Are you struggling with back pain? From managing symptoms to the available treatments and surgeries, this is where you’ll find everything you need to know about back and spine problems.
We don’t tend to think about our back until something goes wrong. It’s a risky strategy. Four out of five people will be affected by back pain at some point. Even mild low-back pain can make life miserable and affect even basic daily tasks. Statistically, if a serious back problem keeps you off work for six months, there’s a 50% chance you’ll never be able to return. A sobering thought.
The main types of back problems are either Sciatica or Brachialgia
The main types of back problems are either Sciatica or Brachialgia.
Most cases that require an operation are compressions relating to sciatica/cervical nerve issues. ‘Sciatica’ refers to pain, weakness, numbness, or tingling in the leg.
By far the most common causes of sciatica are a “slipped disc”, which is a degenerate bulge of a lumbar disc, and spinal stenosis, a narrowing of the spinal canal. Or, more rarely, piriformis syndrome (a pain disorder involving the narrow muscle in the buttocks), pelvic injury or fracture, and tumours may all cause these symptoms.
‘Brachialgia’ refers to similar symptoms in the arm and hand. Symptoms are caused by injury to, or pressure on, components of the sciatic nerve in the spine (or more rarely, the leg).
Common Symptoms of Back Problems
Sciatica pain can vary widely. It may feel like a mild tingling, dull ache, or a burning sensation. In some cases, back problems can cause pain so severe you can’t move. The pain most often occurs on one side. Some people have sharp pain in one part of the leg or hip and numbness in other parts. The pain or numbness may also be felt on the back of the calf or on the sole of the foot. The affected leg may feel weak.
The pain caused by back problems will often start slowly. Sciatica pain may get worse after standing or sitting, when sneezing, coughing, or laughing or when bending backwards or walking more than a few yards, especially if caused by spinal stenosis.
Signs and Tests
When you visit your consultant with back problems they will perform a physical examination. This may show weakness of knee bending or foot movement; difficulty bending the foot inward or down; abnormal or weak reflexes; or pain when lifting the leg straight up off the examining table. He or she will probably request an mri scan.
Treatment for Back Problems
Sciatica is a symptom; it’s the underlying cause that needs to be identified and treated. In 90% of cases no significant intervention is required and within six weeks recovery occurs on its own. To tackle the often constant pain due to back problems take over-the-counter pain relievers such as Neurofen or Paracetamol. Bed rest is not recommended. Reduce your activity for the first couple of days. Then, slowly start your usual activities after that. Avoid heavy lifting or twisting of your back for the first six weeks after the pain begins. You should start exercising again after 2-3 weeks.
Be Good to Your Back: Follow These Tips to Reduce Your Risk of Back Problems
The first thing to remember is posture, as it’s a major cause of back problems. Remind yourself to stand up straight, and if you need support when you’re sitting or driving, use a lumbar roll (a specialist cushion) to support your lower back. Avoid bending down for routine tasks such as emptying a washing machine. Instead, lower yourself by bending your knees, allowing your spine to keep relatively straight.
Getting Your Muscles Right
Your spine is a bit like the mast on a ship: it’s long and tall and depends on the rigging around it to keep it stable. Similarly, our internal ‘rigging’ (the muscles in our back, abdomen, buttocks and thighs) has the job of holding the spine stable and straight. If they’re out of condition, or out of kilter, the forces on your spine are no longer neutralised – and you start to get back problems.
These muscles can be developed through exercises with a physiotherapist, chiropractor or osteopath. Pilates is an excellent alternative. Regular endurance-type exercise is also important, and even a 20-30 minute power walk can have a positive effect.
There are various surgical options available for clients when required. Below we explain some of the options available.
WHAT IS CERVICAL SPINE SURGERY?
Your Cervical Spine is made up of seven bones, each called a “vertebra”. These connect to the skull above and to the thoracic spine below. The thoracic spine is behind the chest and anchors the ribs.
The upper two vertebrae are made differently from the rest. They allow us to turn our head from side to side. The rest of the cervical spine lets us nod and tilt our head and neck. Inside the cervical spine is a channel which protects the spinal cord, called the “spinal canal”.
There is an opening on each side of the spine at each spinal level. A spinal nerve runs through each of these openings and carries nerve impulses to move muscles or carries information to the brain from the sense organs in the skin, muscles, ligaments, and internal organs.
An intervertebral disc sits between every two vertebrae, and cushions the spine. The discs are pads of connective tissue and cartilage (sort of like the tough tissue in the breast bone of a chicken). They act like shock absorbers between the vertebrae.
Sometimes, pieces of the disc can push backward into the spinal canal and press on the nerves or spinal cord. Inflammation from the disc can sometimes irritate the nerves or spinal cord.
Other times calcium deposits can build up on the back of the vertebra and push on the nerves or spinal cord. One of these calcium deposits is called a “spur”, the medical name is “osteophyte”, which means a bony projection.
HERNIATED CERVICAL DISC
If You Have a Herniated Cervical Disc causing neck and arm pain, and if you have not improved from a good program of conservative care, then you might consider having surgery. A herniated disc develops when a disc between the vertebrae breaks down. The back part of the disc becomes weak and the disc pushes backward against the nerves or even against the spinal cord.
Problems can also arise from bone spurs which can develop around the cervical discs. These spurs can pinch the nerves to the arms or can press on the spinal cord itself, causing pain, weakness, or numbness. Sometimes surgery is necessary to remove them.
SIMPLE CERVICAL DISC SURGERY
The simplest type of herniated disc is one which is herniated only on one side and is causing pain on that side.
The surgery can be done through the back of your neck (a “posterior approach”) or through the front (an “anterior approach”). The anterior approach is usually recommended because it is a relatively more comfortable approach for the patient.
WHAT IS LUMBAR SPINAL DECOMPRESSION?
Lumbar spinal decompression is a type of surgery that’s performed to treat compression of the spinal cord or the nerves surrounding the spine. This surgery is usually recommended when non-surgical methods are no longer effective.
It’s often performed to treat spinal stenosis (where the space in the centre of the spine narrows), which can affect the way you walk.
WHAT CAUSES SPINAL STENOSIS?
A combination of arthritis in the spine, thickening of the ligaments, and bulging of the discs can cause spinal stenosis. The nerves can get trapped in the spinal canal or where they leave the spine, which can cause weakness or pain in your legs
WHAT ARE THE AIMS OF LUMBAR DECOMPRESSION SURGERY?
Essentially, the aims of surgery are to take away the pressure on the spinal cord and nerves. Removing this pressure can also help to resolve any sciatic leg pain you may be experiencing. After successful surgery, you should be able to walk further without getting pins and needles, numbness or weakness down your legs.
ARE THERE ANY ALTERNATIVES TO SPINAL STENOSIS SURGERY?
Surgery is an option and there are alternatives available. If your symptoms are mild, you may not need treatment and it’s unlikely that your symptoms will get worse quickly. You may even get better with time.
For leg pain caused by pressure on a nerve in your lower back (sciatica), a steroid injection in your spine may help to alleviate pain. Your symptoms can also be managed with painkillers or physiotherapy sessions.
If your symptoms are severe, a lumbar spinal decompression could relieve your pain and pressure, and help you to return to normal activities.
WHAT DOES THE OPERATION INVOLVE?
The operation is carried out under general anaesthetic, however a variety of anaesthetic techniques are available.
During surgery, you’ll usually be lying on your stomach. Your surgeon will make a cut in the centre of your lower back. Small retractors are used to hold the muscles in place while bone around the spinal cord is removed. Sufficient bone and ligament tissue will be removed from the back of the spine to free trapped nerves. Your surgeon may need to join the bones using a bone graft. Sometimes metal screws and rods will be used.
The operation usually takes between an hour and an hour and a half.
HOW PAINFUL IS IT?
After the operation you will be in some pain. However, this will primarily be located in the back where the operation was carried out. You may also experience leg pain, but this won’t be as bad as the pain you were in before operation.
The initial pain will last between 5-7 days. By two weeks most of the pain should have disappeared, and within 3 months you should feel nearly back to normal.
Any pain you experience following surgery can be well managed by the anaesthetist and you will be given painkillers to help reduce pain throughout your recovery.
HOW SOON WILL I RECOVER?
Everyone is different and the length of recovery can vary from person to person. Most people will normally be able to start walking on the first day after surgery and after three to five days you should be able to go home. After three months you should be almost back to normal.
Physiotherapy sessions will usually be required to help build up strength and confidence. Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, it’s important to ask a member of your healthcare team for advice. Patients with screws and rods may need additional physiotherapy sessions for up to six months after surgery.
You may still experience back ache due to wear and tear in your spine. However, most people can expect to make a good recovery from lumbar decompression surgery.
WHAT IS SCOLIOSIS?
Scoliosis is an abnormal sideways (lateral) curvature of the spine. The spinal column (backbone) of the patient with this condition curves and twists, so rotating the ribcage. X-rays of individuals with scoliosis show an ‘S’ or a ‘C’ shaped curve rather than a straight line. Scoliosis can be disfiguring and often presents with a hump. Scoliosis affects approximately 2% of the population to some degree but serious noticeable curves are much less common. (see Fig. 1).
HOW IS SCOLIOSIS MANAGED?
Scoliosis is managed according to the presenting factors. For small curves, we start with exercise and regular monitoring. If during monitoring, an increasing curve occurs before or during puberty, then the consultant may advise a spinal brace. Even with regular exercise, monitoring and regular use of braces, some patients whose curves keep progressing may be referred for surgery.
WHAT IS DONE DURING SURGERY?
Surgical treatment usually combines correction and straightening of the curvature and deformity with implanted rods and fusion of the involved vertebrae. This means that the levels fused act as one column of bone. Operations for scoliosis can be carried out from the front (anterior) or the back (posterior).
Patients with more severe curvatures might need both an anterior and posterior approach performed. In the hands of a skilled surgeon, neither approach is clearly superior. The consultant will advise you which surgical approach would be most appropriate. Scarring is kept to the minimal for most patients. Invisible sutures are used internally that dissolve and sterri strip plasters are used for the skin.
WHAT ARE THE RISKS OF SURGERY?
Surgery in an adult carries a higher rate of complications and risks than in a child or teenager. Immediate risks of surgery include:
- Neurological complications; this is the loss of movement in all extremities or just partial loss of function. Neurological complications are rare, but they can occur. To reduce the risk, intraoperative electronic monitoring of spinal cord functioning is used.
- Infection; deep wound infections are rare but may require further surgery.
- Surface infections are more common and need wound care and antibiotics.
- Lung problems; collapse of small portion of the lung is a common cause of fever after surgery. Frequent turning of the patient by the nurses and physiotherapists using techniques to encourage deep breathing and coughing help prevent this.
- Ileus (lazy bowel) is a common complication after spinal fusion. To treat this complication, the patient is not allowed to have any food and drink by mouth until the signs of normal bowel function returns, which is usually within three days after surgery.
- Temperature change in the foot, leg because of operation e.g. one foot cold and one foot warm as nerves has been disturbed or severed.
- Numbness in vicinity of operation site, sensation may return after time.
HOW FLEXIBLE WILL I BE AFTER SURGERY?
This depends largely on how many vertebrae are fused, and where in the back these vertebrae are located. Fusing just the middle of the back (the thoracic vertebrae) will not significantly impact the forward bending flexibility, since these vertebrae connect to the ribcage which is fairly rigid anyway.
Fusing the upper back and neck (the cervical region) will limit the bending and twisting flexibility in your neck somewhat, but usually not severely.
The five lumbar vertebrae at the base of the spine are the most important for bending; flexibility and when these are affected by the surgery noticeable stiffness will result. The aim of the surgery is to stabilise the spine by fixing as few vertebrae as possible.