Spinal Surgeon in Liverpool

SPINAL CONDITIONS

Lumbar Spine

Lumbar Disc Herniation (Slipped Disc) 

A slipped or herniated disc occurs when the inner portion of the discs that cushion the vertebrae in the spine, protrude out through the outer ring of the discs. Herniated discs are most common in young to middle-aged adults. Symptoms of a herniated disc usually include pain that travels into one or both legs, often associated with numbness or tingling, muscle weakness. The pain which occurs when the disc presses on the nerves is called sciatica. Sciatica typically  starts from the back, and radiates to the buttocks and legs.

Treatment is usually in the form of painkillers physiotherapy and short period of rest.

In case of persisting pain a nerve root injection may be indicated.

Surgery is usually indicated when nonoperative treatments failed to improve symptoms.

Cauda Equina Syndrome (CES) 

Cauda Equina Syndrome is a rare pathology that requires urgent treatment. It is usually caused by a large disc herniation causing significant narrowing of the spinal canal (stenosis) and less frequently by a spinal tumour. Equina Syndrome usually presents itself with severe low back pain, leg pain and weakness in one or both legs, with associated bladder, bowel and sexual dysfunction.

The treatment of choice in case of CES is emergency surgical treatment to relieve pressure to the nerves in order to prevent permanent damage to the legs, bladder and bowels.

Lumbar Spinal Stenosis (LSS) 

Lumbar Spinal Stenosis generally occurs from degenerative conditions such as osteoarthritis and/or degenerative spondylolisthesis and typically affects patients over 50s. In these patients, stenosis is the result of aging and “wear and tear” on the spine. Patients with lumbar spinal stenosis typically develop “neurogenic claudication” symptoms which consist of pain, tingling, or cramping in the lower back and one or both legs, hips, and buttocks. Weakness or heaviness in the legs may also occur. 

Symptoms often increase when walking and decrease when the patient sits, bends forward or lies down.

Lumbar Spine MRI is the best diagnostic imaging test for lumbar spinal stenosis as this test gives a three-dimensional view of the spinal canal, nerve roots, and surrounding tissues.

Non-operative treatments of LSS may include:

• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Massage, Heat
• Physical therapy, Acupuncture
• Epidural or Nerve Root Spinal injections

Degenerative Disc Disease (DDD)

When the discs between vertebrae degenerate, the discs dry and lose their integrity. Typically afflicting older people but this condition can start in young age.  It can also be caused by wear and tear from sports and daily activities. Symptoms are many and can take the form of a nagging pain that affects the low back, buttocks or thighs, numbness in the extremities, pain exacerbated by bending and lifting. Treating this condition can be through physical therapy, non-steroidal anti-inflammatory drugs or surgery.

Spondylolysis 

Spondylosis is when the vertebrae at the base of the spine are fractured. It frequently happens to adolescents and young adults who engage in sports or other strenuous activity. The pain may take the form of a strained back or pain in the legs and buttocks. Treatment is usually non-surgical and heals with rest, physical therapy and a program of core strengthening.

Visit the British Scoliosis Society website to learn more about spondylolysis -

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Sacro-iliac Joint Dysfunction

If the patient is suffering from lower back pain, sciatic like pain, stiffness or instability this can originate from Sacro-iliac Joint Dysfunction. A number of factors can cause this dysfunction including gait issues, pregnancy, previous lower back surgery and activities that place constant stress on the SI joint. To treat the dysfunction, rest, medication, braces, physical therapy and joint injections can help to alleviate the pain.

If initial treatment fails, or the amount of pain relief does not persist, and there is a high degree of certainty that the SI joint is the case of the pain, then the patient may undergo a Sacro-iliac Joint (SI) Fusion. This is involves fixing the sacrum to the ilium using 2 or 3 metal implants joint to stop any movement.

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Adult Spinal Deformity

Spondylolisthesis

Spondylolisthesis occurs when one vertebra slips forward over the vertebra below it. The term is derived from the Greek language: spondylos means vertebra and listhesis means to slip. There are several types or causes of spondylolisthesis; 

• Congenital spondylolisthesis means the disorder is present at birth.
• Isthmic spondylolisthesis occurs at a young age when a defect, such as a fracture occurs (spondylolysis) and then one vertebra slips over the other.

• Degenerative spondylolisthesis is more common in older age and is often associated with degenerative disc disease.

Physical therapy is generally used to treat the condition. Surgical fusion may be attempted if the damage is particularly severe.

Visit the British Scoliosis website to know more about spondylolisthesis

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Scoliosis

When a spine curves to the side, this can be a symptom of scoliosis. It typically afflicts children and adolescents. Additional symptoms include uneven shoulders, leaning to one side, one shoulder or hip sticking out and a visibly curved spine. Occasionally treatment is unnecessary and the curve may improve over time. Otherwise a brace can be worn to control the curve. When growth stops, an operation may straighten the spine. In adults (Adult Idiopathic Scoliosis), painkillers, spinal injections and occasionally surgery are used to control the curvature.

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Scoliosis in young age (Adolescent Idiopathic Scoliosis):

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Scoliosis in adults (Adult Idiopathic Scoliosis and Degenerative Scoliosis):

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Scheuermann`s Kyphosis

Kyphosis can be found when the back is significantly rounded, by more than 50 degrees. This can be caused by poor posture, arthritis, osteoporosis, abnormal vertebrae, tumours and infections or spina bifida. The symptoms of this condition are tiredness in the back or legs, a hump or severe curve to the back or a bending forward of the head. To correct the curvature, treatment can be in the form of a brace, anti-inflammatory medicine or surgery.

Kyphosis (or Scheuermann`s kyphosis):

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Sagittal Imbalance

Sagittal imbalance occurs when there is a disparity in the front and back of the spine. The lumbar spine has an inward curve whilst the thoracic spine has an outward curve and these generally work in unison. Loss of the lumbar lordosis is the main driver of sagittal deformity. This can result in low back pain, difficulty walking and muscle fatigue. Sagittal imbalance is typically associated with significant disability.

There are a number of reasons for the imbalance so treatment is generally on a case to case basis, but frequently takes the form of surgery.

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Neck-Cervical Spine

Cervical Disc Herniation

In this condition, the inner core of a disc in the neck, leaks out of the disc and presses onto a nerve. This generally occurs after the age of 30 and can arise suddenly or when there is a trauma. Pain may feel dull or sharp in the neck, between the shoulder blades, and may radiate (travel) downward into the arms, hands and fingers and can associated with numbness and tingling.

Treatment can take the form of physical therapy, chiropractor therapy and injections amongst other things. If the pain lasts longer than three months, surgery is also an option.

Cervical Spondylotic Myelopathy 

Typically affecting over 50s, Cervical Spondylotic Myelopathy is a condition where the spinal cord becomes constricted due to normal wear and tear as we age. The condition can also result from severe injury, rheumatoid arthritis bone spurs or an herniated disc. Common symptoms include neck pain, arm numbness and weakness, loss of balance, falls and dexterity problems.  The natural history of cervical spondylotic myelopathy has shown that this condition usually slowly deteriorates with time. In this case the condition closely monitored. Treatment can include physical therapy, non-steroidal anti-inflammatory medication use of a cervical collar short term.  In cases of rapid deterioration of myelopathy surgery is indicated.

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Osteoporosis

Osteoporotic Spinal Fractures

Osteoporosis is a serious disease that reduces the strength of the vertebrae, making them more likely to break. These breakages (fractures) can cause severe back pain. Patients develop stooped posture, loss of height and difficulty in walking, twisting and bending. Fractures typically occur in women, especially those over 50. The best course of action is generally to prevent future fractures with medication to strengthen bones in the body.

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