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FAQs

LOWER BACK PROBLEMS

I have back pain and pain that extends into my leg/buttocks/groin/hips, what is the cause?

Mechanical back pain as above can give pain that extends beyond the back. This is because the spine is very rich in nerves and all structures in the spine have nerves and these nerves can communicate with other nerves and pass the pain along in them to other regions of the body. Pain that is caused by the facet joints, discs and structures surrounding the spine can cause pain that extends into between the shoulder blades, down to the hips, groin and upper leg.

Pain that extends beyond the knee is usually because one of the major nerves that run down the leg is being compressed. This is a different situation to the pain above. The pain caused by mechanical back pain that extends to other parts of the body is called referred pain. Pain that extends beyond the knee is called sciatica and is an indication of impending nerve damage. These large nerves that run down the leg and give sciatica when they are compressed are usually compresses because of a narrowing of the canal in which these nerves run. This can be the main spinal canal or the smaller canals on the side of the vertebrae where the nerves leave the spinal canal. The compression can be caused by a slipped disc or by bony spurs that grow from the vertebrae (osteophytes).

How can it be treated?

Mechanical back pain is treated as in the answer above. Sciatica is treated with analgesia, anti-inflammatory drugs, physiotherapy, non–invasive procedures such as nerve blocks and surgery. Surgery can be minimally invasive such as microdiscectomies or larger operations such as laminectomies or even lumbar fusions. Surgery is only reserved for cases where the pain does not resolve or where weakness of the legs or dysfunction of the bowel and bladder occurs.


I have had back problems for a few years on and off. I now have back pain almost constantly? why is this?

Back pain – or mechanical back pain, in medical terms is caused by a host of factors. It is mostly due to the joints in your spine, the facet joints. These joints are located on both sided between the vertebrae and carry the weight of the spine along with the discs between the vertebrae. With damage to the discs, the weight is carried mostly by the joints and this can lead to osteoarthritis. This is a wear-and-tear kind of arthritis. Many people are predisposed to this kind of arthritis on a genetic basis. There are other factors such as pain from the discs, ligaments and other structures surrounding the spine that contribute.

The nature of damage to these structures is that the damage and resulting pain is cyclical and fluctuant in nature. As the damage mounts over time, the pain becomes more intense and the periods of pain last longer. Eventually it becomes permanent.

How can it be treated?

It is important to establish which of these structures are causing the pain. It is usual that it is a combination of these factors. The history of the pain, the clinical examination and further tests will help your healthcare provider ascertain which structures are responsible. If the pain is purely from the disc, then the treatment will focus on treating the discogenic pain.

Measures that can help are pain-killers, anti-inflammatory drugs, physiotherapy, weight-loss, exercise programs, non-invasive procedures such as radiofrequency procedures and blocks of the joints and finally surgery. Surgery is aimed at removing the disc that causes the pain. In people where the disc is damaged and the joints are healthy, your healthcare provider may suggest that you undergo a disc replacement procedure. Where the disc and the joints are damaged, it is usually necessary to perform a spinal fusion. Both the surgical procedures are major surgical procedures and should only be attempted when all other avenues have been explored.

It is generally accepted that the two main indications for spinal surgery is a threatened spinal nerve and unbearable pain that is reducing the patient’s quality of life and that is not remediable despite extensive conservative and non invasive measures.


What are the symptoms of spinal stenosis?

The symptoms are usually that of leg pain and/or weakness of the legs and unsteadiness when walking and standing. In severe cases bowel and bladder dysfunction might also occur and this is once again an emergency that requires immediate surgery.


What are the symptoms that make my doctor suspect that I have mechanical back pain with referred pain?

Mechanical back pain is usually worse on resting. My patients will frequently tell me that they have pain on sitting and that the pain worsens when they get up, but gets better after walking for a bit. Their pain is frequently worse at night and turning in bed can be quite painful. Getting out of bed is also usually painful. Once again as soon as my patients are fully mobile the pain will settle. Certain movements will elicit the pain and bending forward and especially back wards can worsen the pain. Bending towards one side can also be painful. It is frequent to have hip, buttock, groin and upper leg pain. Some patients report that they can play sport without much discomfort but that they pay the price the following day or later the same day.


What is lumbar spinal stenosis?

This is a condition where the whole spinal canal is narrowed and all the nerve roots that supply the legs and feet are being compressed. This is a slowly progressive condition and results from a combination of factors. It is usually a combination of slipped discs and enlargement of the joints of the back and thickening of the ligaments inside the spinal canal. This can be a hereditary condition but is usually a wear-and-tear age related condition affecting people in their sixth decade and beyond.


What is sciatica?

Sciatica is when a nerve root that supplies the leg is being compressed. This will lead to pain that extends to beyond the knee. Your healthcare provider will be able to get a good idea which nerve(s) is being compressed by the distribution of the pain. It is a frequent occurrence that the pain is accompanied by a tingling, pins-and-needles type of feeling. When the nerve is severely compressed you may experience weakness in your leg or ankle. At this stage the pain might disappear. This may appear to be a good sign, but rather is an ominous sign that the nerve roots function is so badly affected that the pain carrying function of the nerve no longer functions. A dramatic and extremely dangerous situation is when you start having problems to control your bowel and bladder. This is an emergency situation that requires immediate surgery as you may lose bowel and bladder control permanently if you do not undergo emergency surgery.


NECK PROBLEMS

I have had neck problems for a few years on and off. I now have neck pain almost constantly? why is this?

Neck pain – or mechanical neck pain, in medical terms is caused by a host of factors. It is mostly due to the joints in your spine, the facet joints. These joints are located on both sided between the vertebrae and carry the weight of the spine along with the discs between the vertebrae. With damage to the discs, the weight is carried mostly by the joints and this can lead to osteoarthritis. This is a wear-and-tear kind of arthritis. Many people are predisposed to this kind of arthritis on a genetic basis. There are other factors such as pain from the discs, ligaments and other structures surrounding the spine that contribute. Sometimes injuries such as whiplash injuries will contribute to – and speed up – this degenerative process

The nature of damage to these structures is that the damage and resulting pain is cyclical and fluctuant in nature. As the damage mounts over time, the pain becomes more intense and the periods of pain last longer. Eventually it becomes permanent.

How can it be treated?

It is important to establish which of these structures are causing the pain. It is usual that it is a combination of these factors. The history of the pain, the clinical examination and further tests will help your healthcare provider ascertain which structures are responsible. If the pain is purely from the disc, then the treatment will focus on treating the discogenic pain.

Measures that can help are pain-killers, anti-inflammatory drugs, physiotherapy, weight-loss, traction, exercise programs, non-invasive procedures such as radiofrequency procedures and blocks of the joints and finally surgery. Surgery is aimed at removing the disc that causes the pain. In people where the disc is damaged and the joints are healthy, your healthcare provider may suggest that you undergo a disc replacement procedure. Where the disc and the joints are damaged, it is usually necessary to perform a spinal fusion. Both the surgical procedures should only be attempted when all other avenues have been explored.

It is generally accepted that the two main indications for spinal surgery is a threatened spinal nerve and unbearable pain that is reducing the patient’s quality of life and that is not remediable despite extensive conservative and non invasive measures.

If the pain is mostly due to the facet joints, then radiofrequency rhizotomies is a safe and efficient way of treatment that does not require any surgery.


I have neck pain and pain that extends into my shoulder/between the shoulder blades/arm/face/gives me headache, what is the cause?

Mechanical neck pain as above can give pain that extends beyond the neck. This is because the spine is very rich in nerves and all structures in the spine have nerves and these nerves can communicate with other nerves and pass the pain along in them to other regions of the body. Pain that is caused by the facet joints, discs and structures surrounding the spine can cause pain that extends into the shoulders, between the shoulder blades, down to the arms and up to the face and also causes headaches.

Pain that extends beyond the shoulder is usually because one of the major nerves that run down the arm is being compressed. This is a different situation to the pain above. The pain caused by mechanical back pain that extends to other parts of the body is called referred pain. Pain that extends beyond the shoulder is usually an indication of nerve compression. These large nerves that run down the arm are usually compresses because of a narrowing of the canal in which these nerves run. The compression can be caused by a slipped disc or by bony spurs that grow from the vertebrae (osteophytes).

How can it be treated?

Mechanical back pain is treated as in the answer above. Cervical nerve root compression is treated with analgesia, anti-inflammatory drugs, physiotherapy, non–invasive procedures such as nerve blocks and surgery. Surgery can be minimally invasive such as foraminotomies or larger operations such as anterior cervical discectomies with or without fusion or disc srthroplasty. Surgery is only reserved for cases where the pain does not resolve or where weakness of the arm occurs.


What are the symptoms that make my doctor suspect that I have mechanical neck pain with referred pain?

Mechanical neck pain is usually worse on neck movement. My patients will frequently tell me that they have pain when sleeping and suffer from a stiff neck and turning in bed can be quite painful. Trying to look up and bending the neck towards one side can also be painful. It is frequent to have referred pain to the shoulders, between the shoulder blades, down to the arms and up to the face and it also causes headaches.


What is cervical spondylotic myelopathy?

This is a condition where the whole spinal canal is narrowed and all the nerve roots that supply the arms are being compressed. This is a slowly progressive condition and results from a combination of factors. It is usually a combination of slipped discs and enlargement of the joints of the back and thickening of the ligaments inside the spinal canal. This can be a hereditary condition but is usually a wear-and-tear age related condition affecting person in their sixth decade and beyond. The result is weakness of the arms with spasticity in the arms and legs. This is an extremely dangerous situation that requires surgery urgently.


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PAARL

Room 12, Paarl Medical Centre, Berlyn Street, Lemoenkloof, Paarl, 7646
(Next to Mediclinic Paarl)

021 871 1963

paarl@adept.co.za

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Room 23, 4th Floor, Melomed Bellville, Cnr. Voortrekker Road & A J West Street, Bellville, Cape Town, 7530

021 945 3146

melomed@adept.co.za