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FAQ

Question: What are the common causes of low back pain?

The most common cause by far is simple strain of the back muscles and ligaments. It usually improves by itself and goes away in anything from a few days to three months. If you are concerned, finding it difficult to work or feel unwell you should consult your GP. Back pain that radiates into a limb or which persists beyond three months is often due to a herniated disc, disc degeneration and/or arthritis in the spine and should usually be investigated further.
Date Added: 04/02/2008 00:00:00

Question: What do the terms herniated, protruded and bulging discs mean?
A bulging disc is a small protrusion of disc that is most likely still contained in the covering of the disc and often so small that it does not cause any symptoms. A herniated disc and protruded disc mean the same thing: a disc that has bulged out so much that it is occupying significant space within the nerve canals of the spine. If it has actually ruptured out beyond its coverings so that a fragment of disc is lying free within the spinal canal this is often referred to as a sequestrated disc
Date Added: 04/02/2008 00:00:00

Question: Is it true that a bulging disc is common?
Bulging discs and even herniated discs are quite common in the general population and are often picked up coincidentally on MRI scan. The important thing is clinical correlation between your symptoms, signs on physical exam, and findings on a good quality MRI scan.
Date Added: 04/02/2008 00:00:00

Question: How did I herniate my disc?
Disc herniations in the lower back often occur with everyday motions of the lower back. People herniate their lumbar discs twisting, bending, and turning often to pick up something heavy. They can occur without warning or doing something very mild like getting out of bed. Trauma whether on the sports field or in a car is a relatively uncommon cause of disc herniation.
Date Added: 04/02/2008 00:00:00

Question: What is degenerative disc disease?
This is a term applied to a disc space that has undergone a lot of wear and tear most as a result of the normal ageing process. It can occur in younger patients if they have been involved in contact sports such as Gaelic football or Rugby or if they are genetically predisposed to developing early wear and tear in the spine.
Date Added: 04/02/2008 00:00:00

Question: When should surgery be considered for patients with spine problems?
At its simplest when you have persisting symptoms, and your physical exam and investigations (usually MRI) show a treatable underlying cause. Broadly speaking assessment by a specialist for surgery should be considered when (1) There is severe nerve pain radiating into a limb; or a nerve problem such as weakness, impaired sensation or loss of dexterity in a limb. (2) When neck or back pain has persisted, despite conservative treatments, for three months or more.
Date Added: 04/02/2008 00:00:00

Question: I have heard that a disc operation can weaken my spine and cause further problems in the future. Is this true?
Disc removals now are usually partial, and done in a minimally invasive way using small approaches and microscopic techniques. This does not cause instability and most patients can return to a normal life including sport. The older techniques which often involved extensive removal of bone (laminectomy) often did lead to problems of instability and extensive scarring.
Date Added: 04/02/2008 00:00:00

Question: What is lumbar instability?
Instability, put simply, is the inability of the spine to tolerate normal daily stress applied to it without causing pain. In some cases people are born with a small bone defect in the spine that causes a ‘slippage’ of one vertebral body on another – seen as a step on X-rays or MRI. This is referred to as spondyolisthesis.
Date Added: 04/02/2008 00:00:00

Question: What is Spinal Stenosis?
As we get older our bone, joints and ligaments degenerate and thicken. There is a cyclical process of tissue break down, inflammation and repair which leads to the formation of bone spurs, overgrown joints, and thickened ligaments. The normal spaces and canals for the spinal cord and nerve roots become narrower and narrower until ultimately the nerves themselves become compressed and pinched. When this happens, pain, burning and weakness in one or both legs occurs especially with activity.
Date Added: 04/02/2008 00:00:00

Question: What is the treatment of spinal stenosis?
Because symptoms are due to direct physical compression of nerves, conservative treatments such as pain medications, physical therapy and spinal injections seldom bring about lasting relief. It should also be borne in mind that the degenerative changes which cause stenosis usually progress with time. In moderate and severe cases, a relatively small operation can be carried out to decompress the nerves.
Date Added: 04/02/2008 00:00:00

Question: What are the risks associated with spinal surgery?
Risks can be separated into minor risks and major risks. The minor risks for the most part are treatable and reversible and occur less than 5% of the time. The major risks are for the most part difficult to treat and may be irreversible and occur less than 0.1% of the time. The minor risks include infection (can be treated with antibiotics),retained fragment (treated by reoperation) bleeding, (can be treated with blood transfusions), and cerebrospinal fluid leak (treated by repair). The major risks include nerve damage leading to worsening pain and weakness, or paralysis with or without bowel, bladder, and sexual dysfunctions.
Date Added: 04/02/2008 00:00:00

Question: Is surgery always successful?
Thanks to improved microscopic techniques, and enormous advantages in diagnostic imaging - especially MRI - the success rate of the various forms of spinal surgery is very high. Unfortunately, as with all treatments and other surgical specialties, it can never be a hundred percent. It would be very rare for symptoms to be made worse.
Date Added: 04/02/2008 00:00:00

Question: Does my insurance cover minimally invasive spinal surgery?
Yes. At the Hermitage Clinic, Full Direct Settlement is provided, for all spinal procedures, with all the major insurers including VHI, Quinn and Vivas.
Date Added: 04/02/2008 00:00:00

Question: How quickly can I expect to recover from surgery?
This depends on what you get done. Single level decompression procedures, such as microdiscectomy, are relatively short operations and patients usually only take a few weeks to recover from them. This means that you will be up and walking the day after surgery but will feel sore and stiff until the healing process is over. A fusion is a more extensive procedure and a patient may require two months or more to recover. The recovery time also depends on the number of levels you have done. Each additional level l adds time in the operating room and adds to the number of days you many need to recover. Other factors include the length of time you had severe symptoms prior to surgery, age, and other medical problems that might affect healing such as diabetes. The recovery period does not mean being in the hospital or being forced to rest in bed the whole time. Patients are expected to move around, ambulate and become more and more pain free and normal over the course of the recovery time.
Date Added: 04/02/2008 00:00:00

Question: Will I have to have physiotherapy? If so, for how long?
Yes. After you have recovered adequately it is usually advisable to undergo physical therapy for several weeks. You will be taught about posture and how to lift properly. You will also be shown exercises to strengthen your back and stomach muscles that you can continue yourself afterwards.
Date Added: 04/02/2008 00:00:00

Question: When do I need cervical surgery?
The main indications for cervical disc surgery is (1) a persisting neurological deficit such as weakness, impaired sensation or loss of dexterity in the arms or hands; or stiffness and weakness in the legs. And (2) pain which has not responded to conservative measures for a reasonable time i.e. 2-3 months. In general there should also be a correlation of your symptoms with abnormalities seen on MRI, CT and/or EMG studies.
Date Added: 04/02/2008 00:00:00

Question: Why is cervical surgery often done through the front of the neck?
This is usually the easiest and safest rote to get to a herniated disc
Date Added: 04/02/2008 00:00:00

Question: Is a plate in cervical disc surgery necessary? Will I set off metal detectors?
Plate is not always necessary but the use of the plate has provided us with two distinct advantages. a. Using a plate increases the fusion rate by a few percentage points by holding the bony graft in place and not allowing it to come out. b. The plate serves as an internal brace so that the patient does not need a collar after the surgery, A collar can lead to weak neck muscles from not moving the neck and could set up for future neck injuries.
Date Added: 04/02/2008 00:00:00

Question: Will the surgery lessen my mobility?
It may, but by only a few degrees such that you will hardly notice it at all if you only have one level surgery. If you have two or three levels fused then you will most likely notice some loss of mobility. However, many people state that their neck mobility is better after a fusion as they have less neck pain and can move their neck better.
Date Added: 04/02/2008 00:00:00

Question: What are the risks of cervical surgery?
Risks can be separated into minor risks and major risks. The minor risks for the most part are treatable and reversible and occur less than 5% of the time. The major risks are for the most part difficult to treat and may be irreversible and occur less than 0.1% of the time. The minor risks include infection (can be treated with antibiotics), hoarseness (usually transient), bleeding, (can be treated with blood transfusions), and cerebrospinal fluid leak (can be treated with repair and drainage). The major risks include nerve damage leading to worsening pain and weakness, or spinal cord injury leading to quadraparesis or quadriplegia.
Date Added: 04/02/2008 00:00:00

Question: Does whiplash cause herniated discs in the neck?
Whiplash or trauma does not usually cause herniated discs in the neck. What is more likely to happen is that the already non-symptomatic neck disc bulge or herniation that you already have will become bigger or become symptomatic after a whiplash injury. Discs in the neck most commonly herniate when already weakened and aged. A disc may herniate doing normal daily tasks.
Date Added: 04/02/2008 00:00:00