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When Paul Hoolahan’s lower back pain started causing problems with his right leg, he knew he needed to seek care. So, he went to a spinal surgeon he trusted: Matt El-Kadi, MD, at the UPMC Matt El-Kadi Spine Center in Wexford, Pa.

Paul felt surprised to learn that his pain didn’t originate in his back: It came from his hip. Dr. El-Kadi diagnosed the issue and referred Paul to an orthopaedic surgeon who could treat him.

Nearly a year after getting a total hip replacement, Paul is pain-free.

“Amazingly, the lower back pain that I had over the last year or two that I lived with, I’m not having that lower back pain anymore,” says Paul, 64, of Warrendale, Pa. “That was an amazing thing for me. I’m back to golfing, back to fishing, back to doing everything. It’s good to be back doing what I want to do.”

Paul’s case showcases the ability of the UPMC Matt El-Kadi Spine Center to pinpoint the source of patients’ back pain and triage them to appropriate providers for care.

A History of Back Pain

Paul first met Dr. El-Kadi in 2021. He had suffered from low back pain for much of his life, but in 2021, it became debilitating.

“My leg started going numb, I started having tingling in my feet, and then the severe pain came on,” Paul says. “There was absolutely nothing that would alleviate that pain. Just getting up from bed to go to the shower, I was in tears — it was so severe.”

Paul got a referral to go see Dr. El-Kadi. A magnetic resonance imaging (MRI) scan revealed disc herniation and spinal stenosis in the lumbar (lower back) portion of his spine.

Although Paul says he knew surgery was a possibility, Dr. El-Kadi instead prescribed corticosteroids for the pain. The nonsurgical approach relieved Paul’s pain.

“I always tell my patients that knives and surgery should not come as a first option,” Dr. El-Kadi says. “A lot of degenerative disc disease, lower back pain, and neck pain can be treated successfully with conservative treatment first, including medication, physical therapy, and, if they don’t get better, epidural injection.”

Back Pain Returns — But With a Twist

Outside of a few tweaks of pain, Paul had very few problems with his back for the next three years.

But in summer 2024, he started feeling pain in his lower right back. Although it was significant, the pain felt different from the pain he felt in 2021.

“In 2021, it was severe pain where I couldn’t move. This was more of a sharp pain,” Paul explains. “When it would hit, I would scream out. I would try to move, and it would hit.”

The pain also felt concentrated in the lower right portion of Paul’s back. His previous pain was more spread out. Still, he assumed it was likely a recurrence of his prior back issue.

Paul says he held off on contacting Dr. El-Kadi at first, just managing the pain himself. Then, one morning, he woke up with his right leg not functioning.

“It got to the point where if I was lying in bed and I tried to lift my leg up, I couldn’t do it,” he says. “I tried my best, but my leg wasn’t budging.”

A Surprising Evaluation

When he started having trouble with his leg, Paul contacted Dr. El-Kadi.

“I’ve always trusted him,” Paul says. “The way he’s treated me in the past, there was no doubt he was the one I wanted to see.”

However, upon examining Paul, Dr. El-Kadi believed that Paul’s hip was the cause of his back pain.

Back pain can come from many different causes — degenerative conditions, trauma, infection, spinal tumors, and more. Back pain can also result from referred pain. Because the nerves connect to one another throughout the body, pain from one area may radiate to the back.

When Dr. El-Kadi examined Paul, he believed that his symptoms didn’t match those of a degenerative back issue. Instead, they pointed to a hip problem.

An MRI confirmed that Paul had osteonecrosis of the hip, a condition that occurs when the blood supply to part of a bone becomes disrupted. Also known as avascular necrosis, osteonecrosis can lead to bone tissue death and joint damage.

“I was shocked. I was 100% sure it was my back,” Paul says. “When he told me, it was almost like a relief because I was assuming I was going to have to get back surgery. When your leg’s not moving, I assumed I was going to have to have that.”

Dr. El-Kadi referred Paul to an orthopaedic surgeon who performed a total right hip replacement on Paul in October 2024.

A Relationship of Trust

Almost a year after surgery, Paul feels no pain and is doing the activities he enjoys most.

“I’m back to my normal activities, like I was when I was younger,” he says. “I’m golfing. I’m fishing. I’m doing everything I want to be able to do. (Before), if I went to try to play golf, a lot of times I would be quitting after nine holes because it was so uncomfortable.”

Dr. El-Kadi says that Paul’s case is a good example of using clinical judgment when evaluating patients. By recognizing the different potential causes and related symptoms of back pain, doctors can ensure patients get the right treatment for them.

“You cannot be a good surgeon if you are not a good clinician,” Dr. El-Kadi says. “And, in spine, clinical judgment plays the key point in the clinical pathway and in the treatment of patients, which leads to good outcomes.”

At the El-Kadi Spine Center, a multidisciplinary team of experts works together to evaluate, diagnose, and treat patients. The team comprises specialists in neurology, neurosurgery, physical medicine and rehabilitation, as well as spine-focused orthopaedic surgery.

The center can effectively triage patients with back pain, helping them get the right care.

“The advantage of the Spine Center is the fact that many specialists from different areas work under one roof,” Dr. El-Kadi says. “They help each other, and they can collectively get together to make the right and proper diagnosis on the patient. So, we help each other, we consult each other, and it’s in real time.”

The center’s location is UPMC Specialty Care in Wexford, north of Pittsburgh. The facility also has imaging services and physical therapy, among other services.

“It’s totally amazing that Dr. El-Kadi was able to see me, have me go downstairs to have an MRI, and by the time I got home, he was calling me to tell me the results of my MRI,” Paul says. “When everything was done and I ended up having my hip surgery, I was able to go to that location to have my physical therapy.”

Dr. El-Kadi emphasizes the importance of establishing a strong relationship with his patients.

“When you start treating your patient like a family member, they will develop trust in you. They will feel it. They will feel that you care. They will feel that you worry about them. They will feel that you want to do the best for them.”

Paul is thankful to Dr. El-Kadi for all of his help. He has already recommended that other people with back pain visit Dr. El-Kadi.

“I trust him enough to send my family members to him,” Paul says. “He’s a down-to-earth person who tells you things the way they are and actually cares.”