Relieving Hip Pain by Focusing on the Lower Back

When hip pain hit Stephen Rosen, PhD, an 87-year-old expert in cosmic radiation and nuclear astrophysics, he turned to Edward Adler, MD, Chair of Orthopedic Surgery at Mount Sinai Downtown and Associate Professor of Orthopedic Surgery at the Icahn School of Medicine at Mount Sinai. 

Dr. Adler performed an orthopedic physical examination, updated hip X-rays, and reviewed prior lumbar spine imaging, which indicated that Dr. Rosen’s hip and buttocks pain was actually coming from his lower back and not his hip joints. In October 2020, Dr. Adler ordered a new lumbar spine MRI and referred the patient to Amir Mahajer, DO, FAOCPMR, Assistant Professor of Orthopedics, Rehabilitation and Human Performance at the Icahn School of Medicine at Mount Sinai. Dr. Mahajer specializes in Interventional Spine and Sports Medicine.

Dr. Mahajer approached Dr. Rosen by focusing on his background as a scientist. “Dr. Mahajer was the first one who really talked to me about science,” says Dr. Rosen. “I know a little about the lower back from my own research, but Dr. Mahajer really knew how to explain it to me and tell me everything I needed to know.” Dr. Rosen had already attempted conservative care with a home exercise program and over-the-counter medications with minimal relief.

Dr. Mahajer believes that educating the patient is key in the treatment of orthopedic disorders. After reviewing Dr. Rosen’s imaging and conducting a physical examination with special testing, he recommended two to three weeks of a rigid back brace and adjustments in his home exercise program. Unfortunately, this rehabilitation approach did not significantly reduce Dr. Rosen’s pain.

The next step was treating the small joints between the spine’s vertebrae, called facet joints. Arthritis and joint degeneration can cause these joints to become stiff and painful. Dr. Mahajer used a procedure called facet joint medial branch blocks, injecting a local anesthetic guided by X-rays. This 15-minute procedure blocks the nerves to these joints from sending pain signals to the brain. It provided great relief. After two successful medial branch blocks, Dr. Rosen was a candidate for radiofrequency ablation. 

This is also an interventional procedure using needles guided by X-rays. It uses heat to stop the nerves from sending pain signals to the brain. This 30-minute procedure offers pain relief for much longer—up to 24 months. After a while—often about a year—the nerves grow back, and some patients may need a repeat procedure.   

More recently, Dr. Rosen developed pain in his buttocks and leg from nerve root compression. Dr. Mahajer diagnosed lumbar radiculopathy, more commonly known as sciatica, after revaluation and clinical examination. This condition can cause pain, numbness, or weakness of the buttock and leg. Dr. Mahajer provided physician-guided home exercises and non-narcotic medications. This two-pronged effort has alleviated Dr. Rosen’s pain. But, says Dr. Mahajer, if the pain returns, Dr. Rosen may need an epidural injection at some point.

Dr. Rosen is thrilled with his care. “I was impressed by Dr. Mahajer’s wealth of knowledge,” he says. “He was terrific throughout the entire process. He really is a great doctor, a consummate professional, and has an excellent team. I have recommended Dr. Mahajer to all my family and friends who have back pain.”

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