Orthopedics is the medical specialty dedicated to the musculoskeletal system — bones, joints, muscles, ligaments, tendons, and the nerves that control them. Spine care is a subspecialty within orthopedics, but at Grewal Orthopedic & Spine Care we treat the full musculoskeletal picture: shoulder injuries, knee problems, hip arthritis, fractures, and sports injuries — not just back pain.
The scope of the problem is vast. Low back pain alone affects 619 million people worldwide and generates 15.9 million disability-adjusted life years annually (GBD 2021). In the United States, musculoskeletal conditions are the leading driver of healthcare utilization — with LBP costing approximately $40 billion annually at a rate of $2,000 per patient per year (Neurospine, 2024). Among the musculoskeletal system’s most underappreciated pain generators: facet joint pathology accounts for 15–45% of chronic low back pain cases in the US (ASRA 2024) — often missed on routine MRI, requiring targeted clinical evaluation and diagnostic nerve blocks to identify and treat correctly.
Understanding the relationship between spine health and the rest of the musculoskeletal system matters clinically. When the spine is compromised, other joints compensate. When compensation patterns go uncorrected, secondary injuries develop. A practice that evaluates both the spine and the extremities is positioned to see and treat the whole picture.
How the Spine Affects Everything Else
Posture and Alignment
Spinal misalignment — kyphosis, scoliosis, or forward head posture — creates muscle imbalances throughout the body. These imbalances predispose the shoulder, hip, and knee to overuse injury and early degeneration. Correcting spinal alignment isn’t just about back pain — it’s about preventing downstream joint problems.
Nerve Function
The spinal cord transmits every signal between the brain and the body. Cervical cord compression can cause weakness and coordination problems in the hands. Lumbar nerve compression causes leg weakness, numbness, and reflex changes. Identifying whether arm or leg symptoms originate in the spine — or in the peripheral nerve or joint — requires careful electrodiagnostic and imaging evaluation.
Balance and Fall Risk
Spinal stenosis and cervical myelopathy can impair proprioception — the body’s sense of its own position. Older patients with gait problems, frequent falls, or difficulty walking are often found to have significant spinal pathology as the underlying cause.
Spine Anatomy — A Foundation for Understanding Your Condition
Region | Vertebrae | What It Does |
Cervical (neck) | C1–C7, 7 vertebrae | Supports the head; enables rotation and flexion; exits nerve roots to the arms |
Thoracic (mid-back) | T1–T12, 12 vertebrae | Anchors the rib cage; protects heart and lungs; relatively stable |
Lumbar (lower back) | L1–L5, 5 vertebrae | Bears body weight; provides power for lifting; exits nerve roots to the legs |
Sacrum | 5 fused vertebrae | Connects the spine to the pelvis; transfers load to the hips and legs |
Coccyx (tailbone) | 3–4 fused vertebrae | Attachment for pelvic floor muscles and ligaments |
Common Orthopedic Conditions We Treat
Spinal Conditions
- Herniated discs (lumbar and cervical) — the leading cause of sciatica and cervical radiculopathy
- Spinal stenosis — canal narrowing from arthritis and bone spur formation
- Spondylolisthesis — vertebral slippage causing instability and leg pain
- Degenerative disc disease — age-related disc breakdown
- Scoliosis and spinal deformity — from adolescent idiopathic to adult degenerative forms
- Compression fractures from osteoporosis or trauma
Joint and Extremity Conditions
- Shoulder — rotator cuff tears, impingement syndrome, bursitis, AC joint injuries, instability
- Knee — meniscal tears, ligament injuries (ACL, MCL, PCL), patellar disorders, arthritis
- Hip — arthritis, labral tears, bursitis, femoral acetabular impingement
- Fracture care — evaluation and management of all fracture types
- Sports injuries — muscle strains, ligament sprains, stress fractures, tendinopathy
- Osteoarthritis — joint degeneration treated with injections, PT, and surgery when needed
Treatment Philosophy: Non-Surgical First
‘I expect most patients will be treated without surgical intervention.’ That is Dr. Grewal’s stated philosophy, and it shapes every aspect of care. Non-surgical options are always exhausted first. Surgery is discussed openly, with honest presentation of the evidence for and against, and the decision belongs to the patient.
Non-Surgical Options
- Physical therapy through Go Rehab — spine-focused rehabilitation at all Grewal Spine locations
- Epidural steroid injections and nerve root blocks — performed by Dr. Patwary, Interventional Pain Management
- Platelet-rich plasma (PRP) injections — regenerative treatment for osteoarthritis and tendinopathy
- Viscous supplementation (hyaluronic acid) injections — joint cushioning for knee and hip arthritis
- Bracing — cervical, lumbar, knee, and wrist/hand braces fitted on-site at all locations
- Medications — NSAIDs, muscle relaxants, nerve-targeted medications, short-course oral steroids
Surgical Procedures
- Minimally invasive lumbar discectomy — outpatient; small incision; microscopic technique; >90% satisfaction in properly selected candidates
- Lumbar laminectomy / decompression — for stenosis with neurogenic claudication
- ALIF, PLIF, TLIF, MIS TLIF — spinal fusion approaches for instability and recurrent disc disease
- ACDF — gold standard for cervical radiculopathy requiring surgery; most cases outpatient
- Cervical disc replacement — motion-preserving alternative to ACDF for appropriate candidates
- Kyphoplasty — same-day percutaneous vertebral fracture repair
- Cervical corpectomy — for severe cervical stenosis or myelopathy requiring multi-level decompression
Our Orthopedic Team
Dr. Kanwarpaul Grewal, DO — Orthopedic Spine Surgeon, Director
Complex Spine and Deformity Fellowship, University of California, San Francisco. Orthopedic Surgery Residency, Hofstra/Northwell Health System. Faculty, Northwell Plainview Orthopedic Residency. Clinical Assistant Professor, NYIT College of Osteopathic Medicine. 2020 Outstanding Teacher Award and 2020 Attending of the Year — Northwell Health.
Dr. Nabil Farakh, DO — Board Certified Orthopedic Surgeon
Providing comprehensive general orthopedic care across joint conditions, fractures, sports injuries, and musculoskeletal disorders.
Dr. Patwary — Interventional Pain Management
Performing the full spectrum of minimally invasive pain management: epidural steroid injections, radiofrequency ablation, nerve blocks, PRP, and electrodiagnostic testing (EMG/NCS).
John Chen, PA-C — Orthopedics
Physician Assistant providing clinical evaluations, post-operative care, and ongoing orthopedic management across all locations.
★★★★★ Sybille Nagorski-Drew “Dr Grewal changed my life. I went from a 37-year-old living in daily pain to feeling like I have my life back. His office staff is amazing and the other providers are wonderful and knowledgeable too.” |
Sources & Clinical References
- Grewal Orthopedic & Spine Care. ‘Advanced Spine and Orthopedic Treatments.’ grewalspine.com/orthopedics/. 2025.
- AAOS OrthoInfo. Orthopedic Conditions Index. orthoinfo.aaos.org. 2025.
- NASS. Clinical Guidelines. spine.org.
- AANS. Spine Conditions Patient Education. aans.org.
