Neuro Spine Clinic
Backs are our business!
A variety of management options will be considered by our medical staff, led by Dr Ralph Mobbs, and dependant upon your symptoms and other contributing factors. Treatment options vary from conservative management to surgical interventions. In the general population, most people who suffer from back and neck pain will get better in 90 days however, if the pain changes in pattern distribution, or persists after non-surgical management, it would be better to seek medical/surgical advice from a specialist.
Back and Neck Pain
According to a recent study, lower back pain is one of the three most common reasons for Australians seeking medical advice.
Neck and back problems do not necessarily present as neck and back pain. It may present as arm or leg pain or numbness, even tingling, pains and needles, sensory changes. We will use a range of tests to assist in assessing your condition.
Imaging is crucial for back and neck pain. Your surgeon or GP, will usually recommend an MRI to assess your condition. Depending on symptoms and investigations, different decisions will be made and advice offered regarding surgical or non-surgical approaches. Treatment options vary and range from non-surgical (a course of anti-inflammatory medication, cortisone injection, hydrotherapy and physiotherapy) to surgical intervention (micro discectomy and laminectomy, total disc replacement or fusion).
Your back is made up of several small bones separated by a shock absorbing structure and this allows our bodies to bend, twist and rotate. In certain conditions where these shock absorbing structures undergo wear and tear, they sometimes require surgical intervention. This is known as a disc replacement.
This surgical procedure involves removing the disc and inserting an artificial replacement which helps retain/restore our body’s natural movement. The aim of these procedures is to help reduce pain whilst retaining the natural range of motion.
As we age, our bone mineral density decreases. We reach our peak bone mass at the age of 25, and from then onwards, it’s a downwards slope. The effect of this is even more dramatic in post-menopausal women hence they are more susceptible to fractures when compared to men in the same age bracket. The spine is made up of 33 bones (vertebrae). In a typical vertebra, the weight bearing component is distributed into 2 parts: the anterior vertebral body and the posterior part. In the younger population, 80% of the weight is bared by the vertebral bodies and 20% goes through the posterior components. With age, the distribution shifts to a 60:40 ratio.
Considering the above factors, when an individual sustains an injury such as a fall, the forces are being transmitted in the vertebral body which leads to a phenomenon called compression fracture. The collapse of the vertebral body causes structural instability which results in forward bending of the spine (kyphosis). This type of fracture is very common among people with reduced bone mass. Such a fracture can lead to loss of height as well as back pain. Approaches to spinal fractures also range from non-surgical (bracing, lifestyle modifications, physical and occupational therapy) to surgical management (restoration of vertebral body height, decompression for the affected nerves or fusion).
Another type of fracture, known as pars fracture is the distortion of the posterior component of the vertebra. This is a common phenomenon for people whose posterior column of the spine bears more weight than they are meant to. Such fractures will lead to slipping of the vertebral body which eventually impacts on either the spinal nerve root or the spinal cord components resulting in nerve pain. This phenomenon is given a fancy name called ‘spondylolisthesis’. Patients with severe spondylolisthesis will benefit from fusion surgery of the affected level. If, however the symptoms are not severe, and no nervous structures are affected, people with spondylolisthesis can live a normal life.
Minimally invasive surgery
Studies and experiences have proven that patients who undergo minimally invasive spine surgeries recover better and quicker. Our practice offers a wide range of minimally invasive spinal procedures including microdiscectomy, laminectomy and in some cases tumour removal. In addition, by utilising intra-operative imaging (fluoscopy or CT), we are able to perform certain fusion procedures such as percutaneous pedicle screw fixation and anterior cervical disc fusion / replacement using a minimally invasive method. A microscope or an endoscope is usually used in such procedures. With a small incision and using micro instruments, the surgeon is able to complete the procedure with minimal tissue exposure. This results in reduced rates of surgical infections and better accuracy with the magnified view. The recovery rates of patients who undergo minimally invasive spine surgeries are dramatically improved and they are usually discharged in a few days. Additionally a smaller surgical scar gives a better aesthetic result.
Cancer of the spine
Unfortunately, we still cannot eradicate cancer. Two types of cancer can arise in the spine. A primary cancer or a metastatic cancer which originates from other sites of the body. Cancer is a malignant growth/tumour which invades and destroys surrounding structures. Depending on the type of cancer, they can have different behaviours. However, if left untreated, it can eventually invade, destroy surrounding structures which have significant consequences (paralysis) or even death. Currently, there are 3 modalities (surgical resection of the tumour, stereotactic radiation and chemotherapy) for tumour removal and a combination of either or all may be selected.
The main goal of surgical intervention is for tumour removal, symptoms and pain relief, preservation of neurological functioning as well as re-establish structural stability of the spine. Before or after surgery, other treatments may be provided such as radiotherapy or chemotherapy. Physical and occupational therapy will also be prescribed to assist in regaining as much functioning as possible.