Back and Spine Pain

Roughly 31 million Americans are living with spine or back pain at any given moment, and most of them have already been through the standard sequence: rest, anti-inflammatories, physical therapy, and at some point an injection. This page pulls together what has been written here about the low back, the sacroiliac joints, and the muscles and tendons around them, for patients who are past the early weeks, are not getting better, and want a straight account of what orthobiologics and laser therapy can and cannot do for a spine.

Acute back pain, chronic back pain, and the twelve-week line

Most low back pain is acute. It lasts a few days or a few weeks and then resolves on its own, with or without treatment. That is the ordinary course, and it is why the first weeks of a new back episode are not the moment to decide about an injection of any kind.

At least 20 percent of the time, though, acute low back pain does not settle. It crosses the twelve-week mark and becomes chronic low back pain with persistent symptoms. That line matters. Pain that has outlasted three months and stopped responding to the things that usually work deserves an actual diagnosis rather than another round of the same treatment.

What ultrasound guidance reaches in the spine, and what it does not

This is the part most patients do not get told, so it comes first. Every injection in this practice is placed under ultrasound guidance, which shows soft tissue in real time and lets a needle be watched all the way to its target. It also has hard limits. Ultrasound cannot see inside a disc, and it cannot be used to place an injection into the epidural space or onto a nerve root. Because of that, intradiscal, epidural and nerve-root injections are not offered here.

What ultrasound does reach in and around the lumbar spine is a real list: the facet region, the sacroiliac joint, the gluteal tendons, the posterior ligamentous and paraspinal structures, and the deep gluteal and piriformis area. Pain filed under the generic heading of "low back pain" often turns out to be coming from one of those structures, and they can be examined and treated under direct ultrasound view. More on how that guidance works is on the ultrasound guidance hub.

One more piece of plain information: Dr. Buford is an orthopedic surgeon, but he does not perform spine surgery. A patient whose presentation calls for a spine surgeon gets told that and gets referred. Nobody here has an incentive to talk you into an injection for a problem that an injection will not fix.

Why the repeated steroid shot is worth questioning

Steroids are still the most common injection used for spine pain, in the facet joints, the sacroiliac joints and the epidural space. They are genuinely good anti-inflammatory drugs, and that is not in dispute. The problem is what happens when the same injection is repeated in the same region.

Corticosteroids weaken very nearly everything they touch. Used repeatedly, they break down soft tissue. They carry an infection risk each time, and they affect blood sugar, which matters for anyone diabetic or pre-diabetic. None of this makes a single, well-chosen steroid injection a mistake. It does mean a patient on their fourth or fifth back injection of the year should be asking what the plan is beyond repeating it, because the tissue is paying for each one.

The alternative used here is platelet-rich plasma prepared from the patient's own blood, placed under ultrasound in the structures listed above. More on the preparation and the evidence behind it is on the PRP hub.

Where PRP and bone marrow concentrate fit for the spine

Dr. Buford's own position, stated on his PRP page, is that PRP has been shown to be effective in treating back pain from conditions including disk disease and facet arthrosis. Bone marrow aspirate concentrate is likewise listed as an option for cervical, thoracic and lumbar osteoarthritis. Those are his clinical assessments, and they should be read alongside an honest qualifier.

The qualifier is this: the spine evidence base is less mature than the knee's. The knee has a deep body of randomized controlled trials behind orthobiologic injection. The spine does not, and anyone presenting spine injection data as though it were equally settled is overselling it. No injection, in the spine or anywhere else, has been shown to regrow a joint surface, and no result is guaranteed. What can reasonably be discussed is whether a specific, identified pain generator that ultrasound can reach is a sensible target in your case. See the bone marrow concentrate hub and the research hub for how these treatments are being studied.

Put differently, the useful question is not "does PRP work for back pain." It is "what specifically is generating my pain, and can it be reached." A back that hurts because a facet region, a sacroiliac joint or a gluteal tendon is irritated is a very different case from a back that hurts because of a disc pressing on a nerve root, and you should be told which one you are at the consultation rather than after a course of injections.

Class IV MLS laser therapy for back pain

The second treatment used here for the low back is Class IV MLS laser therapy, delivered in office as a series of short sessions. It involves no needle and no drug, which makes it usable for patients who cannot take anti-inflammatories or want to start with something less invasive while the diagnosis is being worked out. It can be used on its own or alongside an injection plan.

Two honest caveats. Laser therapy does not replace surgery when there is structural damage that genuinely requires a surgeon, and the practice's own laser page says exactly that. And the supporting evidence is largely real-world and patient-reported rather than large randomized trial data, so it belongs in the conversation as a well-tolerated adjunct with encouraging reports behind it, not as a settled standard of care.