Spine Treatment

Spine Treatment

CORE Orthopedics specializes in treatments for spinal injuries and spinal pain.

Consisting of 33 bones, also known as vertebrae, the spinal column is the main protective structure of the spinal cord. It is separated into 5 regions: cervical, thoracic, lumbar, sacral, and coccygeal. Alleviating spinal pain and repairing spinal injuries is critical because each vertebrae and disc depends on one another to work properly.

Dr. Joseph Krob is the newest member of the CORE Orthopedics team, joining in fall 2025 following completion of Orthopedic Spine Surgery Fellowship at Kaiser Permanente Northern California in Oakland, CA. He is Board Eligible for Orthopaedic Spine Surgery under the American Board of Orthopaedic Surgery (ABOS).

During his fellowship in spine surgery, Dr. Krob learned minimally-invasive spine decompression and fusion techniques, and has a passion for performing endoscopic spine procedures. His clinical spine practice focuses on operative and nonoperative spine pathology such as stenosis, trauma/fractures, disc herniations, spondylolisthesis, and scoliosis among others. He also cares for general orthopedic injuries and extremity fractures.

Spine Conditions:

• Cervical Radiculopathy
• Compression Fractures of the Spine
• Degenerative Disc Disease
• Herniated Discs
• Lumbar Radiculopathy (Sciatica)
• Muscle Strain of the Upper Back (Trapezius Strain)
• Osteoporosis
• Spinal Stenosis
• Spinal Stenosis (Cervical)
• Spinal Stenosis (Thoracic)
• Spondylolisthesis

Spine Procedures:

Non-surgical Spine Procedures

Caudal Epidural Steroid Injection: This is an injection of a steroid anesthetic medication through an opening in the sacrum. It is used to reduce swelling and inflammation of irritated spinal nerves and only takes a few minutes to complete.

Cervical Epidural Steroid Injection (without contrast): An injection used to relieve pain in the neck, shoulders, and arms that is caused by a pinched nerve in the cervical spine. This pain can be caused by various conditions that compress nerves such as herniated discs, spinal stenosis, and radiculopathy. The physician uses X-ray guidance to inject a an anesthetic and cortisone steroid solution into the epidural space of the neck. The steroid is absorbed around the inflamed nerves to decrease swelling and relieve pressure.

Cervical Transforaminal Epidural Steroid Injection: This injection relieves pain in the neck, shoulders, and arms caused by compression of the nerve root from conditions such as herniated discs and spinal stenosis. The physician guides a smooth needle into the foraminal space near the nerve root and then injects the contrast solution. The steroid solution injected reduces inflammation of the nerve, easing pain in the neck, shoulders, and arms.

Discography (Lumbar): This procedure helps the physician find painful spinal discs. A needle is guided into the target disc or discs. The physician then injects contrast dye into each disc, which raises the pressure inside. When the patient feels pain from the injection, it is a sign that the disc may be diseased. The doctor then takes images and scans of the potentially diseased disc.

Lumbar Epidural Steroid Injection: This is an injection used to relieve lower back and radiating pain. The physician injects the steroid solution by guiding the needle toward the epidural space between the lumbar vertebrae. The medication eases pain by reducing swelling and inflammation of the nerve root.

Osteoporosis Screening: Osteoporosis is a disease that makes bones thin and weak. Osteoporosis screenings begin with a bone density test that shows if the patient has osteoporosis or if they are likely to develop it. If a patient is already being treated for osteoporosis, it can show if the treatment is working. There are different types of bone density scans including X Ray, ultrasound, and a DEXA scan. After being scanned, the doctor will discuss the results with the patient and create a plan.

Thoracic Epidural Steroid Injection: This steroid injection relieves pain in the upper back. The physician guides a needle down between the vertebrae and around the nerve that is causing the pain. The needle is carefully placed into the epidural space, where the physician injects the steroid anesthetic solution. The medication will help to reduce inflammation and reduce pain. Pain relief begins within a few short days.

Surgical Spine Procedures

ALIF: Anterior Lumbar Interbody Fusion: This surgical procedure treats back or leg pain caused by degenerative disc disease. In this procedure, the spine is fused together with bone graft materials. An incision is made just below the umbilicus with careful protection of the neurovascular structures. The damaged disc is removed. The surgeon places a metal or plastic cage implant filled with bone graft into the empty disc space. As a result, the vertical spine is realigned and pressure is lifted off the pinched nerve roots.

Anterior Discectomy and Fusion (ACDF): A surgery that removes a herniated or degenerative vertebral disc in the neck and replaces it with a bone graft, relieving pressure to the spinal nerve roots. After making an incision on the front of the neck, the surgeon removes the painful disc and replaces it with a bone graft. The new graft secures the vertebrae in the correct position.

Anterior Cervical Discectomy and Fusion (Intervertebral Spacer): This surgery can relieve neck or radiated arm pain caused by parts of a diseased or damaged disc that is pinching nerve roots. The surgeon removes the diseased disc after making an incision on the front of the neck. A vertebral spacer with bone graft material is inserted into the empty space where the disc was removed between the vertebrae. During the healing process, a bone fusion will occur.

Kyphoplasty (Balloon Vertebroplasty): This minimally invasive procedure repairs a vertebral compression fracture, restoring the spines natural shape and relieving pain. The physician guides a needle into the fractured vertebra, before pushing a balloon device through the needle, into the vertebral body. After inflating the balloon and expanding the fractured bone, the balloon is deflated and a cavity is left in the middle of the fractured vertebral body. Bone cement is injected into the vertebral body, filling the cavity. This stabilizes the fracture. In preparation for the procedure, the patient will be anesthetized.

Laminectomy (Cervical) with Fusion: This procedure relieves pain from pressure of the spinal cord by the lamina. The surgeon removes the the lamina of the vertebra thereby opening up the spinal canal. This may relieve pressure on the nerve roots. Any bone spurs in the canal are removed and the spine is stabilized with rods and screws, creating a spinal fusion.

In preparation for this procedure, the patient is anesthetized.

Minimally-Invasive Lumbar Microdecompression: This procedure removes herniated discs and overgrown vertebral bone and soft tissue, to relieve nerve root compression in the lumbar spine. The surgeon identifies the diseased vertebral level with an X Ray and guides a series of dilators through the muscles and soft tissue of the area. The surgeon slides a tubular retractor over the dilators before removing them, creating a working channel. Using surgical instruments, excess bone and ligament tissue is removed from the space around the nerve root on both sides of the vertebra, relieving pressure and pain.

In preparation for this procedure, the patient is anesthetized. Most patients are discharged the same day and can return to their normal activities within weeks.

Minimally-Invasive TLIF (Transforaminal Lumbar Interbody Fusion):

This is a minimally invasive procedure used to remove a degenerated disc and relieve pain in the lumbar spine. The surgeon identifies the diseased vertebral level before guiding a series of dilators into the muscles and soft tissue of the area. Sequential tubular retractors are inserted over the dilators before removing them, creating a working channel for the surgeon. Using surgical instruments, the surgeon removes bone at the rear of the vertebrae to create an opening. The nerve roots are decompressed. An implant filled with bone graft is placed into the empty disc space, realigning the vertebral bones. This relieves painful pressure from pinched nerve roots. Over time, the bone graft will grow through the implant and create a spinal fusion.

In preparation for this procedure, the patient is anesthetized. Most patients are discharged the same day and can return to their normal activities within weeks.

Spinal Fusion (Lumbar): A spinal fusion creates a solid mass of bone and stabilizes the spine. The surgeon makes an incision. Any tissue in the way is moved to the side, creating a clear path to the spine. After modifying the spine for the specific procedure, the surgeon uses bone graft either take from the hip of the patient or a donor. A space is created for the bone graft by removing some bone from the vertebrae. The spine is stabilized with hardware and the graft is placed against the vertebrae. In the months after the surgery, new bone grows and attaches to the spine, creating a permanent fusion.

In preparation for this procedure, the patient is anesthetized. Patients may benefit from physical therapy during recovery.

XLIF/Extreme Lateral Lumbar Interbody Fusion: In this minimally invasive procedure, the patients vertebrae is reach through the patients side, avoiding major muscles of the back. It is used to relieve leg or back pain from degenerative disc disease. The surgeon makes small incisions in the patient’s side, inserting a probe into one of the incisions. The probe is used to detect nerves along the side, avoiding them and leaving them undamaged. A series of dilators and a retractor is guided over the probe to create a channel to the spine. Through this channel, the damage disc is removed and an implant filled with bone graft is placed into the empty disc space. This realigns the vertebral spine. Over time, the bone graft will grow through and around the implant, forming a fusion.

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