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
- 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.