Providing comprehensive information about conditions and treatments available for the spine.
Degenerative spine pathology
Tumours involving spinal column and the spinal cord
Complex congenital spinal cord malformations
There are several ways to treat problems of the spine in the neck region depending on the pathology. Generally, surgery is done for relieving pressure on the nerves or spinal cord and sometimes for reliving neck pain without nerve compression.
There are several reasons that surgery on the neck may be recommended for you. The main reasons are:
There are many reasons that you may have pain or neurological symptoms (numbness, pins and needles, or weakness) in your arm. Acute pain can be myofascial in origin meaning from the muscles or soft tissues supporting the spine. Neck pain can also be from the neck joint (facets) or disc degeneration.
Your arm or shoulder region including shoulder blade and chest wall can be painful due to cervical nerve root compression.
The best proven methods is known as “McKenzie Method” or “Mechanical diagnosis and treatment” (MDT). NOT ALL physiotherapist are familiar with this and only few are experienced with it. In this method you are assessed to find out if there is a directional relief of your pain and then given exercises that essentially repeatedly allows the neck to be in that particular direction and/or relief position is sustained repeatedly. This is found to improve the pain. Gentle massage therapy, sometime traction is also used for acute pain but these are usually do not have sustained benefit. Exercises such as swimming can be beneficial but discuss this with your physio or neurosurgeon.
Often patients use anti-inflammatories (Nurofen, Mobic, Naprosyn, etc) or paracetamol or in combination. Your GP may recommend stronger pain medication like Panadine forte, Endone or Targin, and in cases of severe nerve pain (also known as neuropathic pain) Gabapentin (Neurontin) or Pre-gabalin (Lyrica) are used.
These are commonly known as cortisone blocks. Patients are often confused about these as they are given for variety of problems and in different location. For nerve pain these can be given near the nerve and for joint pain (facet pain) these are given near the joint or the small nerves that supply the joints (“medical branch blocks”). Steroid blocks are given often for relief of pain but sometimes these can help to identify the nerve root that is involved as sometimes it is difficult to know which nerve is particularly compressed just by clinical history and examination, and MRI scan does not show specific location of the problem. The duration of these blocks varies and they are usually effective at best in about 60% of cases. Discussion with your surgeon is essential before trial of these injections. Radiofrequency ablation: where the causes of neck pain is localized to the facet joints and this responds well to the steroid block, radiofrequency ablation is a good option for long term relief of this pain. In this technique small sensory nerves that carry pain signal from the joints are heated with ultrasound frequency machine and made dysfunctional. The effect may last 12 months or more. Your surgeon will decide if this is appropriate for your condition.
There are many aspects to this. Some include avoiding lifting, especially above shoulder level, some house hold chores (vacuuming, mopping, carrying heavy pots/pans) or those that cause repeated neck flexion or sustained extension of the neck. Driving for prolonged time 30-60 min. Sitting in front of a screen for more than 30 min at a time. Dr. Mckenzie’s books on treatment of neck and back pain are excellent source for patients with neck or back pain. https://www.mckenzieinstituteaustralia.org/
Recovery from surgery varies depending on the type of procedure and individual variation. This is discussed in detailed based on individual circumstances.
Depending on your problem you may expect:
Improvement of specific symptoms depends on many factors and your neurosurgeon will discuss these with you in detail.
It should be remembered in cases of arm pain without weakness where there is no spinal cord compression, the symptoms can continue with recurrent episodes of exacerbation on and off, without any severe consequences.
However, if the symptoms become chronic (lasting more than 3 months) the following can occur:
With cord compression, progressive sensory abnormality and spasticity may occur which will lead to problems with balance and mobility and if left long enough lead to paralysis. Bowel and bladder disturbance can occur as well.
Prior to recommending a patient for surgery, Dr Kohan will explore all non-operative treatment options that are available. This may include an intensive physiotherapy program or pain management regime.
Lumbar spine is the most common segment of the spine to be affected by degenerative (wear and tear) processes.
It is very important to understand that there are many different conditions that affect lumbar spine and specific treatments or surgeries are required to treat each different condition. Therefore, it is incorrect to think that just because another person was treated with particular surgery and did well or poorly, it is appropriate or required for you or necessarily you are going to respond the same way!
Acute back pain is often due to soft tissue injury (myofascial), or sometimes due to disc injury.
In all acute back pain conditions lasting more than 6 weeks further investigation is indicated to exclude fracture, infection or tumours.
The most common indications that you may need surgery are: