Our back is made up of small bones piled up one and other with intervening soft cushions known as intervertebral discs or discs for short. These discs are soft structures with balloon like tendencies, i.e. they are tense and pressurized.When the disc (balloon) ruptures the contents go out of place and in the process cause back pain or pain in the legs (or in the arms and hands in case of neck problems) if it happens to irritate or cause pressure on nerves that pass nearby it.
“Sciatica” is a very broad term used to describe radiating pain in the legs which is due to some problem with the leg nerves originating in the back. The usual problem is some kind of pressure due to a slipped disc or nerve pressure due to a variety of other causes.
Yes, it is definitely possible to treat sciatica in majority of the cases. The common reasons are some form of pressure on the nerves in the back. If the cause can be diagnosed by investigations it is usually possible to treat it.
Spondylosis or spondylitis, which are commonly used terms only mean that the back is undergoing an age related degeneration.It means “wear and tear”. It is not something to be feared because aging affects each and every one of us. It is only in some individuals this can lead to pain and other problems, which can are treatable.
No, the common notion that a person having back problems must sleep on a hard board or on the floor is not correct. One can certainly use a mattress which is firm enough. A mattress of coir is probably the best. Cotton mattresses which develop uneven surfaces and the very soft cushioned mattresses in which the body sinks inside are better avoided.
Any pain in the legs which seems to be starting from the back or the buttock region and traveling into one or both the legs. Along with the pain there may be a feeling of “pins and needles” or tingling and numbness in parts of the leg. One may find some weakness in the affected leg in the form of heaviness or difficulty while walking. In the middle aged and elderly there are typical symptoms whereby the person feels pain , heaviness, tingling, numbness and weakness in the legs which increases on walking or standing and is relieved by sitting or bending forwards. These complaints are also related to nerve compression in the back and can be treated by medicines, exercises and in extreme cases by surgery.
As a spine surgeon, I would try to put minimum restriction on the lifestyle of any back pain patient especially if the person is young and active. If a person is suffering from a back problem the general precautions include avoid frequent bending (occasional bending is allowed), not to bend and lift (lifting should be done using the knees), not to lift very heavy objects, not to sit continuously for a prolonged period, sit on a proper chair, avoid sitting down on the ground. The restrictions put significant brakes to the person’s life, I would offer a surgery if it is possible to make the person’s life less restricted.
Our neck is a very delicate piece of architecture which has a very high mobility and a tendency to be misused. Occupations involving excessive use of neck lead to neck pain and neck problems. These include computer professionals, persons using computers extensively, telephone operators and person having to write for several hours. Wrong sleeping position, using a very big pillow or no pillow or frequently sleeping in sitting posture with the neck unsupported can lead to neck problems. WARNING SIGNALS(red flags to indentify serious underlying problem)
Pain radiating down from the back or the neck to the lower or upper limbs, respectively. This would be more significant if the pain aggravates on coughing/ sneezing/ certain movements of the back or the neck.This pattern of pain would generally indicatea disc herniation or related problem. Weakness or numbness in a specific part of the hands or legs.This might indicate a nerve getting “pinched” n the spine. Unsteadiness while walking. Though there are a host of problems that can lead to this kind of presentation, one of the foremost and also, one of the treatable causes is compression of the spinal cord in the neck or upper back region.
Pain in the calf or buttocks on walking or standing for some time and getting relieved on sitting down or stooping forwards. This would indicate a pathological spinal condition termed “spinal canal stenosis”. Deformity of the back or a bony hump seen on one side of the midline of the back.This could indicate a spinal deformity which would have the best treatment results if detected early.
INVESTIGATION FOR BACK PROBLEMS
After then patient gives his account of the problem we then perform a thorough clinical examination and then provisional clinical diagnosis is made. Manny times the problems are naturally self limiting ones which may not require further investigations But some times it is important that further investigations are performed to find out the exact cause for the problem. This helps in managing the problem more efficiently. Basic investigations include plain x-rays of the spine and blood investigations like Hb (Hemoglobin),ESR (Erythrocyte sedimentation rate),Blood cell counts, etc.To further delinate the problem some times investigations like MRI SCAN,CT SCAN, etc are performed .
No operation is free of risks. Possibility of complications is higher if the operation is very major.In routine spine operations the complication rate is negligible. Complications occurring after a surgery can make the whole exercise lamentable. But one has to risk something to gain something. Airplane crashes do occur but that does not deter people from flying. That is because the number of plane crashes is only a small fraction of the number of successful flights the world over. Crashes occur despite utmost care from all the involved persons. Similarly doctors take utmost precautions to avoid any complications. The complication rate is too low compared to the number of successful operations. But still complications may occur and one has to be prepared for them keeping faith in the treating doctor. One has to weigh the possible benefits against the potential risks and then venture into an operation if the likely benefits are greater than the risks. It is reasonable enough to know the complications but one need not fear an operation for the possibility of complications just as one hardly bothers about the possibility of a plane crash while deciding to travel by air or a Vehicular accident while travelling by road.
MRI means Magnetic resonance Imaging. It is a new technology which helps in the diagnosis of majority of back related problems. Previously one had to depend on plain x-rays and myelogram (an x-ray taken after injection of certain medicinal contrast material in the back).Computerized axial tomography (CT scan) and Magnetic Resonance Imaging (MRI Scan) which are in vogue since the last decade have completely revolutionized the diagnosis and treatment of back problems. These techniques take several images of the spine, without the need of any injections on most occasions,and are the so-called non-invasive diagnostic techniques.These scanning techniques offer the advantages of a higher level of accuracy and sensitivity to pick up small details, often enabling an early diagnosis. These techniques have also thrown light on certain disease aspects previously not well understood.They show minute details of the back bones, the discs and the nerves and they show whether or not the disc has slipped and whether or not the nerves are getting compressed.Many other details are also appreciable.
Majority of the back problems are to be treated without operations. Initial treatment of all back problems is done by medications, rest and soothing modalities such as local heat or physiotherapy and later on by exercises.There is a middle path between non-surgical treatment and surgery and that is “epidural injections”.Certain patients with slipped disc or similar problems can benefit from these injection of certain medicaments in the back using a special technique called epidural injection. The required course can range from one to three injections. It can give early relief from the problem and about half of these patients can get permanent cure. Regular exercises form the main pillar in the long term treatment of back problems. Even those patients undergoing operations require to do specific exercises on a regular and permanent basis. There is no escape from exercises for a patient having back problems.
PREPARING FOR SPINE SURGERY
This is the most critical step towards preparing for spine surgery! Most spine surgeries are dictated by two factors, pain and nerve function. A doctor can measure a patient’s temperature, he can measure his blood pressure; but he cannot measure his pain. Pain is a very subjective sensation and hence, the need for surgery on the grounds of pain would be decided by the patient himself.If pain is severe enough to interfere with the activities of daily living, if it is becoming a source of constant nagging discomfort, if it is decreasing the patient’s productivity, then it is better to undergo a surgery as per the spine surgeon’s recommendations. If nerve function is affected, then depending on the severity and duration of the problem, as also coexisting disorders such as diabetes mellitus, the spine specialist may recommend surgical intervention.Unless the risk vs benfit ratio tilts very favourably towards surgery it will not be suggested to you in the first place.It is important to realize this as nothing in life comes without an element of risk; even the simple act of walking out on the street is fraught with risk, which we know may sometimes be life threatening too! So, do not confine your life to months and months of futile bed rest for misplaced fears of spine surgery. Discuss the details of your surgery and its attendant risks with your doctor to quell any fears and to clear any and every doubt of yours! If you so desire, your doctor can even arrange to give you references of patients who have undergone similar surgeries.
Patient has every right to understand his problem and to be convinced about the need for surgery. In this process taking a second opinion comes natural to many patients and there is nothing wrong with it. Every conscientious spine surgeon will welcome second opinions. But the process of taking multiple opinions and seeking advice from large number of doctors can confuse and mislead the patient.
The fear of paralysis after a back operation looms large on the patient’s mind, perpetrated by misinformation. The problem has been over exaggerated. It is a rare complication in the hands of a well trained and experienced spine surgeon. The same analogy as travelling by air and not fearing a crash, although one knows that a plane may crash, should be applied.Similarly a person well trained in the specialty of spine surgery is adequately well trained in handling the nerves and the possibility of paralysis in such trained hands is extremely rare. If the benefit to risk ratio is in the positive, one should take the chance of a successful outcome from an operation and trust the doctor to do his best. But in some rare and difficult cases the chances are little more.
The success or failure of spine surgery depends upon the type of problem and the expected result. The ability to predict the result is the single most important aspect of the treating doctor’s experience and expertise. The patient and the doctor must have realistic expectation from a back operation. Often, a complete pain relief is likely. Sometimes it may not be possible to guarantee complete pain relief but a significant reduction in pain is predictable. A patient in extreme pain and disability may become ecstatic even if his or her pain is reduced partially.On the other hand a patient with minimal pain would appreciate only if his pain is completely relieved. In such a situation, partial relief does not have much value for the patient. Hence if the patient undergoing back surgery is clear about the expected outcome, he or she would be better prepared and avoid disappointment. In this context, one gets a so called “bad result”,if the expectation from the surgery is enormously higher than what the surgery can offer in that particular patient.
No. Surgery is not the final answer to all back pain and problems. If medicines and other non-operative treatment does not help a back problem, it is not necessary that surgery will help. There are definite situations where surgery would help and the result is good if surgery is applied to those problems.
In the current state of the art spine surgery, the aim is to get the patient on his feet as early as possible. In majority of the cases, the bed ridden state lasts only for about 3 to 5 days after which the patient is allowed to walk and carry out the activities of daily living. Most of us know a friend or relative who has suffered a fracture and had to treated by placing rods or plates and screws to fix a fractured bone. Till recently such use of metallic rods and plates was done only in the bones of arms, forearms and legs. Due to recent advances, we can now also put these metallic devices in the spine for better results in certain spine problems. These devices are used when vertebrae are not stable and move excessively due to injury or other reasons. In the current orthopaedic concept when the emphasis is early mobilization after an operation, these devices play a major role. With a better understanding of spinal problems, a given condition is tackled with the minimum amount of surgery required. We do not disturb anything that would alter the structure of the spine. Whenever necessary, i.e. in case of structural instability, we use metallic implants or devices to increase the stability of the spine.The belief “Bigger the operation, longer the patient needs to stay in bed” is incorrect. Earlier a patient gets out of bed, earlier the body returns to normal routine and t is morale boosting.
Minimally invasive surgery involves operations in which the surgery is performed using small incisions,Special retractors and the use of Magnification.By this advanced techniques the results are many times better than compared to a classic open surgery. Laser surgery is not a form of surgery, it is only a form of technique.Laser surgery for the back has very limited applications and the results are not yet promising.