The Cavell Hospital spinal surgery
department deals with the diagnosis and management of lower and back pain. Our orthopaedic spinal surgeons are able to provide an initial diagnosis and then guidance on non surgical management of lower back pain and sciatica as well as perform surgery where appropriate.
Broadly, spinal surgery may be aimed at decompressing neural tissue which is performed for individuals with leg pain or neurological symptoms in the lower body, or fusions aimed at stabilizing a painful or unstable segment of the lower back.
Lumbar spine decompressions involve accessing the spine with specialized instruments and removing bone and ligament that has grown inwards into the spinal canal and is impinging or catching the nerve roots or the spinal cord. A decompression may include a laminectomy and undercutting facetectomy (removal of a portion of the facet joints from within the spinal canal) or a discectomy (removal of any prolapsed disc material) and many procedures may involve both elements.
Occasionally, for disabling, persistent lower back pain a lumbar spine fusion procedure may be considered. These are considered very rarely, as although clinical outcomes for decompressive surgery are good for leg pain, outcomes of fusion operations for back pain are poor. Due to this reason, a consultant spinal surgeon may only consider a lumbar spine fusion if there is evidence on MRI or other specialist imaging that there is considerable instability at one joint level that appears to be the cause of the lower back pain.
Another option a consultant spinal surgeon will consider to avoid necessitating surgery is spinal injections. Broadly speaking, injections are offered to relieve sciatica such and may be targeted at different parts of the lumbar spine. Transforaminal epidurals, nerve root blocks and caudal epidural injections may all be offered for sciatic pains. In some circumstances facet injections and medial branch blocks may also be used to relieve acute, unremitting lower back pain.
Fortunately, the majority of cases of lower back pain even if associated with some sciatic leg pains some time modifying activity and physiotherapy guided exercise program is effective. Physiotherapy programs for lower back pain are also important post operatively to gradually restore appropriate range of movement, strength and confidence to use the spine again for normal activities of daily living and sports related performance.
Occasionally, orthopaedic spinal surgeons may offer a procedure known as a vertebroplasty or kyphoplasty which is a treatment to stabilize a collapsed vertebral body (the main bone at each level of the spine). These fractures are almost always due to osteoporosis (thinning of the bones) and may have a trauma or not in the history. A vertebroplasty involves placing a needle into the collapsed bone with a balloon at the end of it. Once in place and verified by specialist imaging techniques in the operating theatre, a type of cement is slowly injected into the vertebral body to strengthen the segment and maintain height.