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Since the vast majority of patients with acute attacks of back pain improve spontaneously, surgery should not be the first line treatment. A course of physiotherapy (or chiropractic treatment) by an experienced physiotherapist is highly recommended for 6 weeks. Even conditions such as sciatica frequently respond to rest, medication, and physiotherapy. Specific conditions such as progressive leg weakness or bladder and bowel problems require surgery as a first line treatment.
Pain, loss of function, time off work and lack of predictability for the future are personal reasons why patients have surgery for their back pain.
Surgery is indicated for back pain when it is not responsive to physiotherapy and simple analgesia and when all other treatments fail to relieve the back pain.
Identifying the cause of back pain (pain generator) is the key for successful treatment. However, sometimes it is difficult to identify the pain source due to the complexity of the spine.
Obtaining a precision diagnosis is done through careful examination and investigations. X-rays, CT scans, MRI scans, nerve conduction studies and discograms help in obtaining a precision diagnosis for low back pain.
Spine injections for back pain may work temporarily or long-term. They help to break the pain cycle and help patients to continue physiotherapy and return to work. The injections vary from nerve root blocks, to sacro-iliac injections, to facet joint injections, to epidural injections.
No, surgery is not the answer to all back pain. However, advancement in technology allows surgeons to treat more patients with back pain. It is vital to match technology with pathology for the treatment of back pain.
The disc is the source of the pain in the vast majority of patients with chronic back pain, hence, removing the disc is the first step for treating back pain. This is followed by spinal fusion or disc replacement.
Spinal fusion involves removing the damaged disc, then replacing it with a cage and a bone graft. This allows new bone to form and cross from one vertebra to another and stop the painful movement.
The fusion of the spine can be performed through a cut on the back (posterior lumbar interbody fusion), or a cut through the front (anterior lumbar interbody fusion). Sometimes, a combination of anterior and posterior fusion is required if the spine is unstable.
Mr Kasis performs a high number of spine operations from the front of the body especially in younger patients.
(Please click on the images for a closer look.)
Fusing a segment of the spine may put more pressure (and load) on the other discs. This may lead to earlier wear and tear in these discs. Therefore, spinal fusion should only be done when it is absolutely necessary and when all the other treatments fail to relieve the back pain.
Total disc replacement is a relatively new technology based on replacing the damaged disc with an artificial disc (prosthesis), which is composed of two metal parts with a plastic moving part in the middle. The disc replacement allows the spine to move in all directions. The quality of the disc replacement has improved dramatically over the last few years since it was introduced in the mid-eighties in Germany.
Disc replacement has the advantage of preserving spinal movement. However, it is a relatively new technology with relatively short follow-up on its long-term effectiveness and outcomes.
No, not all patients are candidates for disc replacement. Some patients are more suitable for fusion. Certain criteria have to be met for the suitability of disc replacement.
This can be more challenging to treat, as fusing 2 discs in the lumbar spine can cause more pressure and stress on the other discs. This may lead to accelerated wear and tear in the normal discs. However, one of the options is fusing one disc and replacing another one (Hybrid construct). The hybrid construct maintains the movement in one of the affected discs, whilst reducing the stress on the other normal discs.
