Back pain: From causes and treatment to minimally invasive surgery, what you need to know

About 80 percent of population experience low back pain at some point in their lifetimes. It is the most common cause of job-related disability.

Back pain - causes

• Sprains and strains
• Disc Prolapse - common cause of low back pain .
• Radiculopathy (sciatica)- is caused by compression, inflammation and/or injury to a spinal nerve root - resulting in pain, numbness, or a tingling sensation in leg or arm.
• Spondylolisthesis - Slippage of vertebra.
• Spinal Injury
• Spinal stenosis - narrowing of the spinal column that puts pressure on the spinal cord and nerves that causes pain or numbness with walking and over time leads to leg weakness and sensory loss.
• Scoliosis – Spinal Deformity
• Infections
• Tumours
• Cauda equina syndrome is a serious and causes loss of bladder and bowel control. Permanent neurological damage may occur.
• Arthritis
• Osteoporosis - can lead to painful fractures of the vertebrae.

You should see a Neuro Spine Specialist if you have:

• Severe neck or back pain that does not improve with rest
• Numbness or tingling in arm and legs
• Pain after a fall or an injury
• Pain travelling to Arm or leg.
• Trouble urinating
• Weakness in hands or legs
• Numbness in hands or legs
• Fever

Diagnosis

• A complete medical history and thorough back examination with neurologic tests are required imaging may be ordered to rule tumours and spinal stenosis
• X-ray.
• Computerized tomography (CT)
• Myelograms
• Magnetic resonance imaging (MRI) - infection, tumour, inflammation, disc herniation or rupture, or pressure on a nerve is suspected.
• Electrodiagnostic - Chromograph (EMG), nerve conduction studies (NCS), and evoked potential (EP) studies.
• Bone scans are used to detect and monitor infection, fracture, or disorders in the bone

Treatment

Most people with chronic back pain do not need surgery.

Hot or cold packs.

Activity: Individuals should begin stretching exercises and resume normal daily activities as soon as possible

Strengthening exercises, beyond general daily activities, are not advised for acute low back pain, but may be an effective way to speed recovery from chronic low back pain.

Medications: A wide range of medications are used to treat acute and chronic low back pain

Epidural steroid injections are a commonly used short-term option for treating low back pain. Pain relief associated with the injections, however, tends to be temporary

Surgery

Spine surgery is typically recommended only when a period of nonsurgical treatment — such as medications and physical therapy — has not relieved the painful symptoms caused by your back problem.

Spine surgery was traditionally done as "open surgery,” with a long incision. In recent years, however, technological advances have allowed more back and neck conditions to be treated with a minimally invasive surgical technique ( Key Hole). Minimally invasive surgical approaches are faster, safer and require less recovery time.

How Minimally Invasive Spine Surgery works

This is facilitated by utilizing a small incision and guiding instruments and/or microscopic video cameras through these incisions.

An operating microscope and Endoscope provides excellent illumination and magnification during minimally invasive spine procedures.

The benefits are:

• Smaller skin incisions (as small as 2 cm)
• Less blood loss
• Reduced risk of muscle damage
• Reduced risk of infection and postoperative pain
• Faster recovery from surgery
• Early return to work.
• Diminished reliance on pain medications after surgery
• In addition, some MIS surgeries are performed as outpatient procedures and utilize only local anesthesia — so there is less risk for an adverse reaction to general anesthesia.

 Conditions treated Using MIS

• Discs prolapse – Lumbar and Cervical
• Lumbar and Cervical spinal stenosis – Spinal compression
• Spinal deformities such as scoliosis
• Spinal infections
• Spinal instability
• Vertebral fractures
• Trauma
• Spinal Tumours
• Degenerative disc disease

Surgical options:

Vertebroplasty and kyphoplasty are minimally invasive treatments to repair compression fractures of the vertebrae caused by osteoporosis.

Spinal laminectomy and Foraminotomy (also known as spinal decompression) is performed when spinal stenosis causes a narrowing of the spinal canal that causes pain, numbness, or weakness

Discectomy (Endoscopic or Microscopic) may be recommended to remove a disc, in cases where it has herniated and presses on a nerve root or the spinal cord, which may cause intense and enduring pain.

Spinal fusion is used to strengthen the spine and prevent painful movements in people with degenerative disc disease or spondylolisthesis.

Artificial disc replacement  - The procedure involves removal of the disc and its replacement by a synthetic disc that helps restore height and movement between the vertebrae.

Microscopic and Endoscopic Surgery for Tumours and Infections of Spine.

Spinal Trauma Surgery

Recommendations for keeping one’s back healthy

• Walking, swimming, or stationary bike riding 30 minutes daily can increase muscle strength and flexibility.
• Yoga also can help stretch and strengthen muscles and improve posture.
• Don’t slouch when standing or sitting
• Sit in a chair with good lumbar support and proper position and height for the task
• Wear comfortable, low-heeled shoes.
• Sleeping on one’s side with the knees drawn up. Always sleep on a firm surface.
• Don’t try to lift objects that are too heavy. Do not twist when lifting.
• Maintain proper nutrition and diet to reduce and prevent excessive weight gain. A diet with sufficient daily intake of calcium, phosphorus, and vitamin D helps to promote new bone growth.
• Quit smoking and alcohol.

Dr Ashish Gupta is director, Neuro and Spine Surgery, Fortis Escorts Hospital, Faridabad

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