fused vertebrae wedged between the pelvic bones. The top of the sacrum is referred to as the first sacral vertebra. The sacroiliac joints are the structures between the sacrum and the iliac bones. In women, the sacroiliac joints are looser than in men and have a tendency to widen during child- birth and allow a natural sway of the hips when walking. There are 3 main joints between vertebrae which allow the vertebrae to articulate with each other. These are the two facet joints and the disk joint.


The intervertebral disk or commonly referred to as disk is in the front part of the vertebrae, in front of the nerves and spinal cord. Whereas the two facet joints are in the back of the vertebrae, one located on each side. Each vertebra connects with four facet joints, two belonging to each vertebra directly above and below, to the right and to the left. The facet joints limit rotation and bending of the vertebrae with respect to each other and are oriented differently depending on the level of the spine. 


Facet joints are composed of cartilage on their surfaces that makes joint fluid, and a capsule that keeps the joint fluid in and the bones together. The intervertebral discs are the shock absorbers between the vertebrae. The disc is essentially a joint and allows motion in multiple directions. The disc resembles a donut filled with thick gel in the center. The outer portion of the donut is called annulus fibrosus and is essentially a layer of fibers that contract or expand. The center gel is called nucleus polposus and has the consistency of crab meat. Over time the restraining fibers get loosens or break, and the ability to contain the gel at the center of the disc is weakened. If the gel moves beyond the boundary of the annulus fibrous, a herniated disc ensues. The gel portion of the disc can move forward, backward and to the sides within the constraints of the annulus, depending on the bending of the spine.


The gel also plays the role of a shock absorber.  A disc's shock absorbing ability depends upon how well the gel remains hydrated. At birth, about 90% of the gel is water, but this diminishes as we age. It also changes during the day. At night when there is no pressure on the discs, the gel retains more water, and we feel taller in the morning. As we stand during the day, the body weight compresses the disc, so that by the end of the day, we are actually shorter. 


The discs not only allow motion between the vertebrae, but also have the role of spacers between the bones. There is a hole, or foramen, between the pedicles above and below the disc in front and the facet joint in back. This allows the nerves to exit the spine and go to other parts of the body. Any disease process that restricts the hole has the potential to cause significant back or neck and leg or arm pain by compressing the exiting nerves.    

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Referring Physicians

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Office Locations:

Houston: 4141 Southwest Freeway, Suite 490, Houston TX 77027

The Woodlands: 25440 I-45 N., Suite 300, Spring, TX 77386

Pasadena: 4802 East Sam Houston Pkwy S, Pasadena, TX 77505

Nederland: 2300 FM 365 Suite 430, Nederland, TX 77627

Mailing Address:
PO box 271463, Houston, TX 77277

Phone: 832-932-9300

409-833-BACK (2225)

Fax: 1-855-790-3974


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