CONSIDERING SPINAL SURGERY?
SPINE & DISC PAIN OR INJURY
CONSIDERING SPINAL SURGERY?
Then consider this…..
Your spine is made up of a number of different structures:
- Bones (vertebrae)
- Intevertebral Discs (which act as shock absorbers in between the vertebrae)
- Facet joints (where each vertebrae connects with its neighbour, and they run in pairs down the sides of the spine)
- Spinal cord and exiting nerves
- Blood vessels
- Other connective tissues
Any of these structures can be injured or damaged, which may cause pain. However research on pain free people often shows damage on scans that doesn’t correlate with pain. Disc protrusions are very common in pain free individuals. (Brinjikji, W. et al. 2015)
Discs may be described as slipped, bulging, prolapsed or degenerative. Facet Joints; arthritic or degenerative. Sciatica is pain felt down the back/side of the leg, referred from a “pinched nerve” in the low back.
What is important is not how your spine looks on scans, but how it moves, and how well you can things that you want to do.
The latest research is showing that exercise-based “pre hab” with a Physiotherapist can determine whether a specific exercise program can actually have a better outcome.
IS SPINAL SURGERY THE ANSWER?
There are a variety of spinal surgeries but no guarantee that it will fix symptoms and improve function. There are also risks of infection, nerve damage, bleeding and loss of life. Therefore, it is important that surgical candidates are chosen carefully and have exhausted conservative methods first.
Types of Surgery
Discectomy and Microdiscectomy involves partial/full removal of the herniated disc that may be pressing on a nerve root or the spinal cord. Removal of the disc should relieve pressure on the nerves and eliminate the pain, however up to 65% of these reinjure within 3 yrs (Suri 2017)
A Spinal Fusion joins two or more vertebrae into one single structure using bone grafts, artificial rods and screws or plates. This is designed to stop movement, however as the spine was designed to move, results of fusion are generally quite poor (Atkinson 2016).
Laminectomy, also known as decompression surgery, involves removing a portion of bone to create more space and relieve pressure on the spinal cord or nerves. If the disc is the problem, it will still be present and may now just herniate into the extra space.
- A major review of the research by van Tulder et al (2006) found there is no scientific evidence to support spinal surgery.
- Various spinal injections showed very poor effect and cannot be recommended. The clinical recommendations to come out of the review were that cognitive intervention (psychology) combined with select exercises (physiotherapy) are most beneficial for chronic back pain.
- Strong research shows there are often certain movement patterns and directions that will either aggravate or relieve your problem. Directional preference exercises will produce better outcomes for pain and function than joint mobilisation alone. (Dunsford et. al. 2011).
Clinical Pilates and Back Pain
DMA Clinical Pilates exercises are tailored to an individual’s specific preferred direction (directional bias) provide immediate improvements in performance and dynamic postural stability (Tulloch et al 2012). Once these patterns are identified, they can be used to develop a Clinical Pilates based exercise program to help you with your problem without resorting to unnecessary surgery.
DMA Clinical Pilates and Physiotherapy and affiliated Clinical Pilates Network Physiotherapists are leaders in Clinical Pilates rehab and Prehab treatment programs.