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By: S. M. Rezaian, M.D., Ph.D.
A former Professor of University, author of books
and over 100 papers with over 500 lectures all over the world.

Before one looks for treatment, it is extremely important to know why one gets back pain. back pain is a common as the common cold. Many back pain problems are benign, self-limited. But some back pain may be a serious condition that needs treatment by skilled experts. In either event today we are able to treat all back pain successfully. Please take your time and before you decide for your treatment, read carefully my lecture on this matter. Send me an E-mail if you need more information or help.



S. M. Rezaian, M.D.

California Orthopedic Medical Clinic, Inc. Beverly Hills, Ca 90211-2927, USA
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Abstract. Based on a review of 600 patients with back problems, we have designed a new classification for practical clinical diagnosis of back pain. The purpose of this article is to present this classification.

Key Words: Low Back Pain- Diagnosis.

Minimally Invasive Back Surgery

Since its inception, back surgery has been considered a very risky, very invasive surgical procedure. This is due to the fact that the spinal column is filled with so many critical nerves, muscles and bones that one false move can leave a patient paralyzed. Unfortunately, even if a patient made it through surgery without anything going wrong, many who underwent the open back procedure realized that their back pain was even worse after surgery than it was before. Because of this, Dr. Rezaian of the California Orthopedic Clinic in Beverly Hills pioneered a new technique known as minimally invasive back surgery. Unlike open back surgery, minimally invasive back surgery is laser guided and does not require cutting the patient’s back wide open to fix the issue. In fact, Dr. Rezaian’s minimally invasive back surgery is so gentle that patients do not need to undergo general anesthesia and have little to no scarring after the procedure.

The beauty of his minimally invasive back surgery is the technology used to perform it: Dr. Rezaian incorporated the principals used in endoscopic surgery and laser surgery into a whole new approach for back surgery. Instead of weeks of agonizing recovery time, patients who undergo the minimally invasive back surgery are back on their feet the same day. The difference is so dramatic that some patients who were brought in barely able to stand have been able to walk out of the office after undergoing Dr. Rezaian’s minimally invasive back surgery. Most importantly, the minimally invasive back surgery yields much better results for patients than traditional surgery. When you look at the facts, it is easy to see why Dr. Rezaian’s experienced hand and cutting edge surgical techniques make him the go-to orthopedic surgeon for minimally invasive back surgery.


Low back pain is surpassed only by the common cold as a cause of lost workdays in the general population about 80% of the population develops back pain at some time in life. Since low back pain is the most common chief complain, surpassing headaches in many clinics, almost all physicians can expect to advise the patient with disability. l yet diagnosis the cause of low back pain can be an unclear and often unresolved task for the physician. Most textbooks give a long list of causes for backache, but matching individual patients against such lists is an illogical and inefficient method of diagnosis.

Searching medical journals over the past ten years for etiological classification of low back pain, one finds that the majority of back pain remains undiagnosed etiological lyaortic called idiopathic or nonspecific back pain. It seems imperative that if we are to treat low back pain properly, we must first be clear on what it is we are treating.

In this paper, we will present a new practical clinical etiological classification of low back pain based on the simple history given by the patient. This will enable the practicing physician to make a quick etiological diagnosis and, therefore, to treat the low back pain patient properly. We have used this classification and come to correct pathological diagnosis in over 98% of 600 consecutive patients with low back pain treated from December 1984 to January 1991.

A New Clinical Classification of Low Back Pain

Based on a review of these 600 patients with back problems, we have created a new practical classification for the diagnosis of back pain. According to this classification, there are only two types of back pain in medicine: the constant or malignant pain., and the intermittent or benign pain.

Constant Back Pain

Constant low back pain occurs day and night, at work and at rest, when the patient is happy, and when angry or depressed. We call this type of pain malignant pain.

Fortunately malignant low back pain is rare and comprises only 3-5% of all low back pain. The etiologies of this type of pain, irrespective of the injury that may be reported by the patient, may confuse the picture and include: infection, benign or malignant tumor, or more rarely a vascular lesion such as aortic aneurysm. If the patient has back pain, runs a low fever, or feels some chills toward the evening, look for disc or other obscure infection. Ask for relevant investigation. On the other hand, if the patient has constant, has lost his/her appetite, and has lost some weight, look for malignant tumor (primary or secondary). If the patient does not run a fever and has not lost weight, suspect a benign tumor or vascular.


Intermittent Back Pain

Intermittent low back pain is relieved for some period of time within a 24-hour period. We call this type benign pain, and it comprises nearly 95% of all low back pain.

Subclassifications of Intermittent Low Back Pain. There are five subclassifications of intermittent low back pain:

1. Low back pain that is relieved by rest and aggravated by activities (over 80%). This pain is caused by macro or micro instability of the spine. It is commonly produced by physical injury. If this pain is limited to the back and does not increase with abdominal tension such as coughing, laughing, sneezing, or straining, it is due commonly to ligament(s), and more rarely to muscle damage on the back. On the other hand, if the pain radiates to the legs or arms and is aggravated by abdominal tension such as sneezing, coughing, laughing or straining, look for discopathy and radiculopathy lesions, this type of back pain is commonly seen in active people 20-50 years of age.

2. Low back pain that is aggravated suddenly and is accompanied by weakness of the muscles, urinary problems, or both, caused by cauda equina syndrome. Look for acute or subacute midline rupture of disc L3-L4 and more rarely L4-L5. This may be seen in all ages and comprises 1-2% of all back pain.

3. Low back pain that gets worse at rest and gets better with exercise and activities, accompanied by joint stiffness, should lead one to consider inflammatory disease, particularly ankylosing spondylitis. This type is commonly seen in middle-aged persons.

4. Low back pain that gets worse with straightening the back is reported by patients who state they cannot lie flat with the lower limbs straight.  They normally feel more pain with walking and then differentiate claudication from endarteritis. This type is seen in the age group over 60 years with history of degenerative discopathy of the lumbar spine. This is mostly due to spinal stenosis.

5. Low back pain that is accompanied by a skin lesion (systemic lupus erythematosus or cafe-au-lait), or multiple joint involvement that changes with cold and hot weather speaks for the correct diagnosis of systemic lupus erythematosus and rheumatoid arthritis.

Using the above classification system, we have been able to diagnose every patient with low back pain in this sample of 600 patients,. We have confirmed our diagnosis with objective tests and have rendered correct treatment on over 99% of the patients to the degree that they have returned to work even after being on disability for up to 8 years.

It was surprising correctly a large number of patients who had been referred for psychiatric therapy which of course did not relieve their back pain. Their pain fit well in our classification, and they were successfully treated.

Laboratory Studies Indicated for Investigation and Evaluation of Back Pain.

1. X-rays including flexion and extension views are required to have a general evaluation of bone structure and to have a baseline for further development. Many authors do not recommend X-rays for back pain for back pain of less than 6 weeks' duration. We disagree since the first X-ray immediately after injury may be normal, but 6-8 weeks later may show degenerative change, and one may then relate these changes to the injury.

2. complete blood cell count (CBC), urine analysis, erythrocyte sedimentation rate (ESR), and blood chemistries including alkaline phosphatase and acid phosphatase are indicated in the management of malignant back pain.

3. Magnetic resonance imagine (MRI) is indicated for any patient who demonstrates neurological deficit, e.g., numbness on nerve distribution, deep tendon reflex changes, or weakness of special groups of muscles.

4. A computerized axial tomography (CAT) scan is helpful to demonstrate bony changes, e.g., osteophytes, old fractures, bony destruction, spinal stenosis.

5. Myelography and CAT scan are helpful in evaluation of complicated cases. e.g., patient with failed back surgery.

6. bone scan is necessary to rule out bony lesions due to infection or malignancy.


Back Pain Laser Treatment

Back pain can be very debilitating for those who suffer from it. Not only is it a mental drain to be constantly in pain, but back pain can end up limiting a person’s daily activity and enjoyment of life. For California residents suffering from severe, persistent back pain, we invite you to visit us at the California Orthopaedic Medical Clinic for the latest back pain laser treatment. Unlike old fashioned spinal surgery, laser treatment for back pain is quick, easy, and only requires local anesthesia. With traditional back pain surgery, patients experienced excruciating pain, long recovery time and less than stellar results. Patients who have undergone the back pain laser treatment at the California Orthopaedic Medical Clinic have experienced astounding results - a full 98% of all patients who receive laser treatment for their back pain report an excellent or good outcome.

Dr. Seyed Rezaian, Medical Director and lead surgeon at the California Orthopaedic Medical Clinic, is a world-renowned expert in back pain and laser treatments. Dr. Rezaian has performed the laser treatment for back pain on over 2,000 patients, many who had previously undergone traditional surgery with poor results. Back pain laser treatments are available for people ages 13 and above, and since the laser treatments do not require risky general anesthesia, they can be performed on senior citizens who would not even be eligible for traditional open back pain surgery. Laser surgery for back pain involves a small incision and is performed laparoscopically, so the procedure is as minimally invasive as possible while yielding maximum results and freedom from back pain.


Back Pain Laser Treatment

It can be a struggle to deal with back pain. Even mild back pain can make everyday activities difficult. Short term remedies aren’t always enough, and some medications cause troublesome side effects. Fortunately, more and more patients are putting their hopes in back pain laser treatment. With advanced endoscopic techniques, back pain laser treatment can be very safe and effective. Patients who cringe at the thought of complicated surgery can see if they qualify for back pain laser treatment. Studies have been done by the Laser Spine Institute to prove the effectiveness of such minimally invasive procedures. Most patients are back on their feet in no time after receiving such treatment. The incisions are very small during back pain laser treatment, which minimizes the risk of surrounding tissue being damaged. This means increased safety and faster recovery time.

Traditional back surgery requires anesthesia, large incisions, and a long recovery time. Indeed, it could take months to recover from traditional, complicated procedures. Now, with advanced technology, back pain laser treatments can be performed in an outpatient clinic with local anesthesia. This can be done with minimal or no scarring. However, despite this type of treatment being less complicated than traditional treatment, it still requires an excellent surgeon. Like all medical procedures, it’s important to choose a good physician. Patients need to search for qualified surgeons who have experience with back pain laser treatment, like Dr. Rezaian. Dr. Rezaian is a pioneer in the back pain laser treatment techniques, and has been helping patients cure their back pain without open back surgery for nearly twenty years.