Degenerative Conditions 

Neck

Wear and tear (degeneration) of the discs and bones in the cervical spine (neck) occur with age and stress and strain. This can lead to compression of the spinal cord and nerves. Often symptoms range from neck pain alone to symptoms related to nerve root or spinal cord compression.

Cervical Radiculopathy

Cervical radiculopathy refers to a pain and numbness in a specific region in the upper limb due to compression of a spinal nerve root in the neck. It is often caused by a herniated disc in the neck but can also be caused by wear and tar of bone. The management is conservative with physiotherapy and pain killers as most symptoms would resolve. If symptoms persist inspite of conservative measures, then surgery may be considered.

Cervical Myelopathy

Cervical myelopathy refers to a loss of function in the upper and lower extremities due to compression of the spinal cord within the neck.  It manifests itself as 2 main symptoms. One is weakness of grip and dexterity problems in hands. The other is difficulty with balance, poor coordination and weakness of legs, increasing stiffness of legs, a feeling of ‘walking like drunk’ and recurrent falls. The onset is often slow however a rapid and progressive deterioration is sometimes present with irreversible deterioration of mobility. It is vital that these symptoms are identified very early with immediate referral to a Specialist as otherwise reversal is unlikely. With symptomatic spinal cord compression either from a herniated disc or wear and tear of bone, surgery has to be considered early with no role of conservative measures. Although much more common in the elderly, young patients too can present with such symptoms.

Back (Lumbar Spine)

Back pain is a very common condition that is experienced in almost 1 in 3 adults at some point in their life. It can be triggered by bad posture, bending awkwardly or lifting incorrectly. In most cases, back pain will improve in a few weeks or months, although some people continue to experience chronic pain with regular flare up of symptoms. Along with the pain in the back, there may be pain that shoots down the leg.

Most cases of back pain get better on their own and nothing needs to be done. Although during the acute episode, some lifestyle adjustments may be necessary such as avoiding heavy lifting, it is imperative to remain active as possible with the message to patients that ‘’such activity may hurt but it will not damage the spine.’’

 

Lumbar Disc prolapse

In the back as the disc degenerates and breaks down, the inner core can leak out through the outer portion of the disc, and this condition is known as a disc herniation or disc prolapse

The weak spot in the outer core of the intervertebral disc is directly under the nerve root, so a herniation in this area puts direct pressure on the nerve.

The nerve runs through the leg, and any type of pinched nerve in the lower spine can cause pain to radiate along the path of the nerve through the buttock and down the leg. This type of pain is also called radiculopathy or sciatica

Symptoms typically include leg pain (sciatica) with or without lower back pain.  Often the leg pain can be severe and excruciating. Occasionally symptoms may include numbness or weakness in the leg.

Rarely if there is a large disc herniation then loss of bladder or bowel control may occur, which can be an indication of a serious medical condition known as cauda equina syndrome. At the earliest onset of such symptoms, patients should be reffered to the local Accident and Emergency department for specialist opinion for investigations and managment.

The treatment of back and leg pain from a herniated lumbar disc prolapse is conservative with physiotherapy and pain killers. In approximately 80% of patients symptoms settle down within 6 months time. In the remaining patients surgery is indicated. Surgery offers a 90% improvement of leg pain.

Lumbar Spinal Stenosis

Lumbar (lower back) Spinal Stenosis is caused by the narrowing of the lumbar spinal canal by wear and tear of disc and bones. This is much more common with age and does not necessarily cause symptoms. When present, symptoms may include pain or numbness in the back and/or legs, or cramping in the legs. Weakness in the legs may occur. The classic symptom is called claudication which is cramps in the leg that is worse with walking and better with rest and bending forwards. Walking tends to slow down and often gets worse. Rarely, bowel and/or bladder problems can occur. With mild symptoms the management is conservative with exercises. If symptoms persist or get worse, a consultant with a spinal surgeon would be advisable so that investigations are done and appropriate management is discussed.

Lumbar Spondylolisthesis

In about 5% of the adult population, there is a developmental weakness in one of the vertebrae which may develop as a stress fracture. Because of the constant forces in the low back, this fracture does not usually heal as normal bone. This type of fracture, called a spondylolysis. However, sometimes the cracked vertebra does slip forward over the vertebra below it. Such a slip can also occur from wear and tear, trauma or previous back surgery. Interestingly the slip may cause no problem at all.  However sometimes this can contribute to back pain and in addition due to further wear and tear the nerve at the side may be trapped leading to persistent leg pain.

If symptoms have been persisting inspite of conservative measures, then a thorough assessment by a specialist is advisable. There are other forms of treatment including spinal injections that are offered and surgery is considered as the last option.

Revision Back surgery

Spinal surgery is a complex field and even the very best and most experienced surgeons do not always get excellent results.

Common reasons for revision surgery include such problems as recurrent nerve compression from recurrent or residual disc prolapse or from wear and tear adjacent to previous surgery or other factors such as failure to achieve solid fusion with metalwork which may be due to poor tissue healing and patient related factors.

Another point to consider is that the spine is a living and dynamic structure. Even after apparent successful surgery the function and shape of the spine can deteriorate requiring further surgery to remedy a problem. With advances in spinal surgery especially minimally invasive techniques, in appropriate patients, further surgical measures may offer improvement of symptoms. However revision surgery is a complex field and each patient must be evaluated and treated in a very individual manner to understand what is causing the problem and how best to address it.

  Osteoporosis and spinal fractures

Osteoporosis is the most common bone disease in developed countries. It is a disease of low bone mass resulting in deterioration of the structure and strength of bones. This deterioration can weaken your bones so much that you can fracture a bone without major trauma. Every day activities, such as lifting a bag of groceries or rolling over in bed can result in a fracture. This can cause a lot of back pain and the treatment ranges from a brace to support the back while it heals to surgery for stabilizing the bone.