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Spine...

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Spine......

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Spinal problems are common and range from back pain to sciatica (a shooting sensation down the back or sides of the leg) to paralysis due to spinal cord compression.

Neurosurgeon or Orthopaedic surgeon?

The perennial question...."Should it be the orthopaedic or the neurosurgeon operating on my spine? Who is better?" Well, it is important to know that both orthopaedic and neurosurgeons operate on the spine. In Singapore, there are many good orthopaedic surgeons subspecialising in "Spine". At the same time, the neurosurgeons in this country are qualified in the management of spinal problems. The final exit qualification exam is a surgical neurology exam with a strong emphasis on spinal pathology. Operatively, all the neurosurgeons have spent at least 2 years in recognised training centers in the U.S, UK or Australia where a large proportion of neurosurgeon's work involves 'bread and butter' spinal problems like spinal stenosis, prolapsed intervertebral discs (slipped disc) and cervical myelopathy. Neurosurgeon's also deal with pathology inside of the dura (the covering of the spinal cord) such as spinal tumours, spinal arteriovenous malformations and congenital spinal cord disorders. Orthopaedic surgeons do not manage intra-dural spinal problems, focusing mainly on bone and disc work. On the other hand, some conditions like scoliosis are managed primarily by the orthopaedic surgeons.

The answer......

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More accurately, my view is that the surgeon (be it orthpaedic or neurosurgical) must be satisfactorily trained in that area. The spinal orthopaedic surgeon and the neurosurgeon are equally qualified in this aspect. There are many spinal units in the world where the surgeons consists of both orthopaedic surgeons and neurosurgeons collaborating and working together....drawing on each other's strong points.

What are the indications for surgery in "spine"?

What is a "pinched nerve?"

There are many forms of spinal surgery for a whole host of conditions. The indications for surgery are:

	1. Progressive neurological deficit (eg sciatica, foot weaknss...) 2. Cord compression 3. Underlying space occupying lesion 4. Back pain - failure of medical / conservative treatment
In general, if there is a "surgical target" with an accompanying symptom attributable to the the former, surgery would likely be helpful.

Sciatica. What is that all about?

Is back pain Sciatica?

Sciatica is a sensation of 'shooting' pain down the leg, usually below the knee that reaches the calves, heel or foot. It is due to compression of the sciatic nerve in the lumbar spine (lower back). The causes of sciatica include:

1. Prolapsed Intervertebral Disc (Slipped disc)
2. Spinal Stenosis
3. Spinal tumours
4. Spinal vascular malformations (uncommon)
5. Pelvic tumours

Neurogenic Claudication. Tell me more.

More on Spinal Stenosis

Neurogenic claudication is a classical symptom of spinal stenosis (lumbar canal stenosis) where the spinal canal (of the lower back) is narrowed causing compression of the nerves. The pain, typically diffuse and radiating down the thighs or legs, is aggravated with walking and prolonged standing. It may be associated with numbness and is relieved with bending over, sitting and lying on one's back (as opposed to the front). Patients with neurogenic claudication tend to walk with the lower back flexed foward as this action opens up the narrowed spinal canal thus relieving the degree of compression. One can imagine why patients with spinal stenosis may not get leg pain on on walking up a slope as he would be flexed foward. Walking dowhill however exacerbates the leg symptoms.

A similar claudicating pain, called vascular claudication or intermittent claudication is due to narrowing of the blood vessels that supply the leg. In vascular claudication, the pain occurs with walking fixed distances and is more rapidly relieved with rest including standing still. Differentiation of these 2 types of leg pain is crucial as the pathology and hence management is entirely different.

Cervical disc disease and spondylosis. What are the symptoms?

Degenerative Cervical Spine

Degenerative problems of the upper neck, while not as common as lower back problems, still contributes to a fair amount of disability. As a whole, they present with symptoms of:

1. Neck pain
2. Radiating arm pain
3. Weakness and numbness of the hands and legs

Cervical Spondylotic Myelopathy.

Degeneration, 'wear and tear' of the cervical spine leads to narrowing of the canal in the neck. In the lower back, canal stenosis compresses only on nerves and not the spinal cord as the latter is absent at that level. However, in the neck, narrowing of the cervical canal can lead to spinal cord compression. Cervical myelopathy develops where there is weakness of the extremeties and spasticity of the lower limbs (stiffness). The patient walks with a 'spastic' type gait. Sensory disturbances are minimal while the reflexes are brisks. There may be associated urinary sphincter symptoms.

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