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.
Most cases of neck and back pain can be managed with rest, medication and strengthening exercises. Your family doctor will be able to advise you on the proper care, but in cases of persistent pain or suspected slipped disc, he or she may refer you to an orthopaedic specialist for a more thorough check-up.
In most cases, standard x-rays will be ordered and in some cases special nerve function tests. When a more serious problem is suspected or when surgery is being considered, you will normally be sent for Magnetic Resonance Imaging, or MRI. This is a sophisticated way of imaging the spine and is very accurate, and it has the further benefit of being without any radiation as it is performed with the assistance of a magnetic field.
Other less common but serious causes of neck and back pain include infection and cancer and in some of these, other special investigations may be needed for the diagnosis.
The exact treatment depends on the cause of the pain, but generally in mild cases you will be advised on:
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:
Spine surgery is commonly undertaken for back and/or leg pain due to:
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.
