
About spain pain
What is our spine made of?
Our spine is made of a number of vertebral bones which are attached to each other with ligaments
There is a cushion like structure called ‘Disc’ between two vertebral bones that acts as a shock absorber and provides mobility to the spinal column
Spinal column houses a very important structure within the spinal canal called spinal cord, which is the link between our brain and rest of the body
There are lot of muscles around the spinal column that stabilize our back & neck and also help our movements
What causes back / neck pain?
Any fault within the numerous structures that form the spinal column can lead to back / neck pain. Additionally, many abdominal organs when inflamed can cause referred pain in the back.
It is therefore important to thoroughly investigate and ascertain the underlying reason for back or neck pain.
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What is disc prolapse?
Disc is a kind of cushion between two vertebral bones. It has a soft center and an outer hard shell. If the disc ruptures, the soft inner material can come out and press the nerve leading to leg or arm pain depending on whether disc prolapse occurred in lower back or neck.
90% of patients suffering from disc prolapse get better with rest and medication. However, 1 out of 10 patients, who continues to have pain or has significant weakness in arm or leg because of disc prolapse may need surgery to remove the material pressing on the nerve.
What is Discectomy / Microdiscectomy?
Discectomy is a surgical procedure for treating disc prolapse. A portion of the disc along with a small amount of bone is removed. It is done with the help of a microscope through a small incision. Because of the use of minimally invasive techniques, patient can be discharged from the hospital quickly and the recovery is fast.
What is Decompression?
Decompression is a standard procedure to release compressed nerves. The material, usually bone, is removed to release the nerves, thus
decompressing them. Whenever suitable, such procedures are conducted through ‘Minimally Invasive key Hole Approach’. In other cases, open surgery is recommended.
What is spinal fusion?
Spinal fusion is a surgery done to join together two bones (vertebrae) of spine eliminating movements between them. This leads to relief of pain from painful segment. In certain selected cases such procedures are conducted through ‘Minimally Invasive key Hole Techniques’ (MITLIF). When required, open techniques are used.
What is Vertebroplasty / Kyphoplasty?
Osteoporosis can lead to spontaneous fracture of back bone: ‘Vertebral Compression Fracture’ (V.C.F.)
This can cause significant pain which can be very disabling at times.
Most of these fractures can be treated with braces & drugs for Osteoporosis. However if pain does not subside, or in certain fracture patterns as seen on X-ray and C.T. scan, it is now possible to insert bone cement into the vertebral bone (Vertebroplasty / Kyphoplasty).
This is done under local anaesthesia while the patient is awake. Patient can be relieved of pain and can walk soon after the procedure.
How to prepare for spinal surgery?
Normally, you will be admitted in the hospital one day before your operation. The operation will take place the next morning. You may be in the hospital for 1-5 nights after your operation, depending on the type of surgery e.g. you may be discharged after a day or so following micro-surgery for slip disc, or may have to stay longer for major decompression and / or fusion surgery.
What is the operation procedure?
Operation is usually done under general anaesthesia except vertebroplasty or kyphoplasty (injecting bone cement in osteoporotic spine fracture).
- Microdiscectomy for slip disc : size of the incision may be 2 cm or above depending on patient’s weight
- Minimally Invasive Fusion (decompression and stabilization) : There may be 4-6 small stab incision and one 3-4 cm incision
- Open decompression and stabilization incision length may be 8 cm or above
When you wake up following your operation you can expect (any or all) of the following :
- You will be lying flat on your back with a dressing over the wound
- A wound drain may be attached to your back to minimize bruising and swelling
- Pain control drug may be administered via a drip in the arm or in the tablet from
- Occasionally, a catheter may be fitted to assist you in urination
How to manage pain?
Medication : Immediate pain after your operation can be managed with a combination of non-steroidal anti-inflammatory drugs (NSAID’s) and other pain killers.
These will be prescribed to you for one week following your discharge from the hospital. It is important to take your medication regularly to gain maximum benefit, and not just when you are experiencing pain. As your pain level becomes less, you should gradually reduce your dose of prescribed medication.
Ice : ice packs applied to your back can be especially useful in reducing pain during the first few days after surgery. Be careful not to apply the ice directly to the skin as it can cause an ‘ice burn’
Physiotherapy : A physiotherapist will see you the day after operation. You will be assessed and shown the best way to get in and out of bed and will be encouraged to attain mobility as soon as possible.
Are there likely to be any complications?
Success rate of surgery is more than 90%. Prior to surgery, I will discuss in detail potential risk and complications of surgery. Fortunately such complications occur very infrequently
- Further disc prolapse
- Back pain
- Nerve scarring
- Nerve damage
- Haematoma
- Infection
- Deep vein thrombosis
- CSF Leak
- Implant failure
- Other less common problems
What are the various activity levels, post surgery?
Mobility : Gradually increase the frequency and distance you walk. Take regular short walks around the house. As soon as you feel you are able to walk longer distances, go for a walk few times a day. Build the routine slowly
Return to work : Post operation, your return to work will depend on the nature of your job. Normally, you can return to work after 4-6 weeks. If you are in a less than active job, you can return to work after 4 weeks, and after 6 weeks if your job involves physical activities. After microsurgery for slip disc, many patients return to work much earlier if the job is sedentary. For more extensive spinal fusion surgery, return to work may be delayed a little more
Driving : Do not drive until after first outpatient appointment .You can be seated as a passenger on the front seat as long as the journey is short and you can sit comfortably for that period of time. Usually you can start driving after 4-6 weeks
Lifting, twisting and bending : During the first 6 weeks avoid lifting, twisting and bending as much as possible.
Long term precaution for Back
- Observe correct posture while sitting, standing or laying
- Always sit with your back straight but relaxed with back support if required
- Do not stand or sit in one position for too long
- While sitting, adjust the chair height so that your knees are slightly higher than your hips
- Use car seat with lumbar support
- Use flat bed with firm mattress for sleeping
- To get up from lying position, turn on your side first, bend the hips, knees and take support of the upper arm
- To lift relatively heavy objects, keep the object close to abdomen, bend your knees and keep the back straight
- Ladies should use high washbasin of correct height (don’t stoop farward)
- Do not try to reach for heavy objects overhead
- Do not read papers or magazines in lying position with too many pillows under the head
- Avoid sudden and jerky movements of the body
- Do not walk or ride vehicles for very long distances at a stretch