Minimally Invasive Spine Surgery (MISS)

There are many people who need back and neck surgery but are afraid of it. Many have heard horror stories of severe pain, long recovery periods and even those who have become paralysed. There is however technology currently available that addresses these concerns. It is true however that these methods are available from only a few neurosurgeons/spine surgeons worldwide. Those of us who have listened to our patients and understood their needs have been working hard to find solutions that are minimally painful, allow quick recovery and are effective treatments.

These solutions include several of the following:

1.Percutaneous Plasma Energy Discoplasty
2.Percutaneous Endoscopic Laser Disectomy-PELD
3.MicroDisectomy
4.Endoscopic Disectomy
5.Microsurgical Discetomy with Dynamic Implants
6.MicroEndoscopic Discectomy-MED
7.Microsurgical Spinal Decompression
8MicroEndoscopic Spine Microsurgery- MESM
9.Percutaneous Disc Regeneration Technology
10.Endoscopic Disc Replacement

Many of these options allow the patient to arrive at a day surgery center, have the procedure under iv sedation and local anesthesia (no general anesthesia) and leave within a few hours of a fairly short procedure. Most patients walk out of the center themselves and can return to work in a few days.

Unlike taking pain medications or pain injections; these procedures do address the root of the problem. They allow reduction in nerve pressure and therefore can prevent ongoing or future nerve damage. Spinal nerves especially the spinal cord, cannot be effectively replaced at this point in time. Stem cell treatment is still experimental and not consistently successful.

These procedures are also evolving and becoming more successful with experience, technology and the passage of time. Many of us who are Minimally Invasive Spine Surgeons believe that more spine doctors need to know and be trained to do these procedures. An informed patient can also help to accelerate these changes worldwide by insisting on the latest and least invasive spine treatments.

Question & Answers on Backache

Q: WHAT ARE THE COMMON CAUSES OF BACKACHE?

Our modern lifestyle is one of the main reasons for backache and neckache . Prolonged sitting, poor posture, air and car travel , and many hours in front of the computer can all cause backache. Many of us exercise irregularly without proper warming up and stretching. This can also lead to increased wear and tear in the spine and cause backache. Obesity also increases stress on the spine. Osteoporosis is a cause in older people.

Q: HOW CAN I PREVENT BACKACHE OR BACK PAIN.

§ PROPER POSTURE
Maintain a proper posture in performing day to day activites.

§ ERGONOMICS
This is especially important in the work place. If you sit for long periods of time, you need to make sure your chair has a proper lumbar support. You should get up every 30 minutes, and stretch before resuming your work.
Learn to lift objects correctly.

§ EXERCISING INTELLIGENTLY
Exercising irregularly and without proper warm-up can put a lot of stress on your spine muscles.
Jogging or aerobics on a hard ground (high-impact activities) without proper shoes is also stressful to the spine. Remember there is an equal upward thrust on your spine for every downward step.

§ MUSCLE RELAXATION
Hot packs , a warm shower, soaking in a warm bath can help relax your back muscles.


WHEN DO YOU NEED TO SEEK MEDICAL ATTENTION FOR BACKACHE ?

§ When your backache or back pain is persistent
§ When you have pain down your legs
§ When you have pain or loss of sensation in your leg or foot
§ When you experience “pins and needles” down your leg or foot
§ When you have weakness in the leg and foot, and have difficulty in walking
§ When you start developing problems with your bladder and bowel

We recommend that all patients with the above symptoms consult a NeuroSpine Specialist for a thorough neurological evaluation and an MRI scan of the lumbar-sacral spine before embarking on any therapy The neurological evaluation will include an assessment of sensation, strength and reflexes. X-rays or CT-scans alone may be inadequate as they cannot show spinal cord or nerve compression. A neurospine specialist can then recommend the various options for treatment depending on the severity of the disc disease and degree of any nerve compression.


WHEN DOES SURGICAL INTERVENTION BECOME NECESSARY?

Surgical intervention, such as microsurgery/micro-endosocpic surgery/endoscopic surgery becomes necessary when pain is not relieved by conservative (non-surgical) treatment or when there are neurological deficits such as weakness in the foot or leg. This is associated with the MRI showing moderate to severe nerve impingement that may be caused by a degenerated /prolapsed disc/discs, thickened ligaments, and overgrowth of bone.
The decision for surgery should be made by you and your neurosurgeon. New and advanced technology is available for the replacement of discs-Artificial Disc replacement, but there is no technology available to replace or repair damaged nerves in the spine. We therefore advise patients not to not wait until their nerves are permanently damaged.
After a microsurgical intervention, patients will still need to be put through a proper and organized spine therapy program such as aquatherapy (www.aquaphysio.com for info). This is for long term spine strengthening and preventing relapses.

Neck Pain or Neckache FAQs

COMMONLY ASKED QUESTIONS ABOUT NECK PAIN or NECKACHE :

Q: WHAT ARE THE CAUSES OF NECK PAIN?

A: The roots of neck pain lie in our modern lifestyle . At the workplace, prolonged sitting and many hours of computer use can cause neck pain. Travel with the carrying of hand luggage and laptops all contribute to neck pain. Recreational exercises performed improperly or without adequate warming up, massages with neck manipulation , poor posture etc can cause wear and tear of the discs in
the cervical spine resulting in neck pain and shoulder discomfort. Most patients with neck pain have varying degrees of spinal disc degeneration.

Q: HOW CAN I PREVENT NECK PAIN ?

A: Proper posture and Good Ergonomics.

This is especially important for those who use computers for long hours. This involves proper placement of the computer monitor such that your head is in a neutral position when viewing the computer screen; a proper chair with lumbar support and an arm rest so that your elbows are resting 90° to your work surface and your keyboard.

Stand up and take short breaks every 20 – 30 minutes, doing neck stretches and back stretches before resuming your work.
Another bad habit is talking on the phone with the receiver tucked between the neck and shoulder. This should be avoided as it puts a lot of strain on the neck muscles. Invest in a hands free device instead.

Neck strengthening exercises help but should be taught to you by a trained physiotherapist.



Q: What about Exercise and the Spine?

A: Exercising Intelligently can prevent spine problems rather than causing or aggravating them.

Exercising irregularly and without proper warm-up can put a lot of stress on your spine muscles.
Jogging or aerobics on a hard ground (high-impact activities) without proper shoes is also stressful to the spine. Remember there is an equal upward thrust on your spine for every downward step.
Swimming though a good form of an aerobic exercise, may actually aggravate neck pain especially strokes like the breast stroke and front crawl. In these strokes, the head is moved up and down or sideways to breathe.
However, specially designed exercises like Aquatic therapy (by trained physiotherapists ) is beneficial as it is specially designed to strengthen the spinal muscles.

Q: How can I relax the spine if the pain is being caused by muscle strain or tension?

A: Hot Packs, and/or a warm shower can help in relaxing the neck muscles.




Q: When do I need to seek medical attention for neck pain?

A: We recommend that patients with neck pain/discomfort consult a NeuroSpine Specialist for a thorough neurological evaluation and an MRI scan of the cervical spine before embarking on any therapy The medical evaluation will include an assessment of sensation, strength and reflexes. X-rays alone are inadequate as they cannot show spinal cord or nerve compression. Your spine specialist can then recommend the various options for treatment depending on the severity of the disc disease and any nerve compression.

Q: When does surgical intervention become necessary?

A: Surgical intervention, such as microsurgery with disc replacement, becomes necessary when pain is not relieved by conservative (non-surgical) treatment or when there are neurological deficits such as weakness in the arm or hand. This is associated with the MRI showing moderate to severe nerve impingement that may be caused by a degenerated /prolapsed disc/discs, thickened ligaments, and overgrowth of bone.
The decision for surgery should be made by you and your neurosurgeon. New and advanced technology is available for the replacement of discs but there is no technology available yet to replace or repair damaged nerves in the spine. We therefore advise patients not to not wait until their nerves are permanently damaged.
After a microsurgical intervention, patients will still need to be put through a proper and organized spine therapy program. This is for long term spine strengthening and preventing relapses. We have found in our experience that a combination of aquatic therapy with physiotherapy works best.




SURGERY MAY BE THE TREATMENT OF CHOICE IF :

§ Conservative therapy is not helping
§ Your symptoms are progressive in your arms and legs
§ Your hands are becoming more clumsy and weak
§ There is difficulty with walking and balance
§ Its preventive – prevents furthur nerve injury
§ You are in good health

Based on the Guidelines of the American Association of Neurological Surgeons.

A Spine Epidemic?

There is an existing and increasing epidemic that is not recognised by the media. HIV, malaria, tuberculosis and bird flu hog the headlines.

Modern life though has contributed to another growing problem : back and neck pain.

In my practise I have noticed that back and neck pain is prevalent in both the young and the old.

The reasons for this lie in the roots of 21st Century living. Children now spend a great deal of time in front of the ubiquitous computer. They are carrying heavier loads of books and even laptop computers to school. Poor posture is an important contributor to this mix of ingrediants.

The bad habits learned in youth persist into the working years. Unfortunately modern office life encourages poor posture and prolonged sitting. Regular travel for work contributes to what I term "spine stress".

Another factor in "spine stress" is the modern concept of exercise. Exercise is often not integrated into daily life in a gradual or even trained fashion. It is often done irregularly and in haste with intensity being a substitute for lack of time.

It is no wonder that all this spine stress contributes to neck and back pain. This pain may come intially from muscle tension and muscular strain. With time, disc degeneration occurs. This of course can lead to disc herniation and spinal cord and nerve root compression. The consequences of these can be far more serious that the mere experience of pain. Apart from pain shooting down an arm or a leg, numbness and weakness in a limb can occur. Unfortunately although we currently have the technology to replace a bady damaged disc in the spine we still cannot replace or even repair well, damaged spinal nerves.

The purpose of this site is to help others understand the spine and to provide information both new and old on prevention, current treatment and research for spine and pain problems.

Dr Prem Pillay