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Managing Backpain - A Surgical Perspective

Back pain is common and often results from a move cantilevered. How can we avoid this?

90% of the back pains are non-structural (or) postural associated with poor posture at work or at home. The most common mistake is to sit with a bent posture for a long time. Repetitive bending forward and lifting weights is also another important cause for back pain. So the best way to prevent is to sit straight in a chair with a good back support to match the spine curve. Every 45 minutes or 1 hour get up from your chair and walk or stretch yourself for 3- 5 minutes and sit back. Avoid bending forward and lifting weights. If you are carrying heavy shopping bags, distribute them in both hands.

Do exercises to strengthen abdominal muscles to better support the spine can help prevent back pain?

Prevention is always better than cure. Proper posture and regular back strengthening and abdominal muscle strengthening will help prevent back pain to a greater extent. Aerobics, Aqua Gym, Yoga and other modes of exercises also will help. But one has to be cautious about manipulating and doing heavy exercises once they have a back problem. It is better to consult the spine surgeon as to know what type of exercises can be done if you have a pre-existing back problem. It is a good practice for everyone to do back exercises but is a must for people who sit and work for a long time and people who repeatedly at home or work use heavy machinery.

What are the consequences of bad postures in the long run?

Bad postures are certain to cause back pain. With the present day working environment we end up sitting and working at a stretch for a long time and with the habit of working on the laptop, ipad or smartphone on bed can also have some bad effect to the spine. Sitting on the sofa with rounded back ‘potato on a couch’ position also would cause back pain. Initially the bad posture causes only non-structural pain or sprain but long run it will lead to disc dehydration, disc prolapse, and arthritis of the joints in the spine leading to persistent severe back pain and consequently nerve problems.

Under what circumstances do they back pain require surgery?

90% of the back pain will get better in 2 – 4 weeks and are non-structural nature. 10% of the patients will have severe back problems requiring some kind of interventions. If the back pain is consistently very severe and persistent, even after trying medications and physiotherapy for considerable period. If the pain is severe enough to affect activities of daily living. If there is radiation to legs with numbness or weakness if there is disturbance in bowel or bladder habits

What are the types of surgical interventions practiced for disc problem?

Types of interventions of spines

• Epidural injection – very selected cases with early disc problem not affecting the nerves. We give steroid + anesthetic medication to decrease the pain

• Microdiscectomy – significant disc prolapse compressing the nerve in young patient. The remaining disk should be normal and there should not be arthritis of joints of the spine. Here we remove the disk portion that has come out and compressing the nerve. Sometimes they can have a recurrent disc prolapse from the remaining disc.

• Laminectomy – We remove the bone coverage and the thickened ligament that is pressing the spinal cord and nerves. We do not remove the disc. We just make more room for the cord and nerves. It is done for elderly patients with settled spine, where the life expectancy of the patient is not great. We also do it in a severely compressed spine needing surgery but the patient is not anesthetically fit to undergo a long surgery.

• PLIF – Posterior lumbar interbody fusion

• TLIF – Transforaminal Lumbar interbody fusion. Here we do the decompression of the spine and we also address the stability of the spine by placing pedicle screws connected by rods. We remove the disc completely and we fill the space with spacer device and bone graft. This procedure will ensure that the spine is decompressed and stable also.

• Other interventions like endoscopic spine surgery. Minimally invasive spine surgery, and Robot assisted spine surgery, essentially give the same result for the same procedure done with most latest equipment.

Does this practice really works?

Yes these surgeries really work wonders to the quality of life of the patient. If the selection of patient is done well and if they are done the appropriate procedure that their condition demands and if done by a competent spine surgeon, in 99% of the cases the patient can stand and walk the next day and go home after 3 days. It makes a huge difference to their life if surgery is done at the appropriate time and paralysis is averted. It also makes a huge difference to the family as well.

What about the risk of complications present in all surgical procedures?

There is an element of predictable and unpredictable risk in all types of surgeries. Risks like infection can be avoided with good sterile preparation and clean operating room practices. Antibiotics also prevent infections. There are patients age related and other medical illness related factors that can be well controlled with the concerned experts help. The most feared complication amongst the public is neurological paralysis and it is the main deterrent that prevents many patients from doing a timely intervention. Please be assured that if done by professional and competent spine surgeon this can be avoided. Almost all our patients go home walking. But I have seen many unfortunate patients who come to us very late with some neurological deficit. They land up with paralysis as they are trying to avoid surgery for fear of paralysis, in these cases it is too late to help.

How much time is needed before the patient can resume operations?

Normally the patient can walk from the post-operative day one. They can go to toilet by themselves and eat at the dining table. We instruct them not to bend forward and lift weight for 6 weeks to 3 months depending on the severity of the problem. Generally they can resume work after 6 weeks but it has to be light work. They can drive for shorter duration as from 6 weeks. After 3 months they can resume their normal activities, work and driving. It is always better if they continue their good back care practices and exercises to prevent any other disc getting involved in the future.

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PATIENT TESTIMONIALS

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Juste quelque mots pour vous remercie de votre acceuille chaleureuse, toujours competent avec les patients, surtout les infirmieres pediatriques, pour Sooreeta, Dr Kevin Teerovengadum, Dr Joomye, Mr Joe, Infirmiere Dorothe, ange gardienne Reshma et la chirurgienne Dr Reshma. Moi je suis fidele a l'hopital Apollo depuis 2009 par l'acceuil et leur sympathie. Je remercie tous les services. Meme ma fille, T., la patiente, elle veut pas quitte l'hopital.

M.S Abdallah
20.03.2017