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.
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