What proportion of the population is
affected by back or neck pain?
Back pain is common. Most people will
experience back or neck pain at some time in their life, and 80% of the
population will experience an episode of pain at some stage of sufficient
severity to prevent them from performing their normal work or social
activities.
How long should it take for back or neck
pain to settle?
Symptoms of back and neck pain will usually
settle, or at least improve significantly, within seven to ten days.
In 90% of cases pain will resolve within six to twelve weeks.
Symptoms of sciatica or brachialgia will also
usually settle within this period.
Should you rest in bed until back pain
resolves?
It is now well accepted that prolonged bed
rest for back pain actually delays recovery. Up to three days rest is
acceptable but the sooner individuals with back pain return to normal
activities, the sooner symptoms resolve.
The more you rest the weaker the muscles that
support the spine become. As this occurs, increased load is placed on
the structures in your back that are responsible for discomfort. If
muscle tone and fitness can be maintained through appropriate modified
activities symptoms will usually resolve more rapidly.
Analgesics, anti-inflammatories and the
assistance of an appropriately qualified therapist may assist this process.
What should you do if pain does not settle?
If pain does not settle or at least improve
following rest (2-3 days), medication and modification of activities you
should consult your local doctor.
X-rays are not usually indicated in the first
instance unless there has been a history of trauma where bony injury is
suspected.
A CT scan is not indicated unless there are
symptoms of sciatica, and only if initial therapeutic modalities have failed
and/or there is evidence of neurological involvement.
Who should you see about back or neck pain?
In the first instance you should consult your
local doctor who will advise you regarding treatment and direct you to an
appropriately qualified therapist if this is considered necessary.
In most cases you local doctor will be able
to deal with the problem. Where symptoms do not resolve as expected,
where there is evidence of neurological compromise or if symptoms are severe
from the outset specialist review may be indicated.
When is surgery indicated in the treatment
of back and neck pain?
Surgery, to treat any condition is the last
resort, and spinal surgery is not different.
Of those who develop back or neck pain 90%
will resolve within six to twelve weeks. About 10% will ultimately be
reviewed by a specialist and of these about 10% will end up having
surgery.
Thus, only about 1% of individuals who
develop back or neck pain, sciatica or brachialgia ultimately undergo
surgical intervention.
The only absolute indication for surgery is
progressive and/or significant neurological compromise due to neural
compression.
Surgery may also be indicated to treat or
correct a spinal deformity and to stabilise the spine after trauma resulting
in a spinal fracture and instability.
Surgery may also be undertaken to treat pain
due to degenerative disease, but usually only if the degeneration is
localised and the origin of the pain has been identified.
However the results of surgery in this circumstance can not be guaranteed.
Should you see a "Neurosurgeon" or
an "Orthopaedic" surgeon about your back or neck pain?
Spinal surgery has become a specialised area
of surgery, and in Adelaide training in spinal surgery involves input from
both the Orthopaedic and Neurosurgical fields.
Many neurosurgeons perform spinal procedures
to decompress neural elements within the spinal canal, and several
neurosurgeons have also developed expertise in the area of spinal
instrumentation and fusion. In the past this area of spinal surgery
has been performed almost exclusively by orthopaedic surgeons.
Neurosurgeons have special expertise in the
management of intra-dural pathology such as spinal cord tumours.
The three operating members of the Adelaide
Spine Clinic were initially trained in Orthopaedic surgery and went on to
further training in spinal surgery, and treat spinal disorders
exclusively.
The members of the clinic have a close
working relationship with two neurosurgeons (Professor Nigel Jones and Dr
Nick Vrodos). Both have a special interest and expertise in the
management of spinal disorders.
It is therefore suggested that you consult a "Spinal
Surgeon", with expertise in the appropriate area, about your spinal
complaint. This may be someone who underwent their initial surgical
training in either Orthopaedics or Neurosurgery.
If surgery is indicated can success be
guaranteed?
NO!
Can microsurgery be used to treat back or
neck pain?
Microsurgical techniques are often utilised
to improve visualisation of neural structures and other anatomical
features.
These techniques are generally not
appropriate in the treatment of spinal deformity or degenerative low back
pain.
Can a diseased or worn out disc be replaced?
A number of "artificial" discs are
now on the market. The aim of these products is to enable removal of a
painful disc while preserving stability and motion. One of the main
concerns with these implants is the uncertainty about how they will wear.
We also need to consider what can be done if these implants fail to relieve
the situation.
Professor Fraser has been involved in the
design and development of a new artificial disc and has operated on a number
of cases over the last few years. The other members of the clinic will
become involved in the next phase of the study and clinical evaluation of
this implant. It is, however, likely to be twelve to eighteen months
before this implant or something like it is ready for general use.
The other products on the market have not
undergone sufficient evaluation through controlled trials to adequately
assess their effectiveness and safety. There have also been some
serious complications following the use of some of these devices.
