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Conditions and Treatments

You have just seen in the Anatomy and Symptoms section that it is important to separate back pain from leg pain.

The causes of each are different and so are the treatments. A common reason for disappointment is the failure to adequately address this issue at the outset.

When dealing with “degenerative disc disease” the following is true:

Back pain comes from the spine itself - unsurprisingly! It comes from the discs, muscles, joints and ligaments.

Leg pain or sciatica comes from irritation of the nerve roots going to the leg as is weakness, numbness and pins and needles. This irritation may result from physical pressure of a narrowed canal or prolapsed disc or the inflammation that can build up in them.

Pain in the buttocks and hip area may reflect nerve pain and or, the brain’s inaccurate localisation of spinal pain.

The nerves in your lumbar spine also control your bowel, bladder and sexual, (erection, orgasm and ejaculation) function. These same nerves supply sensation to the perineum, (the area of skin covered by your underpants). These nerves are called the cauda equina, (horse’s tail), and pressure on them causes the “cauda equina syndrome”.

Unless you have the cauda equina syndrome, there is no rush. It may hurt but you are safe to take your time and for us to decide on what is the best treatment for you.

(Cauda Equina Syndrome is pronounced – Cord-a  Eeeek-wine-err Sin-drome. (visit The Spine Surgery London website for more information about spinal injections Cauda Equina Syndrome)

Below is a general summary of what treatments and surgeries are available for degenerative spinal problems. A more comprehensive review of this is available at our “mother” website at The Spine Surgery London.

Please visit The Spine Surgery London website for a link to The Spine Surgery London site and a more comprehensive account of the treatment options.


What treatments are there for these problems?

In broad terms, there are only three kinds of treatment:

Conservative therapy
Injections
Operations

There are a host of different options within these groups but more or less all treatments fit into one of these three categories.

Conservative therapy

This is in two forms:

Passive Therapy
Active Therapy

Passive therapy consists of “you lie there and they do things”. It can be as simple as a course of anti-inflammatory medications or include one of the physical therapies like:- heat, cold packs, massage, ultrasound, interferential, manipulation, osteopathy, chiropractic, acupuncture, homeopathy, tablets and rest, or complex like cranio-sacral therapy. They are rather like tablets – if they work, they work for a while, wear off and you need some more. That is to say they are aimed at making the symptoms better. The cause may persist and as these things have a tendency to get better they may offer very useful help until that happens.

Active therapy by contrast is aimed at repairing the spine. This involves exercise-based therapies where “they stand there and you do things”. The concept is to work on posture, flexibility and core muscle strength. A variety of methods have been developed for this such as Pilates, Alexander and Mackenzie. It is usually delivered by a physiotherapist or specific instructor and requires time and perseverance. Everyone needs it whether they have injections or operations, they need this as well if troubles are not to return. The problem is that you have to be comfortable if you are to be able to do enough. Often referred to as “rehabilitation” it almost requires you to be better before you start.

In broad terms, leg pain is treated with passive therapies and low back pain with active conservative therapy. Often, as sciatica goes away then patients are left with back pain that then responds to active therapy.

Injections

These may be used to treat low back pain or leg pain/sciatica.

These may be diagnostic or therapeutic or both. Diagnostic is when we use them to confirm if a particular disc prolapse is the cause of the pain. Therapeutic is when the prime aim is to make you better.

Most commonly the injections are steroid-based, though there are many other types. They aim to take the inflammation and swelling away.

They may be given to the:

  • Nerve root canal where they go over the disc as well.
  • The facet joint.
  • The epidural space where they have a more general effect over several levels.

The classic time to use them is if the pain is so severe that conservative therapy, and particularly active conservative therapy is not possible.

They are used in many other settings but this is the common one.

They may be guided by X-rays or the CT scanner.

Operations

There are two broad groups of surgery which relate to their aims:

Surgery to relieve low back pain
Surgery to relieve leg pain

Surgery for back pain has to correct the structural problem in the spine. It often involves the removal of whole discs and part of the bones. These often have to be replaced with bone grafts and instrumentation such as screws, rods or artificial discs. By its nature, it is major surgery with some risks and a significant failure rate.

Surgery for leg pain is, by contrast, usually keyhole, has as its sole aim to relieve nerve pressure and thus once the offending part of the disc is removed the rest may be left. There is no need for major incisions or reconstruction with screws and rods etc.

Surgery for leg pain is therefore simpler and more common than surgery for back pain.

What operations are there for sciatica?

There are essentially three techniques in use.

  1. Keyhole Open Microdiscectomy
  2. Percutaneous discectomy
  3. Transforaminal endoscopic discectomy

For a detailed account of microdiscectomy, please refer to our “mother” website at The Spine Surgery London. This is a very acceptable technique and for some of you is the preferred option. visit The Spine Surgery London website for details.

The whole concept of The Spine Surgery London is that all techniques we have faith in are available and you get the best one for your particular problem. Here at London Endoscopic Spine Surgery we naturally focus on the endoscopic method. However, if in our view an alternative non-operative route is more appropriate, we provide it. Likewise, if you are more suited to another type of operation we will offer it first. Very often there are pros and cons which need to be weighed up.

We do not offer percutaneous discectomy as the cases it has been successful with may either be managed by conservative techniques or, in our view, more successfully treated with the other two types of surgery - transforaminal endoscopic surgery or microdiscectomy.