Natural History of Lumbar Spine Disease

Six decades ago, a publication emerged documenting a successful surgical intervention for a condition referred to as a “ruptured disk.” Despite notable advancements in the field since then, there remain unanswered inquiries regarding the accurate diagnosis and effective treatment of low back pain and lumbar radiculopathy.

Intriguingly, the discussions that ensued after the release of that publication continue to hold relevance in contemporary times. Modern diagnostic techniques, including magnetic resonance imaging (MRI), have supplanted antiquated approaches like lumbar puncture, myelography, and exploratory laminectomy.

Furthermore, surgical procedures have undergone transformation, becoming less invasive and more precise, with a shift towards targeted interventions instead of the extensive bilateral, multilevel laminectomy that was once commonplace.

The ongoing central concerns revolve around determining the necessity of a specific diagnosis for low back pain and radiculopathy, as well as deciding when surgery is the appropriate course of action.

While in the past these questions were addressed on an individual patient level, they now require consideration on a broader population scale. It is essential to evaluate factors such as cost and clinical outcomes. However, the changing perceptions of pain and disability, evolving health expectations, and easy access to medical care pose challenges in interpreting previous research findings.

Even when clinical outcome studies rely on parameters like return to work, daily activity performance, or patient self-assessment of pain, their interpretation remains complex. It is worth noting that our understanding of pathoanatomic abnormalities in the common cold is even more limited, offering little consolation in comparison.

The natural progression of lumbar spine disorders is perplexing. Placebo-controlled studies have shown that even inert injections can lead to substantial improvement in back pain and radiculopathy. Patients with signs of nerve compression and confirmed lesions were included, and conservative treatment had failed before entering the studies.

Understanding the progression of lumbar disk disease and its relationship to pain and disability is a complex matter. While a herniated disk is often linked to symptoms, degenerative spine disease can lead to abnormal imaging results without accompanying clinical manifestations. Differentiating between lesions that are likely to cause symptoms and incidental findings is of utmost importance when interpreting imaging data.

In asymptomatic individuals, large compressive lesions are typically infrequent, but they are frequently observed in symptomatic patients who may require surgical intervention. Interestingly, these same sizable herniations, sequestrations, and extrusions demonstrate the highest rates of natural improvement when assessed through imaging studies.

The lack of consistent alignment between clinical symptoms and imaging findings suggests that the anatomical perspective alone is insufficient to fully comprehend the various aspects of lumbar spine disease.

The existing literature presents an alternate perspective on herniated disks compared to the current understanding. It emphasizes the significance of larger lesions, often referred to as herniations, which were linked to severe motor impairments, sensory loss, or sphincter weakness in their patients. However, it is important to note that the correlation between the size of pathological specimens and imaging findings was not precise due to various contributing factors.

The descriptions of lesions, such as herniation, protrusion, or bulge, vary across studies and even within the works of the same authors. Changes in surgical techniques have also led to inconsistencies in surgical findings, which are often used as a reference standard in diagnostic accuracy studies. Modern imaging studies depict smaller lesions compared to earlier reports, highlighting the evolving understanding of these spinal abnormalities.

There is agreement among experts on certain criteria for imaging in patients with low back pain. Initially, imaging is recommended for individuals who suffer from significant pain-related disability, exhibit neurological findings, have a history of tumors, or require surgery or hospitalization. After an unsuccessful period of conservative treatment lasting 4-6 weeks, imaging can be considered for cases involving simple sciatica.

However, there is no consensus regarding imaging for patients with stable back pain alone. It is widely accepted, albeit without robust scientific evidence, that magnetic resonance imaging (MRI) is the preferred imaging modality for such cases. However, it has not been convincingly demonstrated that the additional cost of MRI compared to computed tomography (CT) is justified on a large scale.

Debate continues surrounding different aspects of lumbar spine disorders. The majority of individuals with acute conditions typically resume work within a few weeks, regardless of the treatment they receive. However, prolonged disability can have lasting effects. Timely diagnosis and treatment are crucial for individuals at risk of enduring disabilities. A comprehensive study is necessary to identify the particular symptoms, signs, and occupational groups where the expense of imaging can be justified by improved outcomes.

Existing literature has presented studies highlighting the potential of long-term conservative management trials coupled with systematic longitudinal imaging evaluation. However, the available data is restricted and inconclusive, albeit revealing interesting trends.

These studies underscore the significance of refraining from prematurely dismissing established approaches to lumbar spine disease solely based on new data. A cautious analysis within the framework of Bayesian analysis is vital before implementing substantial changes in medical practice.

Despite its limitations in detecting significant lumbar disk disease, MR imaging is still considered more reliable than alternative clinical evaluations and pain scales. The straight leg raising test, for instance, has demonstrated suboptimal sensitivity and specificity in identifying disk herniation. A more extensive study would be necessary to establish a definitive correlation between the level of neurologic disability and the abnormalities observed on MR images.

The data indicate distinct patterns of clinical improvement and persistent pain in patients with specific conditions. The study authors approach the hypothesis that imaging findings determine the treatment for lumbar radiculopathy with caution, refraining from refuting it outright.

Further data is required concerning the individuals who remained in the study and those who discontinued participation. Lumbar spine disease encompasses intricate interconnections involving both physical and psychosocial elements. The correlation between lumbar spine-related disability and income exhibits an N-shaped curve, while the association between disability and education varies across genders. The influence of litigation and compensation on the clinical outcomes of patients with lumbar spine disease is firmly established.

What Comes Next?

Moving ahead, there are several critical actions to be taken. Firstly, it is of utmost importance to develop a nomenclature system that is universally accepted, easily reproducible, and applicable to lumbar spine findings observed in MR imaging.

Secondly, there is a need for consensus on the relevant parameters for assessing outcomes and the establishment of standardized methods for their evaluation. Given the existing lack of agreement among physicians, patients, and the general public, it is advisable to explore a wide range of outcome measures to ensure a comprehensive assessment.

To increase the credibility of results, it is advised to replicate studies reported in the literature with a larger sample size and a multi-center, multi-specialty approach to minimize any biases stemming from local practices. Determining the optimal surgery rate and addressing ethical concerns are challenging aspects, and it requires extensive education efforts to secure cooperation from both patients and physicians.

Studies reported by literature have demonstrated the feasibility of the approaches discussed. It is our anticipation that a trial similar to the one they propose will be conducted in the near future. We hold a strong belief that this trial will provide confirmation regarding the efficacy of imaging in the treatment of specific patients with lumbar spine disorders.

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Based on 107 reviews
Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
Tina Rivera
20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

Please take a look at my profile page and don't hesitate to come in and talk.