Spinal conditions //
Below is an overview of common spinal conditions that we manage frequently and successfully at West Wales Spine. We hope this guide will aid you in first aid management of your spinal condition but would advise that if you have any concerns to either seek attention of your GP and/ or book a consultation with Mr. Navin Verghese in one of our clean, comfortable and modern private hospitals.
WHAT is SCIATICA?
Sciatica is the generic term used to describe leg pain caused by pressure on nerves in your lower back. There are many causes of sciatica including:
Herniated disc - (damage to the wall of your discs)
Spinal stenosis - (narrowing of the spinal canal)
Degenerative disc disease - (breakdown of the discs which act as shock absorbers between your vertebra)
Spondylolisthesis - (a condition in which one vertebra slips forward over another one)
Rarely "red flag" causes such as spinal infection, tumour and fractures.
HOW IS THE DIAGNOSIS OF SCIATICA MADE?
It is important to establish the cause of your sciatic symptoms. At West Wales Spine you are assured of the latest diagnostic techniques and equipment in our state-of-the-art private clinics and Hospitals in Werndale, Carmarthen & Saint Davids House/ Sancta Maria hospital in Swansea. More often than not a diagnosis is made by physical examination, testing sensation, muscle strength, and reflexes. An MRI and/or CT scan is also commonly used to aid diagnosis. Once these tests have been performed and the results of your MRI/CT known then a treatment plan can be agreed.
TREATMENT OPTIONS FOR SCIATICA - St Davids House, Sancta Maria Hospital & Werndale Hospital
Often, disc herniations are treated successfully without surgery, and acute symptoms settle within 6 weeks.
Simple analgesics such as anti-inflammatories as well as stronger opiod and neuromodulating medications can help during this period. One or a combination of treatments such as physiotherapy, osteopathic manipulation, diet and exercise can also be of immense benefit.
Spinal injections may be advised if your symptoms do not settle. In West Wales Spine we are able to fast track your spinal injections in one of our private hospitals.
On rare occasion’s surgery may be recommended if the conservative treatment options do not provide sufficient relief, if leg or back pain limits normal activity, if there is weakness or numbness in the legs, or if it is difficult to walk or stand, if medication or physical therapy has been ineffective. Surgery is performed to remove the herniated disc, and free up space around the compressed nerve. In West Wales Spine surgery for sciatica is performed on weekly in-patient theatre lists in one of our private hospitals. Pre and post operative care led by Mr. Navin Verghese is delivered by our team of highly experienced nurses, physiotherapists and medical doctors with a patient:nurse/doctor/physio ratio unrivalled by most hospitals in South Wales.
SYMPTOMS FOR BACK PAIN CAN INCLUDE
Persistent aching or stiffness anywhere along your spine, from the base of the neck to the tail bone
Sharp, localized pain in the neck, upper back, or lower back -- especially after lifting heavy objects or engaging in other strenuous activity. (Pain in the upper back can also be a sign of a heart attack or other life-threatening conditions.)
Chronic ache in the middle or lower back, especially after sitting or standing for extended periods
Back pain that radiates from the low back to the buttock, down the back of the thigh, and into the calf and toes
Inability to stand straight without having severe muscle spasms in the low back
WHAT CAUSES BACK PAIN?
80% of the adult population will experience back pain at some stage in their life. There are a number of causes including generalized muscle strains, disc disease, arthitis and rarely fractures, tumours, deformities or infections.
HOW TO MANAGE BACK PAIN
The majority of patients with back pain can be managed conservatively (Click here for National Institute for Health and Care Excellence NICE guidelines). However in intractable or severe/ deteriorating cases you may need further investigation and treatment. At West Wales Spine we offer rapid consultation, diagnostics and multimodal treatment to ensure prompt treatment of your back pain.
Click below to view Mr Verghese discuss back pain on Swansea Bay TV.
WHAT CAUSES NECK PAIN?
Most neck pain is caused by activities that strain the neck. Slouching, painting a ceiling, or sleeping with your neck twisted are some things that can cause neck pain. These kinds of activities can lead to neck strain, a spasm of the neck muscles, or swelling of the neck joints.
An infection in the neck.
WHAT ARE THE SYMPTOMS
You may feel a knot, stiffness, or severe pain in your neck. The pain may spread to your shoulders, upper back, or arms. You may get a headache. You may not be able to move or turn your head and neck easily. If there is pressure on a spinal nerve root, you might have pain that shoots down your arm. You may also have numbness, tingling, or weakness in your arm.
HOW IS YOUR NECK PAIN DIAGNOSED
Diagnosis can usually be made from your symptoms and physical exam. Symptoms relating to your arms such as sharp radiating pain, pins and needles and weakness may suggest a trapped nerve in your cervical spine requiring prompt investigation and treatment.
If your pain started after an injury, or if it doesn't improve after a few weeks, your we may want to do more tests. Imaging tests such as an X-ray, an MRI scan, or a CT scan can show the neck muscles and tissues. These tests may be done to check the neck bones, spinal discs, spinal nerve roots, and spinal cord .
HOW IS IT TREATED?
The type of treatment you need will depend on whether your neck pain is caused by activities, an injury, or another medical condition. Most neck pain caused by activities can be treated at home.
FOR NECK PAIN THAT OCCURS SUDDENLY
Use a heating pad on a low or medium setting for 15 to 20 minutes every 2 or 3 hours. Try a warm shower in place of one session with the heating pad. You can also buy single-use heat wraps that last up to 8 hours. Or you can try an ice pack for 10 to 15 minutes every 2 to 3 hours. There is not strong evidence that either heat or ice will help. But you can try them to see if they help.
Avoid more injury to your neck by changing activities and habits, such as how you sit or sleep.
Try exercises or physical therapy to help you move your head and neck more easily.
IF SYMPTOMS DO NOT SETTLE
Dependant on the cause of the symptoms the follwoing may be advised
Spinal injections, cervical facet blocks, root blocks, epidurals
Surgery - in cases where there is pressure on nerve roots or less commonly the spinal cord we may advise that surgery is neccessary to prevent further deterioration and disability. At West Wales Spine we perform Cervical spinal surgery including rom disc replacement and fusion procedures.
ARM PAIN OF SPINAL ORIGIN
WHAT ARE THE SYMPTOMS?
Severe pain radiating from the neck to the shoulder/ arms and hands
Sudden stiffness in the neck and arms
Weakness that makes it difficult for the patient to perform daily activities
Numbness in the arms and hands
In rare but serious cases spinal cord compression resulting in loss of balance and fine hand movements (myelopathy)
Treatment of arm and neck/ upper back pain is necessary, as it may signal the presence of underlying health problems.
Also, if the condition remains untreated for an extended period, it can result in other complications due to pressure on the nerves in the neck.
The main objective behind the treatment is to maintain blood circulation and suppleness to the affected area. Since a tight muscle in the lower back portion creates pressure in the upper back, one need to improve the overall blood circulation of the area by doing upper back pain exercises. It is usually done with a series of therapeutic exercises including and self-help techniques. Other treatments include physical therapy, hot packs, and cervical traction. The doctor may recommend medications such as pain relievers, cortisone injections and anti-inflammatory drugs. If these conservative measures do not achieve satisfactory pain relief then we may recommend cervical spinal injections and in severe cases surgical intervention. At West Wales Spine we are able to offer a comprehensive package of conservative, injection and surgical treatments.
WHAT CAUSES spinal stenosis?
There are many potential causes for spinal stenosis, including:
Aging: With age, the body's ligaments (tough connective tissues between the bones in the spine) can thicken. Spurs (small growths) may develop on the bones and into the spinal canal. The cushioning disks between the vertebrae may begin to deteriorate. The facet joints (flat surfaces on each vertebra that form the spinal column) also may begin to break down. All of these factors can cause the spaces in the spine to narrow.
Heredity: If the spinal canal is too small at birth, symptoms of spinal stenosis may show up in a relatively young person. Structural deformities of the involved vertebrae can cause narrowing of the spinal canal.
Instability of the spine, or spondylolisthesis: When one vertebra slips forward on another, that can narrow the spinal canal.
Tumors of the spine: Abnormal growths of soft tissue may affect the spinal canal directly by causing inflammation or by growth of tissue into the canal. Tissue growth may lead to bone resorption (bone loss due to overactivity of certain bone cells) or displacement of bone and the eventual collapse of the supporting framework of the spinal column.
Trauma: Accidents and injuries may either dislocate the spine and the spinal canal or cause burst fractures that produce fragments of bone that penetrate the canal.
WHAT ARE THE SYMPTOMS OF SPINAL STENOSIS?
Spinal stenosis may result in low back pain as well as pain in the legs. Stenosis may pinch the nerves that control muscle power and sensation in the legs. Additional symptoms may include:
Frequent falling, clumsiness
Pain and difficulty when walking
Numbness, tingling, hot or cold feelings in the legs
HOW IS SPINAL STENOSIS DIAGNOSED?
Spinal stenosis can be difficult to diagnose because its symptoms can be caused by other conditions. Usually, people who develop stenosis have no history of back problems or any recent injury. Often, unusual leg symptoms are a clue to the presence of spinal stenosis.
If simple treatments, such as postural changes or nonsteroidal anti-inflammatory drugs, do not relieve the problem, special imaging studies may be needed to determine the cause of the problem. An MRI (magnetic resonance image) or CT (computed tomography) scan may be requested. A myelogram (an X-ray taken after a dye is injected into the spine) may be performed. These and other imaging studies can offer details about the bones and tissues and help with diagnosis.
HOW IS IT SPINAL STENOSIS TREATED?
Spinal stenosis can be treated several ways.
Treatment options include:
Changes in posture: People with spinal stenosis may find that flexing the spine by leaning forward while walking relieves their symptoms. Lying with the knees drawn up to the chest also can offer some relief. These positions enlarge the space available to the nerves and may make it easier for people with stenosis to walk longer distances.
Medications: In some cases, the pressure on the nerves is caused by inflammatory swelling. Nonsteroidal anti-inflammatory medications (NSAIDS) such as aspirin or ibuprofen may help relieve symptoms.
Rest: Rest, followed by a gradual resumption of activity, can help. Aerobic activity such as bicycling is often recommended.
Injection: If conservative measures do not provide lasting pain relief we may advise injection therapy. General this consists of steriod in order to reduce inflammation and pressure around the spinal nerves.
Surgery: If other treatments do not ease the pain, surgery may be recommended to relieve the pressure on affected nerves. In West Wales Spine we offer the full range of decompressive surgeries including minimally invasive techniques.