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A new approach aims to help patients find which treatments work best for back problems, which about 80 percent of adults will have at some point in their lives. A new approach aims to help patients find which treatments work best for back problems, which about 80 percent of adults will have at some point in their lives. Denise Karsten Denise Karsten of the of the Upstate Brain & Spine Center Upstate Brain & Spine Center explains her role as a primary spine practitioner, someone who guides patients through the often bewildering treatment options available. Karsten, who is a nurse and a chiropractor, also discusses common back problems, how diagnoses are made and possible treatments. explains her role as a primary spine practitioner, someone who guides patients through the often bewildering treatment options available. Karsten, who is a nurse and a chiropractor, also discusses common back problems, how diagnoses are made and possible treatments.