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Back Pain, Trapped Nerves and Herniated Discs - when is surgery required?

Posted Dec 29 2013 5:56am

Who are the Spine Experts and what do they recommend?

At what point is a surgeon required to treat back pain and sciaticaPain that radiates along the sciatic nerve, which is the main nerve in each leg and the largest nerve in the body.? Furthermore, what sort of surgeon should I have – a neurosurgeon or an orthopaedic surgeon?

One of the UK’s acknowledged leading spine specialists, Mr Ranj Bhangoo says, “The first stage in the diagnostic pathway should be a thorough assessment by a neurosurgeon who will be able to identify which area of the spine is affected and which nervesBundles of fibres that carry information in the form of electrical impulses. may be involved. In most cases further tests will be ordered and this is usually an MRIAn abbreviation for magnetic resonance imaging, a technique for imaging the body that uses electromagnetic waves and a strong magnetic field. scan of the spine.”

The King’s College Neurosurgeon explains how a stepwise approach is used to treat most spinal disorders starting treatment with physiotherapyThe use of physical therapies such as exercise, massage and manipulation. and osteopathyA therapeutic system that centres around the concept that many conditions are related to musculoskeletal disorders.. If this is ineffective then simple analgesicsAnother term for painkillers. may help. Occasionally the doctor may use injections of steroid/local anaestheticA medication that reduces sensation in a part of the body. mixture which may alleviate back pain and sciatica. These injections may be to the epiduralOn or over the dura mater, the outermost of the three membranes covering the brain and spinal cord. The epidural space is used for anaesthetising spinal nerve roots, for example during pregnancy. space (similar to a technique used in childbirth), facet joints or around individual nerves (perineural block).

Surgical treatments, although proven to be effective and safe, naturally carry greater risks than non-operative treatments and are therefore only used selectively. There are many different operations used to treat back pain, neck pain and sciatica. Surgical treatments for nerve entrapment causing either sciatica or brachialgia are well studied and usually highly effective. Operations for back pain are generally more complex but often produce significant improvements in pain and quality of life.

In his extensive, plain English article , the spine expert describes the types of surget including:

  • Spinal Fusion
  • Lumbar disc replacement surgery
  • Vertebroplasty
  • Neck pain
  • Leg pain/sciatica
  • Lumbar microdiscectomy
  • Arm pain/brachialgia
  • Anterior cervicalRelating either to the cervix (the neck of the womb) or to the cervical vertebrae in the neck (cervical spine). discetomy and fusion/cervical disc replacement
  • Posterior keyhole foraminotomy
  • Lumbar/spinal stenosisA condition in which the spinal canal narrows and compresses the spinal cord and nerves.
  • Lumbar laminectomy

In all cases, due to the range and complexity of treatment options (as well as specialists), patients are advised to get involved in the decision making process and discuss all options with their doctor.

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