Spine

Causes and Symptoms of Spinal Injury

In younger patients, the sudden onset of neck or back pain may be due to a ‘slipped’ intervertebral disc. The intervetebral discs are found between the individual bones (vertebra) of the spinal column, and act to facilitate movement of the spine and also as ‘shock absorbers’ to cushion the transmission of weight down the spinal column.

‘Slipped’ discs may press on surrounding nerves and result in pain, numbness and/or weakness in the arms and legs. When present in the legs, these symptoms are commonly referred to as ‘sciatica’ or ‘lumbago’.

In older people, degenerative changes in the spine may lead to arthritis of the spine, and this may be a cause of pain. In some cases, bone spurs can press on surrounding nerves or even on the spinal cord, leading to pain, numbness and/or weakness in the arms and legs.

The exact treatment depends on the cause of the pain, but generally in mild cases you will be advised on:

• Lifestyle and posture modifications - This may include advice on how to perform manual tasks such as lifting loads to minimise spine injury, and also how to optimise your posture when working and sleeping.
• Physiotherapy - For many patients, a programme of supervised physiotherapy will be helpful in alleviating neck/back pain and maintaining proper spine health. Treatment will normally begin with measures to relieve pain such as traction and heat therapy, followed by exercise programs to improve the strength and stamina of spinal muscles.
• Medication - There is no medication that can cure neck and back pain, but medicines can be used to relieve pain, reduce inflammation, decrease spasm and soothe nerve (‘neuropathic’) pain while physiotherapy is progressing.
  

When will I need surgery?

Surgery is advised when nerve compression is severe and there is a risk of permanent nerve damage, and when symptoms are persistent and disabling despite maximal non-surgical management. There are many types of surgery available for the various causes of spinal disorders, but some of the more common procedures include:

• Discectomy for removal of prolapsed (‘slipped’) discs - In the lower back (lumbar spine), this can also be achieved via minimally invasive surgery which can potentially lead to quicker recovery and a short hospital stay.
• Spinal fusion - In some patients, back pain is due to instability of the spinal column which can be due to degenerative changes in the spine. In such cases, your specialist may advise that the unstable portions of the spine be joined together so as to limit abnormal movements and thus reduce pain. Such procedures are currently normally performed with special rods and screws to increase the success rate of the procedure.
• Vertebroplasty and kyphoplasty - In older patients who are suffering from persistently painful osteoporotic fractures of the lower back vertebrae, these relatively simple procedures have proven to be useful in relieving pain and improving mobility. In both procedures, a special bone cement is injected into the fractured vertebra to stabilise it, but in kyphoplasty, the fractured vertebra is also expanded using a special balloon device before the cement is injected.
  

Minimally Invasive Spine Surgery

In the first case, surgery is aimed at decompressing the affected nerves by removing the ‘slipped disc’ or bone spurs. For the latter, surgery is aimed at stabilising the spine by fusing the spine (by applying bone chips between the affected segments and using screws and rods to hold the segments together).

While traditional spine surgery is good at achieving these aims, the recovery process is painful and can be prolonged due to the damage to the muscles and their nerve and blood supply in the process of exposing the spine. A long skin incision is usually required for the exposure and the muscles pulled apart to aid visualisation.

Benefits

Advancement in technologies and techniques allows the same surgeries to be performed via smaller incisions. The same aims can also be achieved just as safely while minimising damage to the muscles. The overall benefits are shorter hospitalisations; as short as one day for decompression surgery and two days for fusion surgery and quicker return to functions and work.

In this technique, x-rays are used to guide the insertion of tubes to reach the spine and visualisation is achieved with the use of a microscope and special cameras. The nerves are decompressed with specially modified instruments. If necessary, screws and rods are inserted under x-ray guidance.

Who it is for?

Such surgeries may be suitable for patients with low back pain and/or leg pain that interferes with normal activities and work; and for which other treatments such as physiotherapy and medication are not working.

The orthopaedic surgeon will have performed a thorough examination of your back and nerves, including x-rays and MRI scans, before deciding on whether such an operation is suitable for you and which surgery is more appropriate for your specific condition.