29 June 2014
An estimated 50 million working days are lost every year due to back pain, costing the country over £5million in sickness absence costs.
However, whether it's overdoing it in the garden or something more serious, back pain may be more treatable than we think. Mr Am Rai, consultant spinal surgeon, discusses the symptoms, causes and treatments available for this debilitating condition.
How does the spine work?
“The spine provides both incredible strength and extreme flexibility, it gives your body structure and support. Without it, you could not stand up or keep yourself upright. It allows you to move about freely and to bend with flexibility. The spine also protects your spinal cord - the column of nerves that connects your brain to the rest of your body, allowing you to control your movements. Without a spinal cord you could not move any part of your body, and your organs could not function.”
What are the common causes of back pain?
“Back pain will affect four in five people in the UK. Typically my patients are aged between 25 years and 55 years. However some factors may put you more at risk such as living a sedentary lifestyle, being overweight, sitting at a desk for long periods, carrying heavy loads and smoking.
"There is also good evidence now that genetics have a role in a person developing pain. Pain is most common in the lower back although it can occur anywhere along your spine from the neck to the hips. You may also have symptoms in your arms and legs, such as severe pain, numbness, tingling or weakness. Most causes of back pain are easily treatable.”
What are common back conditions you see in your clinic?
“I treat a lot of patients for disc herniation, more commonly known as a 'slipped' disc or a 'disc prolapse'. This is a split or a rupture of the fibrous outside section of a spinal disc. When a disc begins to herniate, its soft central fluid pushes against the fibrous outer ring and triggers lower back pain. If the disc then tears, the jelly-like centre breaks out and inflames the spinal nerves, putting pressure on the sciatic nerve which runs down the leg.”
Sounds painful, what are the symptoms?
“It can be extremely painful, but initially some patients do not seek advice until the symptoms get much worse. In extreme cases, patients have been unable to walk or stand up straight because of the pain. Typically, patients complain of back discomfort, pain running down the leg, sometimes severe but usually affecting one leg. Often the leg is numb, as well as ‘tingly’ and generally weak.”
What causes a herniated disc?
“There can be a number of factors, such as repetitive activities, general wear and tear, injury sustained through sport or heavy lifting, ageing (flexibility in the spinal discs reduces with age) or sometimes it’s purely genetics as some people inherit a higher tendency for their discs to tear.”
How is it treated?
“The majority of herniated discs heal themselves in the first six weeks so conservative treatment may be effective. Pain relief medication and physiotherapy are common treatments for patients.”
And if those treatments don’t help?
“If conservative treatments have failed and the pain persists, surgery may be required. A discectomy removes the bulging disc material that is causing the pressure on the spinal cord or nerves. Sometimes the disc is removed entirely and the vertebrae either side are grafted or fused together to restore stability.
"Alternatively the disc may be replaced with an artificial one. This can usually be performed in a minimally-invasive way via a small incision under general anaesthetic (whilst you are asleep). Most patients go home the same day or next day and pain relief is usually immediate."
What is the age group of patients that developed a ruptured disc or symptoms of spinal stenosis?
“Patients of any age can develop a disc prolapse but generally it is between 20 and 40 years of age. As one gets older the disc tends to loose water and does not function affectively as a shock absorber. This then narrows the space for the nerves and patients often get symptoms of spinal stenosis.
"This usually affects their legs and the patients complain of pins and needles, numbness, weakness and a heavy feeling when they try to walk. If this affects the cervical spine they can get similar symptoms in their hands with loss of dexterity and difficulty using their hands.”
What is the treatment for spinal stenosis?
“Again, most patients are treated conservatively and a number of patients who come to see me require reassurance that there is no sinister cause for their pain. If their pain is very progressive and they cannot walk more than 200 yards then surgery can be very affective in terms of relieving their symptoms. This is usually performed in a minimally invasive manner and most patients are up and about the same day if not the next.”
Are there more serious back conditions that people should be aware of?
“Severe back pain may be a symptom of a more serious disease and if persistent and associated with pins and needles, numbness and weakness in the legs, then urgent investigation is required.
"Patients should also be aware of a condition called cauda equina, which is a surgical emergency and patients often present with bilateral buttock and lower extremity pain. They often have bladder and bowel dysfunction and if this is recognised they require a prompt surgical decompression to allow functional recovery.”
For further information about back pain arrange an appointment with your family doctor or call 01603 255 614 to make a private appointment with Mr Am Rai. For further details regarding common back conditions visit Mr Rai’s website www.norwichspineclinic.co.uk
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