See below for a summary of some of the spinal conditions that can affect people. They include:
Lumbar Spine: Back pain, Sciatica, Lumbar disc prolapse, Spinal stenosis, Spondylolisthesis.
Cervical Spine: Neck pain, Brachalgia, Cervical disc prolapse.
Whole Spine: Spinal deformity, Spinal Fractures, Spinal Tumours.
Back and Neck Pain
There are a large number of causes for back and neck pain. These range from the most common muscular problems through to degenerative causes and structural problems in the spine, such as spinal deformity or spondylolysis. Good core muscle function and general muscle conditioning is essential to help support the spine and maintain normal function. Surgery is not always guaranteed to improve back pain and may only be considered for certain specific conditions.
Full assessment can allow for diagnosis, discussion, and an appropriate treatment plan to be commenced.
This is leg pain caused by a nerve being pressed on in the spine. It is most commonly related to a slipped disc but can be related to spinal canal narrowing (stenosis) or spinal deformity, such as spondylolisthesis or scoliosis.
Lumbar disc prolapse (slipped disc)
This is a common condition and may affect people of all ages. It often causes acute severe pain in the back and radiating down the leg. The prolapsed disc often shrinks down in size spontaneously and the majority of people do not need any treatment other than pain killers. However, if the pain is prolonged or affecting ability to work or perform normal daily activities, treatment options include performing a steroid injection around the nerve to improve the pain, or performing microdiscectomy to remove the disc bulge.
Lumbar spinal stenosis
This is also a very common condition related to the ageing process in the spine. The facet joints and ligament can enlarge and press on the spinal nerves as they pass this area. In some people, this can result in a constant sciatica. In others, they may be painfree when sitting down but, as soon as they try to stand or walk they develop gradually worsening pain and aching in the legs which requires them to sit down frequently (claudication).
Some people have one or two episodes then the pain resolves whilst other people find that modifying activities provides enough relief for them to carry on with fairly normal activities. However, some people have worsening pain and are very limited by their symptoms and are suitable for an operation. A decompression operation often provides excellent relief of the pain.
This occurs when one vertebra slips forward on another. It most commonly occurs as a result of the normal ageing process in the spine but can occur as a result of spondylolysis (pars defect) from childhood. Many people will not require intervention for this but, in some cases, the slip causes pressure on the nerves. If it cannot be resolved by non-operative treatment, an operation may be appropriate to decompress the nerves and, in some people, this will also require a fusion procedure.
This is arm pain caused by pressure on a nerve in the neck. It is most commonly due to age-related changes in the spine but may be caused by a slipped disc.
Cervical disc prolapse (slipped disc)
This often causes acute severe neck pain radiating down the arm. It resolves spontaneously in the majority of people and most people take pain killers until the pain improves. However, in some people, the pain can be prolonged or too severe and it may be appropriate to consider a steroid injection around the nerve to reduce the pain, or an operation to relieve the pressure on the nerve.
Scoliosis is a lateral (sidewards) curve in the spine. It can affect people of all ages. One of the most common types is adolescent idiopathic scoliosis (AIS) which affects children going through puberty; most children do not require any treatment but some may require brace therapy. If the curve becomes large, a discussion needs to take place to discuss whether an operation is appropriate.
Degenerative scoliosis is another common type of scoliosis. This occurs in a large number of older people and is due to the age-related changes in the lumbar spine. It can cause problems with leaning forwards or off to the side, and may also cause pressure on nerves resulting in sciatica. Full assessment and discussion will provide treatment options and allow the optimum course of action.
Kyphosis is a forward bend in the spine. In younger people, it may be as a result of wedging of the vertebral bodies. However, it is a very common finding in older people and is part of the normal ageing process in the spine. Most people progress very well with muscle strengthening exercises. However, in younger people with progressive deformity, or older people with nerve compression or severe pain, an operation may be appropriate. A full assessment and discussion is required to ensure the correct treatment options are considered.
Spinal fractures / broken back
Some people break their back during a high energy collision or impact and will usually be assessed in a trauma centre to see if urgent stabilisation is required, especially if there is any spinal cord injury or nerve injury.
Many people have a lower energy fall from a low height or from standing height. Most of these people will try and pursue non-operative treatment in the first instance and the majority will heal within 2-4 months. However, in a small number of people, the fractures may not heal and they could have ongoing pain. In these people, they can continue non-operative measures or may wish to consider kyphoplasty or vertebroplasty to reduce pain.
Tumours (or cancer) can spread from other organs to the spine. This may be treatable using chemotherapy or radiation therapy. However, if it is causing severe pain or vertebral collapse, it may be suitable to consider surgical intervention such as kyphoplasty or stabilisation. Full assessment and discussion between the patient, oncologist, and surgeon is essential to plan the optimum treatment. Metastatic spinal cord compression may result if the tumour starts to press on the spinal cord, and this should be treated as an emergency.