Spinal surgery in Enfield

Spinal surgery at The Cavell Hospital gives immediate access to experienced spinal surgeons as well as clear and direct established communication channels between our spinal unit, rehabilitation facilities and our expert radiology services. This enables streamlined care for patients with lower back pain and sciatic leg pain without the stress of long waiting lists.  

Our spinal surgeons are able to offer the latest innovations whether it be decompression procedures for sciatic leg pain or in rare circumstances spinal surgical fusion. We offer all forms of spinal injections to address sciatic leg pain or lower back pain. We are also able to provide expertise in the management of acute and chronic osteoporotic fractures of the spine.  

Our hospital prides itself on our patient focused, holistic care for our patients so whether or not patients are referred by their GP or another consultant or self refer to our spinal surgical unit they can be assured that their wishes will be listened to comprehensively and a full discussion regarding treatment options completed before any plan is made. 

All our physiotherapy treatments are available at our private treatment rooms as well as rehabilitation gyms. For patients recovering following any general anaesthesia, we offer private rooms rather than traditional ward based facilities which are fully supported by our specialist nursing staff.

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. 

An initial consultation with a spinal surgeon at The Cavell Hospital will involve a discussion regarding the history of the problem. Although some problems are thought to be back problems they in fact turn out to be problems of the hip joints or something else that is giving rise to the back symptoms. Key questions to be answered in an initial consultation will include:

• History of trauma or incident to cause symptoms
• Location of symptoms and whether the pain radiates to the legs
• Duration of symptoms
• Intensity of pain
• Any neurological symptoms
• Assessment of past medical history
• Patients wishes and goals

Following, an initial history our spinal orthopaedic consultants will examine to determine which diagnostic tests they wish to request. The physical examination may include:

• Assessment of spinal alignment
• Range of motion of the spine and hips
• Neurological examination
• Vascular examination
• Other more specialist tests may be carried out depending on individual circumstances

The most common diagnostic investigation for patients presenting with lower back pain is a lumbar spine MRI scan. In some cases our specialists may request x-rays of the hips or if warranted other specialist imaging such as CT scans of the spine or abdomen, pelvis or chest.

One of the advantages of a face to face consultation is this enables an assessment of a patients overall health status. In some rare cases, spinal pain may be related to an internal organ such as the pancreas, a stomach problem, or a circulatory problem. In these circumstances, our spinal specialists are able to order bloods and other tests according to the indications. 

Our spinal surgery unit is led by very experienced surgeons with upwards of thirty years of clinical experience in their field. Due to their experience and teamwork with other experienced colleagues across our hospital we can arrange immediate diagnosis and relevant investigations as well as appropriate follow up plans. One of our unique selling points is a holistic management approach to patient care, focused on other non surgical elements of treatment rather than pushing for immediate surgical intervention.

Our spinal surgeons utilize our orthopaedic and musculoskeletal physiotherapist's ability to get the best function from our patients with use of manual therapy, ergonomic advice and education as well as strength, flexibility and conditioning programs. injections, which are very short of surgery. Normally, if all those measures fail, we think of doing surgery.

Our spinal orthopaedic surgeons are able to offer the full range of injections if initial physiotherapy routes fail to yield success. All injections are done under sedation by an experienced anesthetist for patient comfort with state of the art imaging techniques used in theatre.