Backache and Neck Pain? FAQs.

Backache and Neck Pain?
Modern Methods can help you.

Many people suffer from back and neck pain. Some have ongoing pain that gets in the way of their everyday activities. This condition affects not only the physical health of these individuals, but their social and economic well-being too. The pain can disrupt work, routine and other daily activities that they engage in. In fact, back pain and neck pain are among the most common reasons for doctor visits, and are major causes of disability, lost work days, and high healthcare costs.

1. Why Do So Many People Suffer From Back and Neck Pain?
According to Dr Prem Pillay, Consultant Neurosurgeon , there appears to be a silent epidemic of spine problems and this is related to our modern lifestyle. A poor posture and long hours sitting with computers at work and home are part of this problem. Sports activities that load our spine like road running and high impact aerobics can also cause damage. Pain in the back and neck area can be acute, which comes on suddenly and intensely, or chronic, which can last for weeks, months, or even years.

2. What Causes Back and Neck Pain?
Dr Prem Pillay states that back and neck pain may be a symptom of several different causes, including:
• muscle strain
• degeneration of the discs in the spine causing a slipped disc
• Spinal stenosis, facet degeneration and osteoporosis
. Spinal Tumors including cancer spread
. Spine Infections

3. How Can Back And Neck Pain Be Diagnosed?
Before your doctor can diagnose your condition and design a treatment plan for you, a complete history and physical examination are necessary.
Imaging tests such as X-rays and MRI (Magnetic Resonance Imaging) scans are helpful for diagnosing most episodes of neck and back pain. In most cases, they are only used if the doctor suspects a serious problem, such as a slipped disc or herniated disc, a spine fracture, or cancer, or if surgery is being considered or planned, advises Dr Prem Pillay. Some patients require additional tests like the DEXA scan to assess for osteoporosis and PET-CT scans if cancer spread to the spine is suspected as a cause of back pain.

4. What Are The Available Treatment Options?
Treatment is determined by the nature and cause of the problem and its severity. For mild slipped disc problems, they can be treated by pain medications and physiotherapy, together with lifestyle adjustments. If the pain is recurrent, prolonged or increasing in severity, a specialist consultation is necessary and a spine procedure may be recommended.

Dr Prem Pillay shares that the modern spine procedures include spine injection treatments that do not require open surgery. These treatments include spine injections mainly for pain relief such as epidural steroids , nerve blocks and facet joint blocks. Newer procedures that more directly treat the affected parts of the spine include discoplasty, annuloplasty, nucleoplasty, biacuplasty, neuroplasty , vertebroplasty, kyphoplasty and others that can be done under local anesthesia as day procedures. However, not all patients can have these done as there are criteria to be followed for a successful outcome. These procedures may give a medium term relief from pain , and may not always adequately treat the root of the problem for conditions such as disc herniations.



5. When Is Surgery Required?
Surgery may be indicated and give a long term solution when degenerative changes in the spine are severe or progressive that the function of the spinal cord or nerve roots is impaired or threatened, there is severe and persistent pain that goes down an arm or a leg associated with weakness of the limbs , or when conservative treatment (anti-inflammatory medication, limited activity, physiotherapy) and spine injection treatments fail.

Dr Prem Pillay explains that patients should be reassured that spine surgery in experienced hands and with the right tools can be safe and effective. Certainly with new technologies including microsurgery and endoscopy, the openings needed are smaller than before and finer instruments are used to remove the damaged parts of the disc. Nerve monitoring during spine surgery can also be helpful in reducing risks. There are now alternatives to spinal fusion such as artificial disc replacement and dynamic spinal implants that allow motion preservation of the spine. All of these methods and precision have allowed spine surgery to become more successful in returning people quickly to normal life.

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Tips for a healthy back and neck
• Be sure that your back and neck are properly supported when you sit and that your posture is correct
A Good pillow and a firm but comfortable bed mattress can reduce stress on your spine during sleep
• If your weight is causing excessive pressure to your spine, weight loss can reduce discomfort.
• Do not lift heavy loads by placing the pressure on your lower back. Always bend your knees so your arms are at the same level as the heavy object you plan to lift.
• If something you are doing causes your back to hurt, stop and rest or stop altogether.
• Talk to your doctor about combating osteoporosis – bone thinning, if you are female and above fifty

More Info at:

www.singaporespine.org

www.spine-neuro.org



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Preserving Your Spine Discs- Discoplasty

Singapore Spine : Discoplasty

Your spinal discs are prone to degeneration leading to disc prolapse, protrusion, extrusion and sequestration. This can place pressure on your spinal nerves leading to back pain, neck pain, leg pain (sciatica) and shoulder/arm pains. As this progresses sensation disturbances such as tingling, numbness and motor problems such as weakness and sometimes even paralysis can occur.

In the past the options were either conservative or spine surgery. Fortunately there are now options that are in between. They deal with the root of the problem without formal spine surgery.

These procedures can be categorized as Discoplasty or Discoplasties. A needle like device is placed under local anesthesia into the discs under CT or high quality spine imaging. An energy beam is released through via a wand placed through the needle into the center of the disc. This can vapourize abnormal disc material in the nucleus pulposus. This reduces pressure within the disc. It also allows disc repair and healing. The energy can be a laser energy using either Nd-YAG, holmium or thulium lasers. Other advanced energies are Plasma energy. This is a day procedure which takes less than an hour to perform, has little discomfort for the person treated and he is able to walk home an hour later.

I have been quite impressed in my practise how effective a single treatment of Discoplasty can be for both cervical and lumbar disc problems. Patients are often able to go to work the next day and resume recreational activities quickly.

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.