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25 MARCH 2018 HEALTHCARE INNOVATIONS


SPECIALIST CLINICS 31


The myths of spinal surgery


H


ere, Mr Navin Verghese BSc (hons), MB.BS, MRCS (Ed), MSc., FRCS (Orth), consultant spinal surgeon at


West Wales Spine, answers some of your most common questions:


WHAT IS SCIATICA? The sciatic nerve is the largest in the human body. It’s formed from lumbar nerve roots emerging from the lower back. It then travels from the buttock as far as the foot (after divid- ing behind the knee). It controls the muscles and sensation below the knee. We all know people complaining of ‘sci-


atica’. Some use it to describe lower back or buttock pain. True sciatica radiates from the lower back to below the knee along the path of the sciatic nerve. It can be agonisingly pain- ful — once you’ve suffered true sciatica you’ll never forget it.


associated with pins and needles, numbness, weakness of the leg and on rare occasions bladder and bowel disturbance.


WHAT IS A SPINAL FUSION? I’VE HEARD FRIGHTENING STORIES ABOUT IT Spinal fusion has evolved a great deal over the past couple of decades. We now have the knowledge and technology to reduce operative time, allow smaller incisions and reduce the hospital stay and rehabilitation period. Yes, it’s major surgery but it can be life-changing if performed on the correctly chosen and prepared patient. This requires a great deal of expertise and experience so must be performed by a highly trained spe- cialist spinal surgeon. Fusion can treat back pain in specific cir-


An MRI scan demonstrating a slipped disc The extremely painful problem of sciatica


WHAT CAUSES SCIATICA? WHAT IS A SLIPPED DISC? The most common cause of sciatica is a disc herniation or ‘slipped disc’. This occurs when the shock absorbers in your spine (interver- tebral discs) become lax and start to bulge inwards and press on the lumbar nerve roots. The compression as well as the resultant in- flammation of the nerves causes the acute and severe radiating leg pain. It can also be


IS THERE A CURE FOR SCIATICA? The short answer is yes. Some 90% of pa- tients spontaneously resolve within 12 weeks. During this period it’s advisable to work on your core stability (perhaps using yoga/ pilates) and take simple painkillers. There are stronger medications known as neuro- modulators and spinal injections which your GP may recommend in severe cases. For the other 10% who do not settle, prompt surgery is generally recommended. Surgery is effec- tive at improving leg pain and generally safe, however, there are a number of potential risks which must be discussed with your surgeon prior to consenting to surgery. Usually the surgery (lumbar discectomy/ decompression) takes less than an hour with an overnight stay in hospital. Most patients experience imme- diate relief of leg pain and can return to work and normal activities in a matter of weeks.


cumstances but is most effective for treating pain caused by nerves which are becoming trapped due to a collapsing spine. I generally perform minimally invasive (keyhole) spinal fusion surgery (see diagram below) to mini- mize tissue and muscle damage but it can also be performed through open surgery (larger incisions). Neural monitoring machines can also be used to minimize the potential for nerve injury during the operation. We’re the only unit in South Wales and one of a small percentage of units in the country who have access to 3D intraoperative screening which allows a high degree of accuracy and safety when placing spinal implants.


We all know people complaining of ‘sciatica’. Some use it to describe lower back or buttock pain. True sciatica radiates from the lower back to below the knee along the path of the sciatic nerve. It can be agonisingly painful — once you’ve suffered true sciatica you’ll never forget it


arthritis. This can cause cramping and weak- ness (or the feeling of deadness) of the legs usually starting in the buttock when walking. This is generally improved by leaning forward or sitting down. If this is the case then surgery to decompress the spine can have a curative effect. Secondly, myelopathy. This is com- pression of the spinal cord in the neck or mid back resulting in clumsiness when walking. Patients (or their family) notice that they walk ‘as if their drunk’. This is a serious condition usually requiring urgent surgery to prevent further deterioration.


Meet the expert minimally invasive lumbar fusion surgery


I START TO GET CRAMP IN MY LEGS WHEN I WALK AND FEEL NUMB TO THE EXTENT I HAVE TO STOP. MY GP SAYS IT COULD BE RELATED TO MY SPINE There are a number of causes for walking problems and leg weakness. There are a couple of spinal problems you and your GP should discuss and consider, however. Firstly, lumbar canal stenosis. This is compression of multi- ple nerves in your lower back secondary to


Mr Narvin Verghere BSc (hons), MB.BS, MRCS (ed), MSc, FRCS (Orth) specialises in all aspects of spinal surgery, including treatment of degenerative conditions of


the


For more information T: 01792 472922 westwalesspine.co.uk


cervical lumbar spine. and


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