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Understanding the Common Signs of Annular Tears

Your spinal discs are strong and able to provide your spine with flexibility and strength, but they aren’t indestructible. It’s entirely possible for them to weaken and wear down over time. This weakening is caused by the development of annular tears, which can lead to conditions like Leaky Disc Syndrome, degenerative disc disease, sciatica, and disc herniations. Knowing what the most common signs of annular tears are may help you get a correct diagnosis and appropriate treatment as soon as possible, preventing further issues. 

The Makeup of the Spinal Disc

In order to get a better understanding of the common signs of annular tears, it may help to understand the makeup of your spinal discs.

Also known as intervertebral discs, the main function of your spinal discs is to increase your spine’s range of motion and strength. Your spine contains 25 spinal discs in total: 7 cervical, 12 thoracic, 5 lumbar, and 1 sacral. These discs make up 25-33% of your spine’s length. 

Each spinal disc works to absorb shock when your spine needs to bear weight as well as prevents your vertebrae from grinding together. The three major components of the spinal discs that work together to do this are the inner nucleus pulposus (NP), outer annulus fibrosus (AF), and cartilaginous endplates that anchor the spinal discs to adjacent vertebrae.

Nucleus Pulposus

The nucleus pulposus is a gel-like structure in the center of your spinal discs and it’s this structure that provides most of your spine’s flexibility and strength. This flexibility and strength are owed to the NP’s makeup of 66-86% water and type II collagen and proteoglycans. The proteoglycans in the NP also include aggrecan and versican, both of which bind to hyaluronic acid in order to help retain water. Aggrecan also helps in retaining the water held in the NP.  This is an important function because water retention helps the NP absorb shock and provide flexibility.

Annulus Fibrosus

The annulus fibrosus is a ring-shaped disc that surrounds the nucleus pulposus. It’s made up of between 15-25 stacked sheets of fibrous connective tissue, known as lamellae. This fibrous tissue is made up of collagen, proteoglycans, glycoproteins, elastic fibers, and connective tissue cells.

The collagen that makes up each lamella is uniformly oriented on a plane that differs in orientation to adjacent lamella. This is called “radial-ply” and makes alternate lamella parallel to each other and provides more strength than if all the lamella had a longitudinal placement. In fact, this construction is mimicked in the production of car tires because of its strength. The lamellae are also interconnected by translamellar bridges. Translamellar bridges also assist in providing strength and flexibility. 

While the AF is the outer portion of the spinal disc, the AF itself contains inner and outer layers. These layers are differentiated by the collagen composition of each section. Both are mostly made up of collagen but the outer part of the AF is made of mostly type I collagen while the inner part is mostly type II collagen. The amount of type I and type II collagen changes gradually from the inner to the outermost layers of the annulus fibrosus. As the distance from the nucleus pulposus increases, the amount of type II collagen decreases, while the amount of type I increases.

The “shock-absorbing” feature of spinal discs distributes forces throughout the spine to reduce the load on any one vertebra, thus reducing the risk of fracture and degenerative changes. This is why it’s important to understand the common signs of annular tears and address these tears as soon as possible.

common signs of annular tears

What Are Annular Tears?

Of course, in order to understand the common signs of annular tears, it’s necessary to understand what annular tears are and how they develop.

Annular tears are literal tears in one or more layers of the annulus fibrosus. They usually occur in the posterior of the AF because this area has a larger amount of vertically oriented fibers, making it weaker than other parts of the AF. 

Most adults have annular tears in their spinal discs and don’t even know it, because these tears are asymptomatic most of the time. If identified tears are asymptomatic, they are usually found during imaging that is done for other reasons. 

If annular tears cause symptoms, it can lead to pain confined to the area around the tear or radicular symptoms caused by irritation of the nerve roots near the tear. If the annular tear occurs suddenly the pain felt may be more acute, while if the tear develops slowly over time, the pain may feel chronic. If the annular tear causes the nucleus pulposus to leak out of the disc, the radicular symptoms caused can include pain, paresthesia, and weakness. The intensity of the common signs of annular tears depends on the degree to which the nerve is irritated.

Leaky Disc Syndrome

In the previous paragraph, we mentioned that annular tears sometimes allow the nucleus pulposus to leak out of the spinal disc. This is known as Leaky Disc Syndrome and it’s a term that was coined by Dr. Kevin Pauza

Leaky Disc Syndrome occurs when the nucleus pulposus leaks out of the spinal disc and irritates or inflames the surrounding spinal nerve roots. This irritation and inflammation can lead to lower back, leg, neck, or arm pain that is usually attributed to a compressed nerve. Physically compressed nerves are sometimes the cause of these symptoms, but it is Dr. Kevin Pauza and the Discseel® Procedure team’s belief that most pain and numbness experienced in the extremities is caused by annular tears that have allowed the nucleus pulposus to come into contact with spinal nerve roots.

While the nucleus pulposus is a natural part of our bodies, it’s meant to stay within the spinal disc. Because of this, the body treats it as a foreign substance when it leaks out of the spinal disc and reacts with inflammation and irritation, leading to the pain associated with the common signs of annular tears.

common signs of annular tears

Common Signs of Annular Tears

Now that you know everything you need to know about the spinal disc, annular tears, and Leaky Disc Syndrome, let’s talk about the common signs of annular tears.

Most adults have asymptomatic annular tears and because of this, they’ll never realize that they have torn spinal discs. However, if you have annular tears that have become symptomatic, you may feel neck or back pain. The location of your pain will depend on the location of the torn spinal disc. If the torn spinal disc is located in your lower back (the lumbar spine), your pain may radiate into your buttocks or down leg. If this sounds similar to sciatica, it’s because Leaky Disc Syndrome can cause sciatica pain! If the spinal nerve root that becomes irritated by the leaking nucleus pulposus is the sciatic nerve root, this will cause sciatica symptoms.

You may also experience pain that becomes more severe when you perform certain motions such as sitting down, bending, or twisting. The pain you feel may be alleviated when you switch positions or lay down, or when you’re exercising. Pain caused by annular tears can also be either sporadic or constant.

Because annular tears most commonly occur in the lumbar spine, we feel that it’s helpful to list some of the most common signs of annular tears in correlation with lumbar discs.

  • L1/ L2: Pain, numbness or loss of sensation in the thigh or groin area.
  • L2/ L3: Diminished strength in the hip flexor; pain, numbness or loss of sensation in the thighs.
  • L3/ L4: Diminished patellar reflex, pain or numbness in the thighs, weakness in the quadriceps.
  • L4/ L5: Numbness or loss of feeling in the feet, diminished patellar tendon reflex, weakness in the quadriceps, pain in the legs.
  • L5/ L6: Numbness or loss of sensation in the feet or toes and weakness in the hips and legs.

How are Annular Tears Diagnosed?

Unfortunately, the only way to be sure that you have an annular tear is by undergoing either a discogram or an annulogram. Both are imaging procedures conducted with the help of live x-ray guidance in which dye is injected into the spinal discs. The goal of both the discogram and the annulogram is to detect torn discs. 

However, a large difference between these tests involves pressurization of the spinal disc. During discograms, the spinal disc is pressurized to determine whether or not this causes pain. Annulograms do not require the pressurization of spinal discs. In the annulogram, if the injected dye flows through the disc, that tells the physician that the disc is torn.

It should be noted that other tests, like MRIs or CT scans can’t detect annular tears.

The Discseel® Procedure

Your spinal discs play a vital role in protecting your spine and are incredibly resilient, but it’s possible for them to weaken over time. If you don’t avoid activities that may lead to the development of annular tears, your spinal discs may begin to break down and degenerate.

This may then lead to Leaky Disc Syndrome, vertebrae rubbing together, and less resiliency when strain is put on your spine. While the most common signs of annular tears may vary, getting a correct diagnosis and appropriate treatment will prevent further issues from occurring and restore your spine’s integrity and functionality.

This can be done with Discseel® Procedure, which is a non-surgical, minimally invasive procedure that uses Fibrin to seal and heal annular tears. 

The natural fibrin biologic used in the procedure is known to encourage tissue growth, allowing spinal disc tissue to grow and heal itself. This solves back and neck pain caused by degenerative disc disease, disc herniations, and sciatica. This is also why the Discseel® Procedure is able to leave you with the same mobility you had prior to undergoing the procedure.

If you’re ready to get long-term relief from your back or neck pain, apply for the Discseel® Procedure today and find out if you’re a candidate.

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Kevin Pauza, M.D.

SPECIALTY

  • Disc Biologics
  • Interventional Spine

EDUCATION & DEGREES

  • Fellowship: Interventional Spine, University of Pennsylvania
  • Residency: PM&R, University of Pennsylvania
  • Internship: Surgery & Medicine, Columbia University College of Physicians and Surgeons
  • Medical Doctorate: Pennsylvania State University College of Medicine
  • Bachelor of Arts: Biology, Lehigh University
  • Bachelor of Arts: Psychology, Lehigh University

CERTIFICATIONS & LICENSES

  • Texas State Medical and Surgical License
  • New York State Medical and Surgical License
  • Florida State Medical and Surgical License

HONORS

  • Lehigh University Four-year Academic Scholarship
  • Magna Cum Laude, Lehigh University
  • Lehigh University President’s Award
  • Lehigh University Tower Society
  • Distinguished Alumnus, Penn State University (selected from 500,000 Penn State alumni)
  • North American Spine Society, Outstanding Paper of the Year, 2003
  • President-Elect, International Spine Intervention Society
  • Founding Partner, Texas Spine and Joint Hospital
  • Commencement Speaker: Penn State University College of Medicine
  • Advisory Board, AMA
    Keynote Speaker, Harvard Pain Center Commencement
  • Founding Chairman, Standards Committee, International Spine Intervention Society
  • Chairman, Spine Committee, Amercian Academy of Physical Medicine & Rehabilitation
  • Appointed Spine Advisor, Japanese Prime Minister
  • Appointed Spine Advisor, Allied Royal Families

EXPERIENCE

  • Founding Partner & Principal, Texas Spine & Joint Hospital

Travis Foxx, M.D. - Premier Anesthesiology & Pain

Kevin Pauza, M.D. - Turtle Creek Surgery Center

Prior to attending Penn State University, Dr. Pauza earned his undergraduate degree from Lehigh University, and furthered his training with a Surgical and Medical Internship at Columbia University College of Physicians and Surgeons. He continued his specialty training at the University of Pennsylvania, followed by an Interventional Spine Fellowship. In addition to his research, philanthropic, and clinical endeavors, Dr. Pauza remains a motivated educator. He established a Spine Fellowship program and continues training physicians from around the world. He heads international committees responsible for establishing standards and educating surgical and non-surgical physicians.

After helping hundreds of patients who failed to experience relief after spine surgery, it became evident to Dr. Pauza that current methods needed to change. This motivated him to seek better ways to help patients, by thinking outside the box.

Dr. Pauza is the first physician in history to pursue FDA approval for using biologics to treat the spine. Millions of patients will benefit from his development of minimally invasive treatments for degenerative disc disease and other more common and serious disorders of the spine.

SPECIALTY

  • Disc Biologics
  • Interventional Spine

EDUCATION & DEGREES

  • Fellowship: Interventional Spine, University of Pennsylvania
  • Residency: PM&R, University of Pennsylvania
  • Internship: Surgery & Medicine, Columbia University College of Physicians and Surgeons
  • Medical Doctorate: Pennsylvania State University College of Medicine
  • Bachelor of Arts: Biology, Lehigh University
  • Bachelor of Arts: Psychology, Lehigh University

CERTIFICATIONS & LICENSES

  • Texas State Medical and Surgical License
  • New York State Medical and Surgical License
  • Florida State Medical and Surgical License

HONORS

  • Lehigh University Four-year Academic Scholarship
  • Magna Cum Laude, Lehigh University
  • Lehigh University President’s Award
  • Lehigh University Tower Society
  • Distinguished Alumnus, Penn State University (selected from 500,000 Penn State alumni)
  • North American Spine Society, Outstanding Paper of the Year, 2003
  • President-Elect, International Spine Intervention Society
  • Founding Partner, Texas Spine and Joint Hospital
  • Commencement Speaker: Penn State University College of Medicine
  • Advisory Board, AMA
    Keynote Speaker, Harvard Pain Center Commencement
  • Founding Chairman, Standards Committee, International Spine Intervention Society
  • Chairman, Spine Committee, Amercian Academy of Physical Medicine & Rehabilitation
  • Appointed Spine Advisor, Japanese Prime Minister
  • Appointed Spine Advisor, Allied Royal Families

EXPERIENCE

  • Founding Partner & Principal, Texas Spine & Joint Hospital

Brandon Tolman, D.O. - Nashville Spine Institute

Boris Terebuh, M.D. - Regenerative Spine & Joint Center

Boris Terebuh, MD specializes in providing personalized nonsurgical solutions for spine problems that interfere with the function patients desire and the independence they deserve. Dr. Terebuh completed his Physical Medicine & Rehabilitation residency training at The Ohio State University in 1997 and has been in solo practice in Ohio since 2001 because he is committed to providing accessible, individualized and attentive care to his patients. His regenerative approach to solving spine problems enhances the body’s natural ability to heal itself. His guiding principle is integrity – doing what is right for patients in a conscientious manner with the motivation of helping them become fully functional, independent and satisfied. Dr. Terebuh is a very unique Medical Doctor because he has earned seven Board Certifications in the field of musculoskeletal medicine and nonsurgical spine care. Boris Terebuh, MD is delighted to be a Discseel® provider because this revolutionary new technology aligns perfectly with his preferred regenerative treatment approach and patient care philosophy. Dr. Terebuh is also grateful to Discseel® developer, Kevin Pauza, MD, for all the years of diligent and meticulous research to create this innovative, paradigm-shifting intervention, which will certainly spare countless individuals the prospect of avoidable spine surgical procedures.

Thierry Bonnabesse, M.D. - Champlain Spine and Pain Management

Gregory Lutz, M.D. - Regenerative Sportscare Institute

Dr. Gregory Lutz is the Founder and Medical Director of the Regenerative SportsCare Institute (RSI). In addition, he currently serves as Physiatrist-In-Chief Emeritus at Hospital for Special Surgery (HSS) and a Professor of Clinical Rehabilitation Medicine at Weill Medical College of Cornell University. Dr. Lutz is one of the world’s leading experts in the field of regenerative interventional orthopedic medicine, appearing annually on Castle Connolly’s and New York Magazine’s “Top Doctors” lists.

Janet Pearl, M.D. - The Boston Stem Cell Center

Dr. Janet Pearl has been in practice since 1999 and is the Medical Director of The Boston Stem Cell Center. She is also the Medical Director of  Complete Spine and Pain Care  an interventional integrated Pain Management practice, both located in Framingham, Massachusetts. Dr. Pearl is Triple Board Certified in Regenerative Medicine, Pain Medicine and Anesthesiology and has over 20 years experience in doing these procedures.

Previously, Dr. Pearl was the Co-Director of the Pain Management Center at St. Elizabeth’s Medical Center, where she was also the Director of the Pain Management Fellowship program.

After graduating from Harvard College with an A.B. in Applied Mathematics with Economics, Dr. Pearl received a M.Sc. in Health Planning and Financing at the London School of Hygiene and Tropical Medicine. She then received her M.D. from the Columbia College of Physicians and Surgeons, where she represented the Medical School as a senator in the Columbia University Senate.

Watch Dr Pearl give an introduction to The Boston Stem Cell Center

Dr. Pearl completed her internship in Internal Medicine at New England Deaconess Hospital, her residency in Anesthesiology at the Massachusetts General Hospital, and her fellowship in Pain Management at the Brigham and Women’s Hospital. Dr. Pearl was the first resident ever to serve on the Accreditation Council for Graduate Medical Education (ACGME)’s Residency Review Committee for Anesthesiology. She is a Joseph Collins Scholar and a Rotary Scholar and was awarded the AMA/Glaxo Welcome and AMA/Burroughs Welcome Resident Leadership Awards.

From 2004 to 2010, Dr. Pearl served on the University of Massachusetts Board of Trustees. While there she chaired the Committee on Science, Technology and Research, was a member of the Committee on Academic and Student Affairs and the Governance Committee and also served as Vice Chair of the Advancement Committee, and as a member of the Committee on Athletics.

Dr. Pearl is Board Certified in Regenerative Medicine, Pain Medicine and Anesthesiology with the American Board of Regenerative Medicine and the American Board of Anesthesiologists.

Memberships:

  • The American Pain Society;
  • The Massachusetts Medical Society;
  • The Massachusetts Society of Anesthesiologists;
  • The Massachusetts Society of Interventional Pain Physicians;
  • The American Society of Anesthesiologists;
  • The American Society of International Pain Physicians;
  • The American Institute of Ultrasound in Medicine; and,
  • The American Board of Regenerative Medicine.

PUBLIC SERVICE:

  • Member, Massachusetts Department of Industrial Accidents, Health Care Services Board 
  • Member of the Association of Harvard College Class Secretaries and Treasurers
  • Past Member of the Board of Directors of the Harvard Alumni Association
  • Former Member of the Board of Trustees University of Massachusetts. (10/2010 – 10/2014) 

Mark Reecer, M.D. - Fort Wayne Physical Medicine

Dr. Mark Reecer is board certified in Physical Medicine & Rehabilitation and Pain Management. He has over 20 years of work comp experience, and he routinely provides Independent Medical Examinations (IMEs) for the Indiana Workers’ Compensation Board. Dr. Reecer has lectured extensively and has authored multiple publications that promote his specialty and the use of treatment modalities to eliminate pain, improve function and avoid surgery.

Dmitry Buyanov, M.D. - IV Infusion Treatment Center

Dr. Buyanov is originally from Kiev, Ukraine. He received his training in Anesthesiology and his Interventional Pain Management Post-Doctoral at Penn State Medical Center, PA. Dr. Buyanov moved to San Antonio in 2003 at which time he was part of a multi-specialty group before he founded Premier Pain Consultants in 2004. His practice has over 5000 active patients in his practice. Dr. Buyanov treats his patients in a cost-effective manner although giving them the best care with interventional pain treatments/procedure to help each patient improve their quality of life. Dr. Buyanov strongly believes in an individualized and multidisciplinary approach to pain management, he believes in the Buddhist saying: “pain is inevitable but suffering is optional”. He works closely with the area internists, physical therapists, chiropractors, psychiatrists, neurologists, and spine surgeons to insure that each patient has the most optimal individualized treatment plan. Dr. Buyanov enjoys spending his spare time with his children.

Desmond Hussey, M.D. - NASA Neuroscience and Spine Associates. P.L

Dr. Hussey earned his undergraduate degree from Dartmouth College, and proceeded to earn his Medical Degree from The University of Miami School of Medicine. He then attended Northwestern University Internal Medicine Program, followed by a Neurology Residency Program at Emory University. Dr. Hussey continued his specialty training at John Hopkins University pain clinic. A member of The Spinal Injection Society and The American Academy of Neurology and Psychiatry.

Haley Burke, M.D. - Mile High Sports and Rehab

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Maxim Moradian, M.D. - Interventional Spine Care & Orthopedic Regenerative Experts

Dr. Moradian is triple-board certified in Physical Medicine and Rehabilitation (PM&R), Sports Medicine and Pain Management. Dr. Moradian’s clinical practice is devoted to the comprehensive care of spine, joint, muscle, tendon, ligament, and peripheral nerve disorders. He is proficient in performing advanced, minimally-invasive procedures under fluoroscopic and/or ultrasound guidance in the entire spine. Dr. Moradian performs electrodiagnostic testing (EMG/NCS) for the accurate diagnosis of muscle and/or nerve disorders. He has a special interest in regenerative medicine, sports concussions, neuromuscular ultrasound, medical education, and clinical research. His true passion is to treat his patients like his family and friends.

Wendi Lundquist, D.O. - Active Life Physical Medicine & Pain Center

Dr. Lundquist is the Medical Director and founder of Active Life Physical Medicine & Pain Center, Innovative Surgery Center, and Regena Spa. She is dual board certified in Physical Medicine and Rehabilitation along with Pain Management and a diplomat with the American Board of Pain Medicine. She completed her training at Loyola University in Chicago, Illinois in July of 2005. During her time there, she served as Chief Resident and was involved in several research projects. Prior to, she completed medical school at Midwestern University at the Arizona College of Osteopathic Medicine campus in Glendale, Arizona and internship at Doctors Hospital in Massillon, Ohio. She also has a Bachelor of Science in Biology and minor in Chemistry from the University of New Mexico in Albuquerque. She has a special interest in sports medicine, pain and spine. With 17 years experience, she has great enthusiasm towards regenerative medicine.

Yasuyuki Nonaka, M.D. - ILC International Lumbago Clinic

Haley Burke, M.D. - Colorado Rehabilitation & Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Haley Burke, M.D. - Colorado Rehabilitation & Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Matthias H. Wiederholz, M.D. - Performance Pain and Sports Medicine

Founding Partner, Triple Board Certified – Physical Medicine & Rehabilitation; Sports Medicine; Anti-Aging, Regenerative & Functional Medicine

Dr. Matthias H. Wiederholz is cofounder of Performance Spine & Sports Medicine, LLC. He is a fellowship-trained interventional pain physician whose clinical interests include: Interventional Pain Management, Sports Medicine, Musculoskeletal Medicine, Minimally-Invasive Spine Surgery, Non-Surgical Orthopedics, and Anti-Aging / Functional Medicine.

He received his specialty training in Physical Medicine and Rehabilitation at Baylor College of Medicine in Houston, Texas where he served as chief resident. He completed fellowship training in Interventional Pain Management in Marietta, Georgia. He is board-certified in Physical Medicine & Rehabilitation and Sports Medicine. He also received advanced fellowship training through the American Academy of Anti-Aging Medicine and is board-certified in Anti-Aging, Regenerative & Functional Medicine.

Dr. Wiederholz performs a myriad of interventional pain procedures including, but not limited to the following: epidural steroid injections, facet joint injections, radiofrequency ablation, sacroiliac joint injections, discography, percutaneous disc decompression, epidural lysis of adhesions spinal cord stimulator implants, and minimally-invasive discectomies. Endoscopic spine surgery is a very unique and valuable tool in his armamentarium and makes Dr. Wiederholz one of the most specialized physicians in the field of Pain Medicine.

Dr. Wiederholz uses musculoskeletal ultrasound in the diagnosis of musculoskeletal injuries. He incorporates ultrasound for precise injection therapy including cortisone injections, prolotherapy, and PRP (platelet rich plasma). This technology is also utilized to perform the Tenex procedure, a percutaneous procedure for treating chronic tendon pain (tennis elbow, rotator cuff, plantar fasciitis, etc).

Dr. Wiederholz is the fellowship director for the sports and spine fellowship at Performance Spine & Sports Medicine. Dr. Wiederholz holds an affiliation with Capital Health System and JFK Johnson Rehabilitation Institute.

Being advanced fellowship trained in Anti-Aging, Regenerative & Functional Medicine means that Dr. Wiederholz has the most advanced training in Anti-Aging Medicine available. He is a leading expert in Bio-Identical Hormone Restoration and helps patients achieve wellness through nutrition, lifestyle, and hormone therapies.

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Michael Wolff, M.D. - Southwest Spine & Sports