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Common spine conditions

What is scoliosis?

Scoliosis is a 3 dimensional spinal deformity consisting of a “twisting” of the spine that results in distortion of the torso with heart, lung and pain issues if severe.

 

There are may types with the most common being the idiopathic (genetically linked but largely unknown cause) the most common.  This type typically manifests in girls from around 10 years of age and can rapidly deteriorate with growth.

 

Other causes are congenital (birth abnormalities), related to neuromuscular conditions (such as cerebral palsy, spina bifida and many more) and degenerative conditions, which occur in the elderly.

 

Every scoliosis follows a different course dependent on when it occurs, remaining spine growth and severity.

 

Treatment ranges from monitoring until the end of growth (16 – 18 years old), bracing in selected individuals and corrective surgery.

 

more information

I have back pain, do I need surgery?

Back pain is extremely common and the vast majority of patients the pain will settle with time and symptomatic care.  It is generally managed by your GP with exclusion of dangerous causes, weight and muscle tone optimization and pain medication.  In patients with unremitting pain, associated fever / loss of weight, leg pain, pain at rest, disrupting sleep, or pain persisting for months – specialist assessment is indicated.

Unremitting pain, especially at rest and associated with weight loss and fever may be due to cancer or infection.  This requires urgent investigation and management.

 

Persistent lower grade back pain with associated leg pain may well be due to “wear and tear” and if unresponsive to physical optimization, surgery may be indicated.  You will need to be assessed by a specialist clinically and by means of x-ray and most likely MRI.  In a select group, surgery may be indicated.  This will involve fusion surgery which has it’s own risks, costly and put one off work for 8 – 12 weeks.

 

 

Is disc replacement surgery for me?

 

 

Disc replacement surgery is an attempt to maintain ongoing cervical motion and reduce the stressors on the adjacent non-operated segments.  Fusion surgery results in increased forces at adjacent segments with accelerated degeneration and risk of additional future surgery.  Disc replacement requires surgery from the front.  In the lumbar spine this entails trans-abdominal surgery with increased risk and seldom benefit in most patients.

 

In contrast, the default access to the cervical spine (neck) is through the front so there is no additional approach risk.   In younger patients with reasonable facet joints, a disc replacement is a good option.

Such cervical surgery is quick with short hospital stay, and an excellent therapy for persistent shoulder / arm pain due to nerve root entrapment from a herniated cervical disc.

What is spondylolisthesis?

 

 

Spondylolisthesis refers to one vertebrae sliding forward on another.  This occurs typically in the low lumbar spine.  It may occur in young children from a “dysplastic” condition and be rapidly progressive as they grow.  It may present in the teenage years in highly active children, especially gymnasts and bowlers, with a stress fracture or in adults due to disc degeneration.

 

They all present with back and leg pain.  The leg pain can be of variable intensity, from hamstring tightness to debilitating buttock and calf pain.

 

This can be resolved with nerve decompression, anatomical re-alignment and fusion.

I could live with my back pain, but not this new leg pain!

Leg pain can be due to local muscle, vascular, hip AND spine pathology.

 

Nerve irritation from spinal stenosis or disc herniation is however far less toleratable than back pain. It is also less responsive to medication. Disc herniations may resolve spontaneously despite the acute, severe pain.

 

Therefore unless there is bladder / bowel control dysfunction or loss of motor power, there is no urgency for surgery. There relative pro’s and con’s need to be discussed with your surgeon.

 

With more sub-acute pain limiting walking distance may be due to reduced space for the nerves from arthritis. If debilitating, this can be resolved with surgica decompression.