Back pain is very common, with over 20% of the adult population suffering with chronic lower back pain. It can be acute (short-term), or it can continue for many months or even years. The intensity of pain varies widely, ranging from a mild ache to excruciating shooting pain.
The cause of back pain is not always known, although it is often associated with injuries, arthritis, slipped discs, sciatica, spondylitis, and age-related degenerative changes in the spine.
Some kinds of back pain can be treated conservatively with physiotherapy or steroid infections while other kinds may require surgery when conservative methods fail to provide relief.
Successful spinal surgery requires the use of advanced technology and an expert medical team. Complex spinal conditions often require a multidisciplinary approach to spinal care, where specialists, such as orthopaedic surgeons and neurosurgeons work together to provide high-quality, personalised care.
Acute (sudden-onset) neck- or back pain can be brought on by bad posture, awkward bending, lifting incorrectly, prolonged keyboard use and many other types of wrong manual handling practices. For less serious types of back pain your doctor may recommend physiotherapy, over-the-counter painkillers or prescribe anti-inflammatory medication.
If you have sustained a serious injury or have ongoing neck- or back issues, you may need to see a neurosurgeon. Besides performing spinal surgery, a neurosurgeon can prescribe more effective medication or perform conservative pain treatments such as steroid joint injections.
Conservative pain treatment options may include:
- Medication, depending on the nature of your pain, may include pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen or naproxen), muscle relaxants, topical pain relievers, narcotics (such as opioids) and antidepressants such as amitriptyline which have been shown to relieve chronic back pain.
- Physiotherapy can help manage or relieve your pain and restore your normal movement and physical function. A physiotherapist will initially assess your symptoms and then device a treatment plan accordingly.
- Pain relieving injections may relieve your back and neck pain and can provide important information about your pain and clarify diagnosis. Injections deliver steroids or anaesthetic into your joints, ligaments, muscles or around your nerves.
- Facet joint injections are commonly performed to diagnose and treat facet joint pain, which is also known as lumbar spondylosis. These injections can be helpful when weight bearing joints in the spine become inflamed and painful. During this procedure, anti-inflammatory steroid is injected through the skin into the facet joint.
Surgical Spine Procedures
Intractable pain is a pain that cannot be controlled with standard medical care and is difficult to treat or manage. It can be constant, excruciating, or unrelenting and is resistant to all types of conservative (non-surgical) treatments.
Surgery is often required to provide long-term relief from conditions that cause intractable, persistent, and progressive pain. Such conditions may include herniated or ruptured discs, spinal stenosis or the narrowing of the spinal canal that compresses the nerves or spinal cord.
As all surgery comes with their own specific benefits, risks, and expected recovery times, it is important to discuss the pros and cons of your surgical procedure with your specialist in order to make an informed decision.
Often a combination of back surgeries is performed. Common conditions treated by surgery include:
- Cervical disc herniation – occurs when the gel-like centre of a spinal disc ruptures.
- Prolapsed disc removal – necessary when a disc is damaged and presses on the nerves.
- High cranial cervical junction instability.
- Spinal stenosis – caused by age-related wear and tear which narrows the amount of space within the spine.
- Lumbar spinal decompression – helps reduce pain caused by pinched nerves. During this procedure a small piece of bone is removed to give the nerve root more space.
- Lumbar discectomy – removes lower disc material that is pressing on a nerve root or the spinal cord.
- Lumbar laminectomy – performed to alleviate pain caused by neural impingement.
- Spinal fusion surgery – stops movement in a painful vertebral segment, thereby reducing pain.
- Neuromas, neurofibromas and cancerous gliomas – tumours that can be removed with surgery.
- Scoliosis – causes the spine to twist and curve to the side.
- Spinal cord herniation.
- Spinal synovial or ganglion cysts – non-cancerous lumps caused by a buildup of fluid in a joint.
- Spine deformities.
- Spine fractures and other spine injuries.
Frequently Asked Questions
Spinal stenosis occurs when the space inside the backbone is too small which puts pressure on the spinal cord and nerves.
Complications can result from any surgery. Spinal surgery complications, when they occur, can be very serious and cause pain and impairment. If complications occur, you may require additional surgery.
This condition occurs when the soft centre of a spinal disc pushes through a crack in the outside of the disk. It can irritate surrounding nerves and cause pain, numbness, or weakness in your legs.