Spine Surgery

Reference Corner [PDF]

• 手腳麻痺之原因及治療 • 脊柱側彎 • 背痛之成因及治療

• 脊柱側彎運動 • 坐骨神經痛及微創手術治療

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Everyone will have an attack of neck or low back pain at least once in a lifetime. Prolapsed intervertebral discs, spinal stenosis, spinal cord compression due to osteophytes or calcified ligaments are common spinal conditions. Bony secondaries to the spine are dreadful diseases that require early treatment.

It is our expertise to perform spinal surgery using minimally invasive methods to exercise prolapsed disc materials. Simple implants are applied to give better stability of the spine after surgery and facilitate early rehabilitation. In addition, we also work in close collaboration with the Department of Physiotherapy to offer spinal pain management programmes.



Sciatica & prolapsed intervertebral disc
What is sciatica?
The sciatic nerve is composed of the nerve roots from the lumbar spine. It starts from the lumbar spine, through the buttock and back of thigh to the leg and foot. Sciatica is a form of back pain associated with leg pain. It follows the path of the sciatic nerve.

What are the causes of sciatica?
Any disease that presses on or irritates the sciatic nerve or the nerves that form the sciatic nerve at the lumbar spine can cause sciatic pain. The commonest cause of sciatica is prolapsed intervertebral disc at the lower lumbar spine, mostly at the fourth and fifth levels. The protruded disc material presses on the nerve root of that level and causes symptoms.

What are the causes of prolapsed intervertebral disc?
The main reasons for the damaged and protruded intervertebral disc at the lumbar spine are:

• Frequently carry heavy weight or stress the back
• Poor posture
• Weak lumbar spine due to genetic factors

Symptoms of sciatica
The severity of symptoms depends on the degree of the prolapse and the pressure effect on the nerve root. The sciatic pain is often worse with coughing and sneezing. Prolonged walking may also aggravate the pain.

Patients will also have numbness in the foot and/or on outer side of the leg. In serious cases, there is weakness in the movement of the toes and ankle. If the patient experiences numbness in the perineal region and loss of urine and bowel control, this is an urgent situation and he/she must consult a doctor immediately.

Treatment of sciatica

• Rest: This is the most important and the best method
• Analgesics
• Physiotherapy: Hot or cold pads may help. Ultrasound, lumbar traction and other methods are also useful

Exercises
Exercises that are appropriate for patients depend on the severity of the disease. Patients should observe the changes in the intensity or location of pain during exercises. Fluctuation of the pain level is common during the treatment period. If the pain is getting worse, medical advice should be sought immediately. The following exercises may help to alleviate pain:

Exercise 1

• Lie flat on the back. Bend the knees
• Hold the left knee with both arms.
• Hold it for 5 seconds, and release. Repeat 5 times
• Repeat the same with the other leg

Exercise 2

• Lie on chest. It is a first-aid exercise for acute pain.
• Use hot packs to relax the back muscle
• 5 minutes every 2 hours

Exercise 3

• Lie on chest. Place the elbows under the shoulders and support the body with the forearms
• Relax the back
• Hold it for 2 to 3 minutes

Exercise 4

• Lie down with face down. Place the hands under the shoulders in the press-up position
• Straighten the elbows slowly. Push the body up and keep the pelvis and legs relax in bed. Relax the back
• Hold it for 1 to 2 seconds and return to starting position
• Repeat 5 times every 2 hours

Exercise 5

• Do this exercise when the back pain and leg pain have lessened
• Stand upright with feet apart by the shoulder width (see diagram)
• Place the hands to support the lower back
• Slowly bend backward and keep knees straight
• Avoid bending too much and causing pain to the back and the leg
• Hold it for 1 to 2 seconds and return to starting position
• Repeat 5 times every 2 hours

Surgical treatment: Microdisectomy
When symptoms are serious, surgery may be required. Microdisectomy is a minimal access surgical technique used to treat sciatica. Using a 2 cm skin incision and the specially designed instrument, the prolapsed intervertebral disc materials are removed. Patients can often go back home within a few days.

Possible complications of Microdisectomy
The rate of serious complications following microdisectomy is low. Common ones are:

• General complications in relation to the patient’s general health status such as stroke, heart attack, etc.
• Damage to the spinal nerve with possible permanent loss of sensation and leg movement, and poor urine and bowel control
• Wound infection
• Recurrence of the prolapsed intervertebral disc