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?
CONSIDERING SPINAL SURGERY?
Then consider this…..Your spine is made up of a number of different structures including vertebrae, discs, the facet joints, the spinal cord and exiting nerves, ligaments, muscles, blood vessels, and other connective tissues. Any of these structures can be injured or damaged, however it doesn’t always indicate pain. 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. 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) 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. 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 SurgeryDiscectomy and Microdiscectomy involves removal of herniated disc material that may be pressing on a nerve root or the spinal cord. While removal of the offending material should relieve pressure on the nerves and eliminate the pain, 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 motion, 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 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).