Successful treatment of a spine problem first and foremost depends on an accurate diagnosis. From a thorough clinical history and examination with adjunct investigations, we ensure the right diagnosis is made. Conditions of the sacroiliac joint or the hips may sometimes mimic a spine condition. Similarly, a neck condition may sometimes be diagnosed as a shoulder problem.
In our centre, spinal conditions can be treated by an experienced in-house physiotherapist specialised in both spinal and orthopaedic conditions with appropriate exercises and stretching.
Figure: Problems in the hip and sacroiliac joints may sometimes present like a spinal problem.
Figure: Neck problems may sometimes be mistaken for shoulder problems2. Spinal injections
An injection done under X-ray guidance may sometimes be done for the treatment of spinal problems such as pain in the lumbar spine, neck pain or radicular pain (pain down the arm or leg originating from the spine). In certain instances, a spinal injection may sometimes give additional information so that targeted treatment of the spine can be done. Patients are usually discharged a few hours after the spinal injection procedure.3. Minimally invasive (keyhole) spinal surgery
In cases where we need to perform a spinal operation, it can be done using minimally invasive (keyhole) techniques in order to decrease post-operative pain, quicken recovery and shorten the hospital stay. A number of spine surgeries and procedures are suitable for this to the benefit of the patient.4. Minimally invasive (keyhole) decompression surgery
Nerves in the spine may be compressed for a variety of reasons. Often the treatment for this is non-surgical comprising of medications and physiotherapy. Should the symptoms or signs not improve, spinal surgery may be required to free (decompress) the nerve or nerves. This can be done via a minimally invasive (keyhole) technique. Using a microscope, the nerve is decompressed through a small incision in the skin. Patients may be discharged the same day.5. Minimally invasive (keyhole) slipped disc surgery
A slipped disc occurs when the cushion between the bones (vertebrae) slips out of its usual confines. Often, there is no need for surgical treatment. If the disc compresses the nerves in the spine, surgery for slipped disc may sometimes be required to free the nerve (decompression). This can be done using a minimally invasive (keyhole) technique. The disc is visualised using a microscope and the loose part of the offending disc is removed. Patients may be discharged the same day.6. Artificial disc replacement (ADR) or arthroplasty
Slipped disc can also occur in the neck. In young patients with a slipped disc in the neck causing compression of the nerves, the offending disc can be removed and an artificial disc can be inserted to restore movement of the neck. Surgery is done through a cut in the front of the neck parallel to or along the skin crease. Patients can be discharged the day after surgery.
Figure: An artificial disc replacement (ARD or arthroplasty) that is used in the cervical spine (neck)
A slipped disc can occur in the cervical spine (neck). The disc may compress one nerve or the main spinal cord. In young patients, the slipped disc causing nerve compression may be removed and replaced with an artificial disc to restore neck movement. Spinal surgery is done through a cut in the front of the neck parallel to or along the skin crease. Patients may be discharged the day after spinal surgery.
Figure: The artificial disc allows movement in the neck when bending forward (flexion) and backward (extension).7. Vertebroplasty or Kyphoplasty (injection of cement into a spine fracture)
Elderly patients who are osteoporotic (where the bones are softer) are prone to getting a spine fracture from a trivial fall. Patients can be treated with medications and sometimes a brace. If the pain does not get better and inhibits the activities, vertebroplasty or kyphoplasty (injection of cement into the spine) may be done to give good pain relief from the fracture. This is done through 2 needles which are inserted into the fracture site and cement is injected from both sides. A balloon is sometimes used prior to injection of the cement (kyphoplasty). Patients may be discharged the same day of the procedure.
Figure: An X-ray of the spine after injection of cement into a spinal fracture8. Minimally invasive fracture stabilisation and open spinal fracture dislocation treatment
Some patients with spinal fractures may need stabilisation with screws. In suitable patients, these can be done through multiple keyhole incisions (cuts in the skin). This can result in less post-operative pain and quicker recovery from surgery. In more severe injuries such as fracture dislocations of the spine, open surgery may be required. The spine dislocation is reduced and the fracture is stabilised with screws and rods. Spinal fusion (joining of bones in the spine) may be done.9. Anterior cervical discectomy and fusion (ACDF)
Figure: Plate and screws used for anterior cervical discectomy and fusion (ACDF)
In older patients who have compression of the nerves or spinal cord, an artificial disc may not be suitable. Here, a cervical fusion (joining the bones together) can be done after removing the disc and/or osteophyte (bone spur) that is pressing on the nerve. Spinal surgery is done through a cut in the front of the neck parallel to or along the skin crease. The bones are fused after removing the disc with a plate and screws. Multiple levels can be operated if required. Patients may be discharged the next day.10. Spinal fusion and TLIF (Transforaminal lumbar interbody fusion)
Spinal fusion may need to be done in a select group of patients with nerve compression and/or instability (where the spine is moving in an abnormal fashion). This is done using screws and bone graft to join the bones together so that they do not move. In a TLIF, a spacer is used together with the rods and screws in order to improve the alignment of the spine for fusion. Multiple levels may be fused at the same time if required. Most patients can walk the same or next day after spinal surgery.
Figure: A transforaminal lumbar interbody fusion (TLIF) involves putting in screws and a spacer between the vertebrae (bones of the spine)11. Cervical laminoplasty (creating space for the nerve in the neck)
In certain conditions, surgical decompression of the nerves may need to be done from the back of the neck. In order to preserve movement, a cervical laminoplasty (where the bone is hinged open to create space for the spinal cord) can be done. This creates a larger space for the spinal cord much like enlarging a room by moving the wall on a hinger to create an enlarged space in the room.12. Surgery for Spinal tumours
Most spinal tumours are secondary i.e. occur as a result of spread from the original or primary tumour. Spinal tumours can end up compressing the nerves or may sometimes cause the spinal bone to fracture (vertebral fracture). In these patients, treatment is often via a mutli-disciplinary team approach comprising the medical oncologist, radiation oncologist and the spinal surgeon. In certain cases, surgery is not required while in others, spinal surgery may be done for decompression (freeing the nerves) and stabilisation (making the spine stable).13. Scoliosis treatment and correction (treatment for curved spine)
Common forms of scoliosis (curved spine) that we see are adolescent idiopathic scoliosis (in the young) or degenerative scoliosis (in the elderly). In the young, many mild curves can be observed. Moderate curves that are at risk of progression can be braced while larger progressive curves may sometimes require spinal surgery. This involves correction of the curve of the spine and fusion (joining the bones together) to prevent curve progression. In the elderly, the curves are stiffer and there can be associated compression of the nerves. Spinal surgery may involve concomitant neural decompression (freeing the nerves) together with spinal instrumentation (putting screws into the spine) and fusion.14. Spondylolisthesis treatment
Spondylolisthesis is a condition where one spinal bone (vertebra) has slipped over another. This may cause low back pain. In certain cases, this can be associated with compression of the nerves. Treatment options include medications, physiotherapy and sometimes operation which involves reduction of the slipped bone using screws (for example a TLIF).15. Re-do or revision spinal operations
Patients who have had previous spinal operations may sometimes require revision spinal surgery for a variety of reasons. Before embarking on any further spinal surgery, the patient will be thoroughly assessed and investigated to first determine if another operation will be beneficial and secondly, what type of procedure to perform if any. Treatment is patient specific and we will have to discuss in detail with the patient the treatment options prior to embarking on the plan of action.16. Spinal Surgeries using Computer Navigation
For complex spinal cases especially revision or re-do surgeries, we sometimes use intra-operative computer navigation. This gives us better intra-operative imaging and 3-dimensional real time visualisation of the structures during the operation, improving surgical safety in these complex cases.
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