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Specialist clinics
6 OCTOBER 2019 • HEALTHCARE INNOVATIONS
New frontiers in the management of spinal conditions — current concepts and the future
Professor Arun Ranganathan is one of the country’s leading spinal surgeons. He treats a number of high-profile patients, from celebrities and dignitaries to world-renowned athletes, and manages this alongside his NHS practice where he was recently featured on Channel 5’s Operation Live, operating on 18-year-old Chloe in the spine-straightening episode. He gives us his thoughts on some of the current concepts and the future of spinal surgery and innovations
your back into the leg is termed ‘sciatica’ and if the pain goes into the hand from your neck, it’s called brachialgia. Often the pain
PROFESSOR ARUN RANGANATHAN LONDON SPINE CARE
Back pain and neck pain are two of the main causes of sickness & absen- teeism after the common cold, and much work has been done into the research and management of these conditions. Back and neck pain can represent the early presentation of benign mechanical or muscular dysfunction to more serious condi- tions such as tumours, infections or spinal deformity. Tey may not always be associated with leg pain or ‘Sciatica’ and weakness, but this is the case in at least 30-40 percent of cases. Back and neck conditions are often
managed by other medical specialties such as physiotherapy and these can provide a lot of support and great outcomes. Yoga can be beneficial in moderate discogenic or mechanical low back and neck pain. In conditions where excess mobility is a problem, like in hypermobility syndrome or in post-op patients, and even in other serious conditions, Pilates is thought to be more suitable as it starts the core muscular training from the spine being in a neutral position. For patients with any sort of curvature of
the spine, the Schroth Method,
which originated in Germany in the early 1900s, is an effective non-sur- gical option. Te Schroth exercises are three-dimensional conservative management exercises and patients are taught to improve their posture, breathing and strength with specific derotation exercises. Osteopathy and chiropractic treatments traditionally involved passive manipulations of the spine. However, in the current day all three types of practitioners work hand in hand and there’s an overlap in their techniques. (Nikos Stamos — Physio Move). If physiotherapy or Pilates don’t
help or solve the problem, then a specialist would recommend an MRI scan to look carefully at the struc- tures of the spine.
ADVANCEMENTS IN MOTION PRESERVING SPINE SURGERY Any radiating pain shooting from
PATIENT STORY — THE UNEXPECTED CAN HAPPEN! On 1 March, I had the first major operation in my life — I guess as a 58-year-old, I could count myself lucky. Medically, it was an excision of intradural lesion, Left L4/5 decompression by keyhole surgery. To me, it was a remedy to having extreme pain down my left leg and backside, which had stopped me even being able to sit down for more than a few minutes. This had developed over quite a short period of six to eight weeks. Thankfully, Professor Ranganathan performed the operation just two days after I first met him. And he got me home the day after the operation, as promised. I thought I’d done well just being able to walk the length of the ward, without any pain, on the day of the surgery. So, on 1 September, I set out on a run (I’d actually been running for a few months by now) and two hours, 56 minutes and 30 seconds later, I’d completed a half marathon. Now that really impressed me. That’s the fastest I’d run in at least five, perhaps even 10 years.
settles down in a few weeks, but sometimes it can be excruciating, not responsive to analgesics and can lead to weak- ness in the foot or hand. If this is the case, we’d usually treat it with a steroid injection in the back. Tis is a quick procedure and often reduces the prolapsed disc enough to alleviate any pain
or numbness. If the prolapse is too large or the steroid injections aren’t effective, surgery may be the only option. With minimal access surgical techniques and equipment,
it’s now
possible to do this surgery as a day case through a two to three centi- metre incision. Tis surgery allows the patient to return to normal activi- ties and work very quickly because we don’t cut through any muscles. Tis latest technology and
advanced skills also mean that we can do more complicated surgery, such as tumour removal, as keyhole surgery, allowing patients to leave hospital within just 24 hours with excellent clinical outcomes.
THE INTEGRATION OF TECHNOLOGY, INTELLIGENCE AND SURGICAL SKILLS ARE INCREASING THE SCOPE AND SAFETY OF MODERN-DAY SPINAL SURGERY
DISC REPLACEMENT These are X-rays of a 56-year-old patient who had severe entrapment of the nerves in her neck and was unable to move her right hand. She had three of her discs replaced and flew back to the US within a week. Disc replacement allows movement in the neck and realignment of the neck bones versus the stiffness and lack of movement of something like fusing the vertebrae together, as is often the case.
Rarely, patients may experience
numbness around the front or back passages, or bowel or bladder dysfunc- tion — a condition that’s termed cauda equina syndrome. Tis is a surgical emergency that will require immediate attention. Sometimes more than one nerve can
be trapped in your neck as a result of arthritis and with newer disc replace- ment technologies and computerised monitoring of the nerves, we’re even able to perform these cases safely.
MAKING SPINAL SURGERY IN THE ELDERLY ‘SAFE’ In some cases of arthritis, the spinal cord itself is compressed and this can cause severe dysfunction in terms of balance and walking. Te patient can also lose the use of their hands. Spinal surgery may be accompanied by extensive blood loss, since blood pressure has to be kept relatively high during surgery in the elderly. New drugs such a tranexamic acid mini- mise bleeding and careful positioning and attention in keeping blood pres- sure normal ensures blood flow to the vital organs. Tis has reduced the incidence of postoperative visual loss and damage to the spinal cord; condi- tions the elderly are vulnerable to. Advances in newer ventilation tech- niques have reduced incidence of lung damage during anaesthesia.
‘SURGERY SAVED ME FROM BEING IN A WHEELCHAIR’ I’m 82 and live with my wife in Italy. I enjoy walks on the beach and do stretching exercises for back pain. In April 2018, I noticed a tingling in my hands. During a session in February 2019, after doing my stretches on the yoga mat, I was unable to move my hands or legs for 15 minutes. This was a very scary experience. Within a few days, I started to lose my balance and was unable to walk steadily anymore. I also lost the ability in my hands to feed and dress myself, having to rely on my wife. Being 82, with 100% carotid artery occlusion and having had a severe stroke, we were told that surgery was too risky. We did some research and were recommended Prof Ranganathan, who agreed on the risks but said surgery was possible with the right teamwork. Following surgery, the improvement was dramatic. I was able to walk normally the next day and can now feed and dress myself. I even returned to Italy by the end of the week and continue to do well
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