Back Pain, Trapped Nerves and Herniated Discs - when is surgery required?

Who are the Spine Experts and what do they recommend?

At what point is a surgeon required to treat back pain and sciatica? Furthermore, what sort of surgeon should I have – a neurosurgeon or an orthopaedic surgeon?

One of the UK’s acknowledged leading spine specialists, Mr Ranj Bhangoo says, “The first stage in the diagnostic pathway should be a thorough assessment by a neurosurgeon who will be able to identify which area of the spine is affected and which nerves may be involved. In most cases further tests will be ordered and this is usually an MRI scan of the spine.”

The King’s College Neurosurgeon explains how a stepwise approach is used to treat most spinal disorders starting treatment with 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. These injections may be to the epidural space (similar to a technique used in childbirth), facet joints or around individual nerves (perineural block).

Surgical treatments, although proven to be effective and safe, naturally carry greater risks than non-operative treatments and are therefore only used selectively. 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 often produce significant improvements in pain and quality of life.

In his extensive, plain English article, the spine expert describes the types of surget including:

  • Spinal Fusion
  • Lumbar disc replacement surgery
  • Vertebroplasty
  • Neck pain
  • Leg pain/sciatica
  • Lumbar microdiscectomy
  • Arm pain/brachialgia
  • Anterior cervical discetomy and fusion/cervical disc replacement
  • Posterior keyhole foraminotomy
  • Lumbar/spinal stenosis
  • Lumbar laminectomy

In all cases, due to the range and complexity of treatment options (as well as specialists), patients are advised to get involved in the decision making process and discuss all options with their doctor.

A medication that reduces sensation. Full medical glossary
Another term for painkillers. Full medical glossary
Relating either to the cervix (the neck of the womb) or to the cervical vertebrae in the neck (cervical spine). 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
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
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
A condition in which the spinal canal narrows and compresses the spinal cord and nerves. Full medical glossary
Narrowing of a tubular structure or valve. Full medical glossary