SPINE CONDITIONS & TREATMENT
The spinal column is made of bones, facet joints, ligaments and intervertebral discs that cushions the joints.
These structures protect the spinal cord and nerves situated within the spinal canal (space behind the vertebral body). There are a number muscle attachments to the spinal column. These muscles provide support to the spinal column as well as aid in movement of the spine.
LOW BACK PAIN & SCIATICA
Low back pain is a very common symptom. It can affect both the young and old. It can be caused by:
Low back muscle strain
A fracture of the spine (due to trauma like fall or conditions like osteoporosis)
Facet joint arthritis
Sciatica refers to pain radiating/shooting down the leg. This is typically at the back of the leg, which is where the distribution of a nerve called the sciatic nerve, thus the term sciatica. This occurs most commonly when nerve roots in the spinal canal are compressed. Symptoms also involves pain, numbness, tingling down the arms or legs. This occurs when there is compression of the nerve roots in the spinal canal.
A slipped disc is a condition where the cushion (called the intervertebral disc) between the bones of the spine (vertebral body) has slipped out of its usual position. Another term for a slipped disc is herniated disc or herniated nucleus pulposus, referring to the jelly-like substance inside that has come out.
Slipped discs or herniated discs occur in the neck (cervical slipped disc) or in the low back (lumbar slipped disc). Rarely, it occurs in the middle of the spine (thoracic slipped disc).
Treatment of a slipped disc is often done successfully using non-operative measures (conservative treatment). Good pain relief from a slipped disc occur when different modalities of treatment are combined.
Operative treatment of a slipped disc may be indicated when conservative treatment (non-operative treatment) for a slipped disc has failed. This is because prolonged pressure on the nerves or spinal cord can cause irreversible damage to the nerves or spinal cord. If there is associated weakness of the arms or legs showing significant compression from a slipped disc, surgery sometimes may need to be done early to preserve the remaining nerve or spinal cord function and potentiate recovery.
Scoliosis refers to a medical condition where the spine is bent or curved to the side. Scoliosis can sometimes be seen in young children but more commonly seen in adolescents. The commonest type of scoliosis in the young is adolescent idiopathic scoliosis or AIS. It often involves the thoracic spine and the curve is noticed in the mid-back. A hump on one side of the back if often noticed by either the patient or their parents.
Some Possible Associated Symptoms with Scoliosis include(s):
A hump present in the upper or lower back
Asymmetry of the chest wall
Shoulders or the pelvis are not level
A patient with scoliosis might notice that one hand brushes against their hips while walking while the other hand does not
Numbness or tingling of the legs
Weakness of the legs
Treatment for scoliosis depends on the type and degree of scoliosis. In patients where the curves are moderate, bracing may sometimes be done for treatment in order to minimise progression of the curves. In patients with rapidly changing or large curves, surgical treatment of scoliosis may sometimes be required. Multiple screws are often used to straighten the curve and maintain correction. Surgical treatment of scoliosis can result in good correction of the curve.
Patients with degenerative scoliosis often present with back pain. Treatment of degenerative scoliosis often involves medications and physiotherapy. Surgical treatment of degenerative scoliosis can give good results in selected patients.
NECK PAIN/ CERVICAL MYELOPATHY
Neck pain is a very common symptom. In this modern day and age, text neck is becoming a problem where looking down places stress on the neck resulting in neck pain. Neck pain may also occur from a change in the structure of the disc. Problems in the neck can be referred to the back of the shoulder and patients can sometimes mistake a neck problem for shoulder pain.
Symptoms of cervical radiculopathy and myelopathy
When one particular nerve is compressed in the spine, there may be pain or tingling going down the arm. There may be associated numbness or weakness of the extremity. It can often be caused by a slipped disc or disc herniation.
Treatment of nerve compression symptoms depends on the nature and severity of the nerve(s) compression. Non-operative treatment of the spine can be instituted first for mild cases.
If there is severe compression of the nerve(s) or spinal cord in the spine, surgical treatment of the spine may sometimes be necessary. This is done to prevent further damage to the nerve(s) and give the nerve(s) a chance to recover.
Spinal stenosis is a condition where the spinal canal is narrow causing compression of the nerves. Narrowing of the canal can occur anywhere in the spine causing symptoms of nerve compression.
Some Possible Associated Symptoms with Spinal Stenosis include(s):
Pain down the legs especially when standing or walking
Tingling, numbness down the legs
Weakness of the legs
Bladder bowel disturbance
Treatment of spinal stenosis can be done with medications, physiotherapy, injections and sometimes an operation. There are different types of surgical treatment for spinal stenosis. The type of surgical treatment of the spine depends on the severity of the problem as well as the anatomy.
Spine tumours can be either secondary (i.e.; spread from elsewhere) or primary (i.e.; tumour occurring in the spine or spinal cord/nerves itself). They can sometimes be picked up incidentally or present with a wide variety of symptoms. It is important to always maintain a high degree of suspicion in patients with a previous history of cancer as the spine is a common site for tumour metastases (spread of the tumour).
Some Possible Associated Symptoms with Spine Tumours include(s):
Severe Pain in the neck or back
Weakness or numbness of the arms or legs
Pain that does not goes away with rest
Back pain along with other symptoms, such as loss of appetite, unplanned weight loss
Before embarking on treatment of the spine, an accurate diagnosis is first required. A biopsy is sometimes done before deciding on the type of treatment for spine tumours. A multidisciplinary team involving surgeons, medical and/or radiation oncologists if often required in the treatment of spine tumours. There are multiple options for surgical treatment of the spine ranging from minimally-invasive techniques to a more extensive approach. Chemotherapy, hormonal therapy and/or radiotherapy are often adjuncts to surgical treatment of the spine.
SPINE TREATMENT SPECIALITY
How Radiofrequency Ablation Works
The heat lesion on a nerve may be produced by any one of the following three methods:
Conventional continuous radiofrequency (CRF) ablation—continuous high-voltage current is passed to produce a heat lesion.
Pulsed radiofrequency (PRF) ablation—short bursts of high-voltage current are passed with silent phases in between when no current is transmitted.
Water-cooled radiofrequency (WCRF) ablation—a specialized needle is used that is heated but also cooled by a continuous flow of water to prevent over-heating.
The effects of RFA may last for a few months to years, after which the nerve usually regenerates, and the pain may or may not return.
Fluoroscopy or x-ray guidance is used to guide the treatment needle to the target nerve.
When Radiofrequency Ablation (RFA) Is Performed
RFA is considered for treating facet joint pain in the cervical, thoracic, or lumbar spine; or for sacroiliac joint pain in the posterior pelvis.
RFA may be performed in the following cases:
Vertebral and/or spinal conditions such as degeneration causing neck, mid-back, or low back pain
Facet joint pain or facet arthritis
Posterior pelvic pain stemming from the sacroiliac joint
Side-Effects and Risks of Radiofrequency Ablation (RFA)
For the first few weeks or days, a sunburn type burning and or numbness may be felt over the injection site, typically for RFA performed in the neck. Resting, using an ice-pack, and using topical or oral medications may help relieve the discomfort.