Always first the person, with correct diagnosis, appropriate treatment, emphasizing the Minimally Invasive Techniques
Disc Degeneration – Disc Hernia – Spinal Stenosis
Yes. Epidemiological studies have shown that by the age of 20, 50% of the population has experienced low back pain. The corresponding percentage reaches 80% at the age of 60 and is second in appearance after the common cold.
In most cases, the diagnosis of “degenerative disease of the spine” is heard by experts. More specific diagnoses are compression fractures of the spine (eg in the case of osteoporosis), slippage – in cases of younger and older ages -, tumors, ankylosing spondylitis and inflammation. About 2% are diagnosed with coexisting symptoms from the sciatic nerve where it reflects on the corresponding leg.
Lumbar Discoplasty
Endoscopic Discectomy
Lumbar Microdiscectomy
Disk Replacement
Minimal Invasive Spine Ligation
Backache
It is the pain in the lumbar region, basically in its lower part. In other reasons, back pain is called lower back pain.
This is a common problem, as studies have shown that by the age of 20 about 50% of the population has experienced low back pain.
The corresponding percentage reaches 80% at the age of 60 and is second in appearance after the common cold.
A percentage of 2% is diagnosed with coexisting symptoms from the sciatic nerve, thus reflecting the pain in the leg (Sciatica).
The causes of back pain are mostly the general degenerative diseases of the intervertebral disc, which are referred to by experts as “degenerative disease of the spine”.
More specific diagnoses are compression fractures of the spine (eg in the case of osteoporosis), slippage – in cases of younger and older ages -, tumors, ankylosing spondylitis and inflammation.
Nevertheless, intervertebral disc herniation is the most common cause of back pain-sciatica.
Symptoms are caused when under various chronic conditions the outer hard sheath of the disc (called the fibrous ring) “breaks”, causing the inner soft contents (gel nucleus) to “slide” backwards, compressing the spinal cord or the nerve roots, leading to the symptomatology we analyzed.
The initial treatment of back pain includes some general principles, such as learning the correct movement pattern and feedback, so that the patient learns through them the correct posture of his body so as not to burden his waist.
In addition, emphasis is placed on special exercises that involve the waist, such as strengthening the torso (abdomen-back), but also stretching exercises of the muscles of the back and hind thighs.
The initial treatment approach finally includes medication with Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), as well as the application of cold and wet compresses.
However, if the pain persists and / or worsens, as well as in the case of paralytic conditions or anemia (ie temporary loss of ability to move one or both legs or numbness in the legs), but also in disorders of urination and defecation (hippuric syndrome), surgical treatment is unreservedly indicated, with the best technique being endoscopic perforated discectomy, under local anesthesia and sedation.
This achieves complete removal of the hernia with minimal complications and optimal postoperative condition of the patient.
Is low back pain a common problem?
Yes. Epidemiological studies have shown that by the age of 20, 50% of the population has experienced low back pain. The corresponding percentage reaches 80% at the age of 60 and is second in appearance after the common cold.
What are the most common causes of low back pain?
In most cases, studies have shown that the most common diagnosis is essentially “non-diagnosis.”
In most cases, the diagnosis of “degenerative disease of the spine” is heard by experts.
More specific diagnoses are compression fractures of the spine (eg in the case of osteoporosis), slippage – in cases of younger and older ages -, tumors, ankylosing spondylitis and inflammation.
About 2% are diagnosed with coexisting symptoms from the sciatic nerve where it reflects on the corresponding leg.
What is the natural course of lumbar pain?
In most cases the pain is self-limiting.
The problem nevertheless remains, and due to the incorrect initial diagnosis but also for other reasons, the symptoms recur.
The timing of relapse is unknown and is often part of the course of the disease.
Is there a way to prevent relapses?
In order to do this, the doctor must first make a correct diagnosis.
General principles, regardless of the underlying pathology, are the learning of a correct motor pattern and the feedback, so that through them the patient learns the correct posture so as not to burden his waist.
Also special exercises that concern the waist such as strengthening the torso area (abdominal-dorsal), exercises for stretching the muscles of the back and hind thighs.
In addition, applying cold and warm compresses can help. Anti-inflammatory therapy (NSAIDS) is recommended as medication.
Is there really a correlation between low back pain and imaging findings?
As mentioned before, many abnormalities can contribute to the pathology of low back pain.
Nevertheless, in large studies that have been done, there is no statistically significant correlation of the imaging findings (plain X-rays) with the underlying pathology and this is often misleading for the doctor and for the patient himself.
It is no coincidence that the expression arthritis or degeneration of the spine is often heard without knowing the exact underlying cause.
The reality is that beyond the general characterization of degenerative spine disease it is quite difficult to speak with certainty about the exact cause.
Are there more detailed tests that can help with the diagnosis?
Apart from the classic examinations such as CT and MRI, there are other examinations such as bone scintigraphy (SPECT) as well as the minimally invasive method of discography.
The latter and having personal experience, becomes a routine in large Spine Clinics abroad such as Guy΄s and St. Thomas Hospital and Kings College London. Fans of the method claim that in addition to the help it offers in the diagnosis of disc disease, it is also useful in deciding the type of surgical treatment, especially when there is integrity of the posterior vertebral elements.
In all these cases, Khai Lam, one of the greatest Spine surgeons, follows a method of treatment that is dictated by the results of the discography.
Given all this, what is the most useful tool in diagnosing the underlying cause of low back pain?
Believe it or not, the right history and the right clinical examination are what play the most important role, despite the new, very expensive technology.
The latter becomes even more important in countries like ours, where money for hospitalization and care is declining.
How do you conservatively treat a patient with acute low back pain?
Entering the Clinic such a patient, a detailed history is necessary.
Analgesic pills, anti-inflammatory, muscle relaxants, posture-lifting learning, proper gait learning and personalized physiotherapy exercises have a place.
In the latter case there is a dichotomy even about the duration of the start of operations.
Others claim that the position of any kind of manipulation-physiotherapy is after the first 3 weeks while others suggest it even earlier.
Perhaps the truth lies in the type of underlying pathology and not in the exact time of onset of symptoms.
Also part of the conservative treatment are the radioscopically directed injections (in the epidural space as well as in the posterior spine joints) performed by specialized Spine Surgeons and Anesthesiologists.
Does lying in bed help?
In the past, not knowing much, lying down and resting in bed were recommended by many.
Today, and having a good knowledge of the world literature, multicenter studies have shown that patients have the best results when they follow a normal activity and not when they lie in bed.
So what should be recommended is to follow a moderate and relaxed activity and avoid those movements that aggravate the pain.
Is there anything different about surgery today?
We must first conclude that the patient needs surgery and that there will be beneficial results from it.
So if we decide that our patient will benefit from a possible surgery then new techniques make this easier for the patient.
In Minimally Invasive Methods such as microdiscectomy (using or without a surgical microscope), MISS TLIF, PLIF and XLIF techniques, complications such as intraoperative blood loss are minimal and the patient’s hospitalization is 1 to 2 days.
Is this surgery performed by an orthopedic or neurosurgeon?
In countries such as England, Switzerland, America and others, in short in countries that theoretically have a good level of education of their doctors, such a question would not be appropriate.
In all these countries there is officially a Spine Surgeon, who can be an Orthopedic Surgeon or a Neurosurgeon and does exactly the same job.