If you are suffering from a spinal condition, including one that isn’t listed below, please contact us today to find out how we can help.
Back and Neck Pain
With 85% of us experiencing significant back and neck pain at some point, this is a very common issue and a cause for many people taking time off work. Episodes of neck and back pain can vary in severity and are most commonly due to general wear and tear of the spine.
Treatment for back and neck pain will usually involve appropriate pain killers, accupuncture and physiotherapy in the first instance. If these routes fail to treat the condition, then targeted injections can be of benefit. Spinal decompression with or without instrumented fusion surgery would be the last resort.
Cervical Disc Herniation
A cervical disc herniation (also known as a Prolapse or Slipped Disc) occurs when a disc in the neck tears, resulting in the soft central part squeezing out and pressing on the spinal cord or exiting nerve. Pressure on the spinal cord can cause a number of symptoms such as arm and leg pins and needles, numbness, loss of balance, and bladder and bowel work control problems.
Management will begin after assessing with relevant imaging, followed by exercises led by physiotherapists if appropriate. As far as the intervention is concerned first route of treatment would be a cervical nerve root block, which usually results in the relief of symptoms and can help to avoid invasive surgery. If symptoms still remain following this procedure then surgery is an option, and will involve operating through the front of the neck to remove the disc, followed by either a cervical disc replacement or insertion of a cage for fusion.
Cervical Spondylopathy, also known as “wear and tear”, refers to the slow aging onset of arthritis or degeneration in joints and disks in the neck. As such, this condition is less likely to be related to injury or occupation, although this can aggravate symptoms. Degeneration can cause a number of spinal conditions, such as Brachialgia, when a nerve is pinched and sends pins and needles to the arm and fingers, or Myelopathy, when pressure on the spinal cord causes a progressive loss of balance resulting in falls.
Mechanical stiffness is best managed with a combination of physiotherapy, lifestyle modification, and analgesia. Refractory episodes of pain can be settled with cervical facet joint injections, rhizolysis, or selective nerve root blocks. Significant symptoms that do not respond to these treatments are managed with surgery in the form of cervical disc replacement or cage insertion.
Lumbar Disc Herniation
Lumbar Disc Herniation is most common in people aged 30-50, and occurs spontaneously or as a result of twisting, lifting or bending. When disc herniation occurs, the spinal disc can press on nerve roots causing Sciatica (leg pain with pins and needles/ numbness). As symptoms progress, the neve may occasionally stop working, resulting in ankle or leg weakness known as foot drop. In extreme cases, the disc herniation can press on the nerve roots that supply the bowels, bladder and sexual organs. This is known as Acute Cauda Equina Syndrome. This requires immediate referral and urgent surgery.
Treatment for sciatica beings with anti-inflammatory medicine, strong analgesia, and gentle stretching with physiotherapy. For around 90% of patients, pain will settle over 3 months as the disc resorbs. For others, a targeted nerve root block is often effective and can be provided within a few days of symptoms starting. If symptoms still do not subside, a Lumbar Microdiscectomy may help. This is performed through the back via minimally invasive approach.
Lumbar Spinal Stenosis
Lumbar Spinal Stenosis refers to the gradual onset of leg pain, pins and needles and weakness brought on by standing or walking or from lying on the back at night. Symptoms can fluctuate but are generally seen as a gradual deterioration.
Physiotherapy and epidural steroid injections can relieve symptoms for months or longer. Severe spinal stenosis with significant symptomatology usually requires surgery and will involve a posterior lumbar decompression and discectomy.
Osteoporotic Vertebral Fractures
Osteoporotic Vertebral Fractures are usually caused by a fall, twist or lifting while bending forwards with pain spreading around the chest. It can be painful to stand or walk, and some patients may notice a loss of height as a result of being bent over or stooped. Fractures typically heal slowly over 3 months with gradual improvement in symptoms. Vertebral compression fractures can lead to Kyphosis, a rounded back deformity.
Treatment for persistently painful unhealed fractures is cement augmentation (vertebroplasty and kyphoplasty) which can relieve pain and possibly restore vertebral height.
The most common tumours affecting that spine usually spread from other parts of the body. Cancers such as Myeloma and Lymphoma can also be present in the spine. Cancers arising from spinal structures are less common or can be benign, and can generally be managed in specialist tumour centres. Symptoms of a spinal tumour are typically back pain, feeling generally unwell, with unexplained unintentional loss of appetite and weight. A spinal tumour can also cause weakness in the arms and legs, and loss of bladder and bowel control.
The definitive treatment and prognosis depends on the specific type of tumour and it’s spread/ metastasis (lung, kidney, prostate, kidney or thyroid). An x-ray guided biopsy will enable the definitive diagnosis. Metastatic disease in the spine is best managed by multi-disciplinary team including oncologists and spine surgeons. Surgery usually involves decompression and instrumented stabilisation. There would also be peri-operative chemo/ radiotherapy.