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FAQ

Frequently asked questions.
All FAQs
Surgery
Injections
Conditions
Investigations
Red Flags

Are lasers used in spinal surgery?

Yes. The laser is being used in spine surgery mainly to treat disc problems. A procedure called thermodiskoplasty is when your surgeon uses a laser to change the shape of a disc. This procedure may be used in combination with microdiscectomy. Although the use of lasers in spine surgery is still pretty new, it shows promise as a minimally invasive way to treat disc problems of the spine. It reduces scarring around the nerve roots and can lead to a faster recovery. Also, the hardening affect that lasers have on the disc itself may help keep your spine from becoming unstable after disc surgery. There are guidelines regarding this type of treatment available on the National Institute of Clinical Excellence Web Site.

What are the risks of cortisone injections?

Cortisone is a steroid. Steroids have got a bad reputation because of some really bad side effects suffered by people, such as body builders, who take steroid pills for a long period of time. Injections of cortisone into a sore joint or aching back do not carry the same risks. However, there are risks associated with cortisone injection. These risks include infection, bleeding, and headache.

I have degenerative disc disease and spurs in my neck and back. Will I be in pain, the older I get?

Not necessarily. The idea of “degeneration” gives an image that the bones of the spine are pretty much falling apart. Actually, changes in your spine are a common part of the aging process. Sometimes spurs can lead to more pain, but there is no guarantee that pain will happen. Some people who show spurs on x-ray have pain, but others do not. An exercise program focusing on mobility, strength, and good posture and body movement, can help you prevent future problems. Also, the aging process itself can help stop pain. Aging tissues lose water content and become generally stiffer. Structures that do not move do not usually cause pain. The best advice is to keep active, exercise regularly, and see your doctor if you have pain or difficulty that you cannot manage yourself.

Will a lower spine fusion effect my flexibility?

There is not very much movement in the joints of the lumbar spine when you bend forward. Most of the movement of bending forward takes place at your hips, so as long as your hips are okay, you should not have any problems bending forward after lumbar spinal fusion.

If I have surgery using rods and screws, will they be removed?

Metal implants used in surgery are not always removed. Once your spine fusion has healed, the metal rods and screws are no longer necessary. Still, the implants are usually not removed unless they cause you pain or discomfort, can be felt or seen under your skin, or have broken. If a follow-up x-ray shows that an implant is broken, it may be a sign that your fusion did not heal successfully. Your surgeon may suggest additional tests to see whether your fusion has healed before taking out the broken implants.

What are the benefits and risks of minimally invasive surgery?

Benifits Smaller incisions less postoperative pain less surgical blood loss shorter hospital stay less postoperative pain medicine faster return to work and daily activities. Risks Same risks as traditional surgery vision is decreased and a surgeon may choose to turn to traditional surgery if more vision is needed

What is minimally invasive surgery?

Traditional spine surgery typically requires long incisions in the back. Muscles are cut and separated from the spine to allow access to the spinal anatomy. Minimally invasive spine surgery is performed through small incisions in the back. Surgeons use specialized instruments and navigational tools such as interoperative x-ray, microscopes and tubular retractors. Like traditional spine surgery, the goal of minimally invasive surgery is to relieve your back and/or leg pain. But it adheres to a different philosophy—that as little muscle tissue as possible should be damaged.

If I have surgery to remove my disc, what replaces the area removed?

Usually, surgeons do not remove the entire disc. Instead, they take out just the material in the middle of the inside of the disc. After a simple discectomy surgery, scar tissue fills the area where disc material has been removed. When a fusion using a bone graft is needed, the disc is taken completely out and the bone graft is put in place of the disc between the two vertebrae. In an anterior interbody fusion surgery, a metal cage may be used in place of the disc between the vertebrae.

Will I need surgery?

The first decision that must be made is whether your problem is very serious, or less serious. Some problems need immediate attention—possibly even surgery. For example, if you have significant muscle weakness or have nerve pressure that is affecting your bowels or bladder, you may require immediate surgery. (See the Red Flag page on All About Spines) If you have pain that cannot be tolerated or you are unable to gain reasonable function for daily activity, surgery may be suggested. The good news is that the majority of back problems do not require surgery. Once the most likely cause of your problem has been determined (once your diagnosis is made), you and your doctor can decide on a plan for taking care of your back now and into the future. A variety of treatment options exist for different types of back pain. In most cases, conservative therapies such as mild pain medications and rest are effective in relieving the immediate pain. The overall goal of treatment is to make you comfortable as soon as possible, design a program to reduce further pain and injury, and get you back to normal activity as soon as possible. The more you know about how your back works and what you can do to prevent further injury, the better your program will work.

What is the difference between a bulging disc and a herniated disc?

A disc begins to bulge when the centre of the disc pushes out against the ligament that surrounds it, much like air being blown into a balloon. Bulging discs are common, and can be seen on MRI even in people who do not have pain. A bulging disc will cause problems when it balloons into the space in the spinal canal. In comparison, a herniated disc is like a balloon that has popped. The disc herniates when the soft, inner material squeezes its way through ligament tendon and ruptures — like a popped balloon. Pain occurs because of the tear in the ligament, the pressure of the disc material against your nerves, and from the inflammation caused when the inner material is squeezed out of the disc. If there is pressure on a nerve, symptoms of numbness and weakness may also be noticed in the areas supplied by the nerve.

What is the difference between a ruptured disk and a herniated disc

Nothing. “Ruptured disc” and “herniated disc” are two names for the same thing.

MRI shows a bulging disc, do I need to see a specialist?

Not necessarily. Studies show that many people have a “bulging disc” but have no pain or problems at all. The fact you have a bulging disc is not necessarily a problem, but if you have symptoms of pain, numbness, or weakness, you should see a doctor or a spine specialist.

How did I herniate my disk?

Heavy lifting, falls, and twisting can all cause a herniated disc. However normal healthy discs do not usually break or herniate. As you get older, your discs become effectively worn and weaker. It is these discs that can herniate.

Is a pinched nerve cause my numb hand and weakness in my arm?

Your symptoms may be a sign that a nerve is “pinched.” The medical term for this is radiculopathy which happens when a nerve is irritated from something rubbing or pressing on it. This can cause numbness in your skin, weakness in your muscles, and loss of reflexes in the area controlled by the nerve. Usual causes of radiculopathy include herniated discs and bone spurs. Other causes are tumours or fractures that cause pressure on one or more nerves.

Arm pain caused by my neck, how?

The pain you feel in your arm can be from a problem in your neck, much like leg pain can be from the low back. This type of pain is called referred pain. When there is injury or irritation in the tissues deep inside your body, your brain is not able to determine exactly where the pain is coming from. Instead, the pain is felt further away from the actual source of the problem. For example, pain in or around your heart may be felt in the jaw or down the left arm. In the same way, problems in your neck can “refer” pain down into your arm. When the source of pain is more toward the surface of your body, your brain has an easier time figuring out where the pain is coming from. A pinprick on your palm hurts right where the pin sticks your hand. Characteristics of referred pain include the following: The source of pain is usually deep and toward the centre of your body. It is often felt as a vague, deep, burning, or aching pain. Intense pain radiates further. Treatment for referred pain must address the source of pain. If your doctor determines that your arm pain is coming from your neck, you will need treatment for your neck, not your arm. Helping your neck problem should take away or reduce the pain in your arm.

Neck pain and what causes it

Neck pain can be a crippling ailment for many patients. The cervical spinal region is the second most problematic area and is only beaten by the troublesome lumbar spine. There are a wide range of symptomatic conditions which can cause cervical pain due to injury, disease or degeneration. Luckily, most structural painful neck conditions respond well to appropriate back pain treatments. Neck ache is known to affect many surrounding tissues, as well, including the head and face, shoulders, upper back and arms. Most neck pain is due to degenerative changes that occur in the neck. The overall condition of the cervical spine usually determines how fast you recover from an injury, and whether your neck pain will become a chronic problem. Severe pain in the neck can also affect the upper back, head, face, shoulders and arms. Cervical injuries can affect a variety of possible structures, including soft tissue and vertebral bones. The most common type of injury affects the muscles of the neck and upper back. Whiplash is a good example of cervical muscular pain. This scenario can be very sore, but is usually not serious. Most cases of muscular neck pain will resolve with little or no medical treatment. Disc injuries are often problematic and can cause severe pain which might last for some time. Medical intervention might be required for serious disc concerns. Damage to the actual vertebrae or spinal cord can be a grave matter and must be handled by experts in emergency medicine. Degenerative processes are often blamed for severe neck pain but are rarely the actual cause. Far too many people demonstrate identical degeneration of the cervical structures without suffering from any symptoms. While degeneration can be a contributor to neck pain, it is not usually the main or only cause

What replaces the space after removing the disc?

Often only a small amount of disc is removed. and scar tissue fills the area left behind (such as during a discectomy) However, during a fusion a bone graft is needed and the disc is completely replaced with the bone graft. In some cases (such as during an ALIF surgery) a metal cage may be used to replace the disc.

What are ‘Red Flags’?

Red Flags are symptoms which indicate serious problems requiring urgent action. If you have any of these you should seek immediate advice from a doctor. If you have any of these symptoms, it does not mean that you need an urgent operation, it means that you should seek URGENT assessment by a doctor who will decide whether urgent action should be taken. If you, or a friend, has back pain related to any of the following, seek immediate help from a medical specialist: Younger than 20 or older than 55 and getting back pain for the first time. Back pain after a violent injury, e.g. road traffic accident. Back pain is constant and getting worse. Back pain is in the upper part of the spine. Back pain and have, or have had cancer. Back pain and are taking (Cortico)steroids. Back pain and use illicit drugs or are HIV infected. Back pain and generally unwell or feverish. Back pain with significant unexplained weight loss. Back pain and continuing to have great difficulty bending forwards. Nerve related problems other than pain: loss of sensation (especially of the area that would sit on a saddle – so called saddle anaesthesia) or loss of power Urinary or bowel incontinence. Back pain with obvious structural deformity of the spine. Debilitating back pain that is not reducing after 4 -6 weeks. If you are in doubt about any of these symptoms, you should seek urgent advice.

Will I need surgery?

If your condition is serious and is classified as a red flag, you need to seek immediate medical attention (refer to ‘What are red flags’ section in any FAQ) The majority of back problems do not require surgery, and in a lot of cases pain medication and rest can effectively relieve symptoms. Once your doctor has diagnosed the cause of your pain, you can discuss with them possible treatments and preventative measures to make sure you get your back to full function and keep it that way. Possible non surgical treatments include exercises and stretches (self managed or performed by a physiotherapist), injections and medication.

What is spinal decompression and spine fusion surgery?

Spinal decompression and spine fusion surgery are two common surgical procedures that can be performed using traditional and minimally invasive surgical approaches

I hear a crunching noise when I turn my neck. Is this bad?

Popping sounds can sometimes be heard when a muscle or tendon slides over a bony bump. The sound you hear may also be the gliding of joints as you turn your neck. Articular cartilage forms a smooth covering over the surface of healthy joints. If your joint has been injured or becomes inflamed, the surface may thicken, creating a rubbing sound as you move. A courser grinding or crunching may indicate more advanced changes in the surfaces of one or more joints. Such changes can be caused by osteoarthritis (OA). OA can happen from normal wear and tear, especially when there has been a change in the alignment of your joint. Joint alignment can be changed following an injury, when your muscles are tense or in spasm, or from poor spine postures that have been used over the years. A physical therapy program to help with your posture and muscle balance can improve movement in your neck and may help stop the noise.