Frequently Asked Questions
What proportion of the population is affected by back or neck pain?
Back pain is common. Most people will experience back or neck pain at some time in their life, and 80% of the population will experience an episode of pain at some stage of sufficient severity to prevent them from performing their normal work or social activities.
How long should it take for back or neck pain to settle?
Symptoms of back and neck pain will usually settle, or at least improve significantly, within seven to ten days. In 90% of cases pain will resolve within six to twelve weeks.
Symptoms of sciatica (leg pain) or brachialgia (arm pain) will also usually settle within this period.
Should you rest in bed until back pain resolves?
It is now well accepted that prolonged bed rest for back pain actually delays recovery. Up to three days rest is acceptable but the sooner individuals with back pain return to normal activities, the sooner symptoms resolve.
The more you rest the weaker the muscles that support the spine become. As this occurs, increased load is placed on the structures in your back that are responsible for discomfort. If muscle tone and fitness can be maintained through appropriate modified activities symptoms will usually resolve more rapidly.
Analgesics, anti-inflammatories and the assistance of an appropriately qualified therapist may assist this process.
What should you do if pain does not settle?
If pain does not settle or at least improve following rest (2-3 days), medication and modification of activities you should consult your local doctor.
X-rays are not usually indicated in the first instance unless there has been a history of trauma where bony injury is suspected.
A CT scan involves a relatively high dose of radiation and is not indicated unless there are symptoms of sciatica, and only if initial therapeutic modalities have failed and/or there is evidence of neurological involvement.
MRI does not incur a radiation penalty (i.e. there is no ionizing radiation associated with MRI) and so is a safe investigation, and is becoming more readily available. However, like CT, investigation by MRI is only indicated if there is a suggestion of sinister underlying pathology or if interventional treatment is being contemplated.
Who should you see about back or neck pain?
In the first instance you should consult your local doctor who will advise you regarding treatment and direct you to an appropriately qualified therapist if this is considered necessary.
In most cases you local doctor will be able to deal with the problem. Where symptoms do not resolve as expected, where there is evidence of neurological compromise or if symptoms are severe from the outset specialist review may be indicated.
When is surgery indicated in the treatment of back and neck pain?
Surgery, to treat any condition is the last resort, and spinal surgery is not different.
Of those who develop back or neck pain 90% will resolve within six to twelve weeks. About 10% will ultimately be reviewed by a specialist and of these about 10% will end up having surgery.
Thus, only about 1% of individuals who develop back or neck pain, sciatica or brachialgia ultimately undergo surgical intervention.
The only absolute indication for surgery is progressive and/or significant neurological compromise due to neural compression.
Surgery may also be indicated to treat or correct a spinal deformity and to stabilise the spine after trauma resulting in a spinal fracture and instability.
Surgery may also be undertaken to treat pain due to degenerative disease, but usually only if the degeneration is localised and the origin of the pain has been identified. However the results of surgery in this circumstance can not be guaranteed.
Should you see a "Neurosurgeon" or an "Orthopaedic" surgeon about your back or neck pain?
Spinal surgery has become a specialised area of surgery, and in South Australia, fellowship standard training in spinal surgery involves input from both orthopaedic and neurosurgical fields. Neurosurgeons certainly deal with intracranial pathology, but with regard to spinal pathology we have moved away from distinguishing between spinal surgeons of orthopaedic or neurosurgical backgrounds and simply refer to ourselves as Spinal Surgeons. In that regard Adelaide has been at the forefront of neuro-orthopaedic fellowship training, and Adelaide Spine and Brain is the final realisation of that collaborative approach pioneered in South Australia. Whilst spinal surgery is a highly specialised sub-specialty, we all have even more specialised expertise in particular areas of spinal management. Adelaide Spine and Brain specialists promote a collaborative approach with exchange of ideas to provide maximum benefit to the patient.
If surgery is indicated can success be guaranteed?
Unfortunately, there is no surgical procedure of any sort that can be guaranteed to be successful. Similarly this applies to spinal surgery, but your surgeon will be pleased to provide a prognosis relevant to your condition.
Can microsurgery be used to treat back or neck pain?
Microsurgical techniques and magnification are regularly utilised to improve visualisation of neural structures and other anatomical features during surgery, but do not have any magical powers per se.
Is keyhole surgery appropriate in spinal surgery?
Wherever possible, minimally invasive techniques are employed in the management of any surgical condition, and also in regard to spinal conditions. Keyhole surgery is not new. It has been around since the 1980’s, and there have been a number of comparative studies that have failed to show advantage of keyhole surgery over open conventional surgery. Nevertheless, it is emerging that minimally invasive techniques do have a role in the treatment of percutaneous stabilisation of the spine for fractures or malignancy. Every individual case must be assessed on its merits, and you will be advised if your surgeon perceives that there is an advantage in a minimally invasive approach.
Intraoperative navigation certainly has a role, particularly in the treatment of intracranial pathology, but there are significant pitfalls with regard to spinal surgery. Similarly, whilst robotic guidance has captured the imagination of the public through media releases, at the present time there is no proven advantage in the use of the technique, and indeed there are many significant disadvantages.
Can a diseased or worn out disc be replaced?
There are a plethora of artificial disc replacement devices for both the cervical and lumbar spine available on the market at the present time. Indeed, members of Adelaide Spine and Brain have been involved in clinical trials on artificial disc replacement, but we ceased our involvement with the visco-elastic disc replacement of the lumbar spine in 1999 owing to structural complications with the device. Since then there have been many new devices on the market, and whilst on the face of it there is support in the literature for the use of these devices, this is a very controversial area and opinion is divided. This is a subject that your surgeon would be pleased to discuss with you more fully at the time of your consultation, but it is fair to say that at the present time there are serious reservations regarding the utility of these devices over more traditional approaches.