Diagnosis & Treatment
The initial assessment will be performed by a Consultant Spinal Surgeon or a physiotherapist working at one of our approved premises, following the Spinecare Guidelines.
The initial contact is with the Spinecare Office, either by telephone or through our enquiry form on the web site when a series of brief questions will be asked to determine the type of problem you are suffering and the most appropriate person to see. Further questions and physical examination will then take place and in most cases a working diagnosis can be made and treatment started immediately if it is a straightforward problem.
There will be some patients who have more complex problems that will need immediate MR scanning or specialist Consultant opinion which can be arranged rapidly.
Even if you do not need an immediate Consultant opinion, all cases that are seen by any of our experts are discussed at multi-disciplinary meetings where doctors, physiotherapists, nurses, pain specialists will consider different aspects of the problem to ensure the most appropriate rapid treatment available.
Back pain is a very common feature of life affecting all age groups from teenagers to the very elderly. Some of the causes of back pain can be serious and need urgent specialist intervention, but most back pain originates from the wear and tear of the intervertebral discs and the small joints(facets). The spine is very complex with the bones(vertebrae), ligaments, muscles and the discs (or shock absorbers) all acting in concert to enable the spine to be mobile, yet protect the vital spinal cord and the nerves which exit at different levels . The discs and joints can wear, leading to back pain, and if the nerves are crushed or trapped then the pain can be very severe and radiate down into the arms or the legs.
Acute back pain and spasm can be very frightening and disabling and may come on suddenly with very little warning and not necessarily associated with heavy lifting. A simple twist or bend can often precipitate such problems. The reason for this is that the intervertebral disc tends to wear naturally and lose its supporting capacity allowing the spine to move abnormally, to tear ligaments and seize up. The problem is usually focused at one area of the spine, usually the low back or neck and is treated with analgesics, (pain killers), and a brief period of rest; when the acute spasm is relieved the next step is early mobilisation with physical therapy. Sometimes several areas of the spine are affected at the same time.
The majority of these attacks settle rapidly. In some cases radiation of pain occurs, into the arm if it was a problem in the neck, or the leg if it is a low back problem . This nerve pain can be particularly severe. If this type of pain is not resolving over three or four weeks with physical therapy and strong painkillers then urgent expert assessment is required to determine the next stage of treatment . Many more serious conditions do present with pain in the back and our experts are skilled in identifying the serious problems so that they can be referred for immediate specialist opinion.
We treat the following conditions:
- Acute neck pain, cervical spondylosis
- Acute mid back pain, thoracic spine wear and tear or degenerative problems
- Acute low back pain due to wear in the discs and small joints
- Acute sciatica (pain down the leg) usually due to a prolapsed intervertebral disc crushing one or more of the nerves that leave the spine in these areas
- Spinal stenosis, a narrowing of the spinal canal which is sometimes naturally occurring, but often develops in later life causing back pain and inability to walk any distance
- A slipped disc in the neck, as well as causing very severe arm pain, can cause compression of the spinal cord (the nerves that travel down into the lower body) which is very serious. The standard treatment is an anterior cervical decompression usually with a fusion performed through a keyhole incision in the neck. This operation has a very rapid recovery rehabilitation. The patient needs to be in hospital no more than two to three days
- Osteoporosis of the spine and collapse of spinal vertebrae, using pain injection, advice on lifestyle and medication and in some cases vertebral reinforcement (Vertebroplasty or Kyphoplasty)
- Serious conditions such as spinal infection and tumours of the spine
The main stay of the treatment of most back and neck pain are painkillers, appropriate advice and physical therapy. This may take the form of heat, different forms of electrical treatment, deep massage, mobilisations, manipulations and traction. The majority of back and neck problems can be resolved with this type of treatment without the need for injections or operations.
Epidural injections, which many people know are used in childbirth, can be used to deliver local anaesthetic and a small dose of steroid into the region of origin of a painful sciatica and is successful in relieving persistent sciatic pain in most appropriate cases.
Other injections such as facet joint injections and trigger point injections can be used, particularly in intractable problems in the back.
Discogram with root block injections are also used to try to identify particular discs and nerve roots which are under irritation or pressure.
All these procedures are carried out either by Spinal Surgeons or Pain Specialist Anaesthetists with much experience treating these conditions.
Microdiscectomy - The commonest condition requiring surgery is a slipped or prolapsed lumbar intervertebral disc which presses on one of the spinal nerves causing severe pain into the leg. A microdiscectomy, which is keyhole surgery is designed to remove the prolapse and allow the nerve to recover. It is possible to do this type of surgery as a day case but most patients require one or two nights in hospital.
Non-fusion spine stabilisation - We offer a number of modern techniques in spinal stabilisation including the X-stop and the Wallis implant, both of which in slightly different ways provide treatment for spinal stenosis and spine stabilisation , eliminating the need for spinal fusion in most patients.
Disc replacement - The place of disc replacement is not fully established in spinal surgery. There are a number of alternative treatments, but if this is the most appropriate treatment then Spinecare can offer this type of surgery.
Spinal fusions - If the spine is so unstable that simply removing the pressure on the nerves is not sufficient then a fusion is carried out, usually with screws and rods at the back, sometimes with space r s between the vertebral bodies, either put in at the back or front. These are complex operations only used when all other treatments are inappropriate or have failed. A successful fusion can allow the patient to lead a completely normal life, young people even getting back to highly competitive and physical sporting activities.
One of the problems with existing medical practice is the range of different practitioners, who work in varying ways and collect lots of different data that is not standardised and rarely is passed from one health professional to another. Key facts can be overlooked, unnecessary duplication occurs and reliable data on the results of treatment is not collected. This is all extremely important in relationship to spinal treatment. The unique care plans provided by the Spinecare UK team will ensure a streamlined treatment process for each of its clients.