Back and neck pain: from symptoms to surgery

Almost a third of the UK population lives with a musculoskeletal problem, which often includes back and neck pain. Although muscle strain and spasms are common causes of back and neck pain, wear and tear of the spinal joints and nerve problems can also cause back and neck pain

While physiotherapy, massage and gentle exercise can all help treat back and neck pain, depending on the underlying cause, they may be ineffective and in rare cases, can also do more harm than good. This is why it’s important to see a doctor and if needed, have imaging tests to diagnose the cause of severe or persistent back or neck pain. 

Back and neck pain symptoms

Symptoms of back and neck pain can differ depending on the underlying cause. 

If the problem is muscle strain, your back or neck may feel achy or stiff. Often physiotherapy and over-the-counter painkillers are enough to treat this type of back or neck pain. 

If your back and neck pain is caused by a disc, bone or ligament in your spine pressing against a nerve (compression), you may experience numbness, weakness and/or shooting pains down your legs and arms. In severe cases, which require emergency attention, this can also affect your ability to control your bladder, bowels and sexual function.

Sciatica is a common cause of nerve-related back pain. It is usually caused by a disc between the bones (vertebrae) in your spine slipping out of place and applying pressure to the spinal nerve roots that form the sciatic nerve, which runs down your legs to your feet. 

As with most spinal problems, they are best managed through a combination of approaches, including painkillers, physiotherapy, gentle exercise and core strengthening. 

For situations where your pain has not settled after trying conservative measures, your doctor may recommend steroid injections or surgery.

When to see a doctor

If you have persistent back or neck pain that doesn’t improve with painkillers and stretching exercises, is severe or is affecting your quality of life, you should seek medical help through your GP, a neurosurgeon or spinal surgeon.

You should seek urgent medical attention via your local A&E department if you’ve noticed any weakness in your limbs or any combination of the following symptoms:

  • Any changes in feeling when wiping around your perineum (the area between your back passage and genitals)
  • Any change in your ability to get or maintain erection or achieve ejaculation
  • Bladder or bowel incontinence
  • Difficulty initiating or controlling the flow of urine
  • Loss of feeling or pins and needles affecting your inner thighs, buttocks, back passage or genitals
  • Loss of the urge to open your bowels or urinate, and/or loss of feeling when opening your bowels or urinating

These symptoms can occur with a condition called cauda equina syndrome, which is a medical emergency that needs urgent assessment and in some cases, surgery to relieve the pressure on the nerves in your spine.

Getting a diagnosis

Your doctor will ask you questions about your symptoms and your medical history. They may also perform a physical examination. It can be difficult to diagnose the underlying cause of back and neck pain, which is why they may refer you for imaging tests, such as an MRI scan or CT scan, as well as blood tests that can help detect certain underlying conditions such as rheumatoid arthritis

When is surgery needed for back and neck pain?

Surgery is usually reserved for relieving the pressure on compressed nerves, which has not responded to more conservative treatments. 

Spinal decompression surgery can relieve the pressure on the affected nerve and improve the chances of your symptoms getting better. In some cases, spinal decompression surgery may be accompanied by surgery to stabilise your spine and prevent the nerve being compressed again. 

As with any surgery, there are risks involved, which your surgeon will explain to you so you can make an informed decision. After surgery to relieve your back and/or neck pain, you will likely need physiotherapy during your recovery. 

Author biography

Mr Alex Leggate is a Consultant Neurosurgeon at Spire Nottingham Hospital and at Queen's Medical Centre, part of the Nottingham University Hospitals NHS Trust. He specialises in minimally invasive spinal surgery (neck and back) and neuro-oncology, and is also trained in all aspects of neurosurgery, spinal pathology and management, including spinal injections.