Back Pain and the Neurosurgeon

Back pain usually only lasts a short time and most of us can manage with normal painkillers. Other treatments that may be helpful include the following:

  • Manipulation therapy such as physiotherapy
  • Exercise routines
  • Osteopathy
  • Chiropractic care
  • Acupuncture and
  • TENS

However, if none of the above treatment options bring relief it may be necessary to consider surgical approaches. An MRI to look for specific abnormalities is normally the next step. The MRI may reveal pathology such as herniated discs within the facet joints and an injection of steroid may help. If the discs appear to be the worn the specialist may recommend further investigations including discography to identify whether surgery such as spinal fusion may be of benefit.

Stepwise Diagnostics and Perineural Block

Therefore a stepwise approach is used to treat most spinal disorders. In his article, 'Neurosurgery for Pain Management'. King's College Hospital, Consultant Neurosurgeon, Mr Rhanjeev Bhangoo explains how this approach, " involves starting treatment with non-invasive and effective treatments such as physiotherapy and osteopathy. If this is ineffective then simple analgesics may help. Occasionally the doctor may use injections of steroid/local anaesthetic mixture which may alleviate back pain and sciatica."

He goes onto to say that "These injections may be to the epidural space (similar to a technique used in childbirth), facet joints or around individual nerves (perineural block)."

Moving forward, there are many different operations used to treat back pain, neck pain and sciatica. Surgical treatments for nerve entrapment causing either sciatica or brachialgia are well studied and usually highly effective. Operations for back pain are generally more complex but may produce significant improvements in pain and quality of life.

Evolution of Spine Surgery

Spine surgery has evolved with many procedures now performed using keyhole techniques resulting in smaller incisions that reduce the risk of infection and blood loss, post-operative discomfort and usually reduce the length of hospital stay. Endoscopic discectomy is where a small camera and surgical instrument are introduced through a tiny incision and the disc and bone compressing the nerve removed. 

For further information see -

A medication that reduces sensation. Full medical glossary
Another term for painkillers. Full medical glossary
A fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. Full medical glossary
On or over the dura mater, the outermost of the three membranes covering the brain and spinal cord. The epidural space is used for anaesthetising spinal nerve roots, for example during pregnancy. Full medical glossary
The basic unit of genetic material carried on chromosomes. Full medical glossary
When part of an organ pushes through the wall of the body cavity that normally holds it. Hernias can develop in many different parts of the body. Full medical glossary
Invasion by organisms that may be harmful, for example bacteria or parasites. Full medical glossary
The part of the back between the lowest ribs and the top of the pelvis. Full medical glossary
An abbreviation for magnetic resonance imaging, a technique for imaging the body that uses electromagnetic waves and a strong magnetic field. Full medical glossary
Bundle of fibres that carries information in the form of electrical impulses. Full medical glossary
Bundles of fibres that carry information in the form of electrical impulses. Full medical glossary
Any test or technique that does not involve penetration of the skin. The term 'non-invasive' may also describe tumours that do not invade surrounding tissues. Full medical glossary
A therapeutic system that centres around the concept that many conditions are related to musculoskeletal disorders. Full medical glossary
The use of physical therapies such as exercise, massage and manipulation. Full medical glossary
Pain that radiates along the sciatic nerve, which is the main nerve in each leg and the largest nerve in the body. Full medical glossary