Tests to Diagnose Spinal Problems
Most patients with spinal problems present with pain as a significant problem in their history. Other spinal problems relate to a significant change in shape of the spinal column - like a curve in the back, called 'scoliosis'. Scoliosis management is a very large part of Dr Labrom's practice and in many cases, spinal surgery can be avoided.
- Clinical History and Examination
This remains a very important part of work up for all spinal problems. Usually, this is enough to have a very good understanding of what is going wrong with the patients back or neck.
- X-rays
These are very useful and simple. They provide a lot of information, especially with regards scoliosis conditions.
- CT (or CAT) scan
These images help provide a more detailed picture of the persons spinal anatomy. Bony detail is well defined on CT scan.
- MRI (Magnetic Resonance Imaging) scan
This scan uses magnetic radiation and it provides very good detail of soft tissue structures - especially nerves and discs. It also shows any unusual conditions such as tumours and infection in a more exact way.
Treatment Options
Many problems in the spinal column relate to pain that either comes from the degenerate area in the lower back or neck. There is often a very nasty degree of referred 'sciatica' experienced down the persons leg (or arm if there is a cervical spine problem).
Most often, such acute pains settle within 6 weeks of the onset. Initially, the pain may follow a twisting or lifting type manouvre. Sometimes, there is no obvious cause for the onset of back pain. After a day or two of rest and simple pain killers and anti-inflammatory tablets, the pain settles enough for the person to move around and they can usually return to work or active pursuits. Quite often there needs to be a more prolonged symptomatic pain management program and then a more regular preventative physical therapy daily routine that helps avoid the onset of pain again.
Treatment options include:
- Medication
Usually over the counter pain killers is enough, though sometimes a prescription for more powerful drugs is necessary. Paracetamol is very safe and can be taken regularly for the first few days and then for longer periods of time, often in combination with anti-inflammatory tablets. Caution must be taken to avoid gastric upset with anti-inflammatory tablets and should be taken with caution by people with cardiac disease.
- Heat and Cold Packs
This helps with muscle spasm and may offer comfort
- Physiotherapy and Exercise
The main aim of all physical therapies for spinal pathologies is to add more muscular control and support to the spinal region that is 'unstable' and causing pain. The abdominal muscles and lower back muscles help control the lumbar vertebrae when the degenerating discs cause back ache.
- Chiropractic Treatment, Acupuncture and Osteopathic Treatment
These options may have been tried before a visit to a spinal surgeon. They can offer good relief.
- Lumbar Corsets
These can offer good symptomatic relief for low back pain and can be useful when the patient needs support when performing physically demanding tasks at work and at home. Time should be spent out of the corset for as long as possible so the normal lower back and abdominal muscles can maintain their strength.
- Facet Joint Injections
These injections are usually performed after referral by Dr Labrom to a specialist radiologist. The technique is performed by using CT scan guidance to allow exact delivery of a small dose of steroid (cortisone like drug) and local anaesthetic into the degenerate facet joints in either the lower back or neck. The effect is often immediate. The local anaesthetic wears off after about 6 hours and the steroid works after a few days to reduce degenerate inflammation around the facet joint.
- Nerve Root Injection
This technique is similar to the above facet joint injections, yet the specialist radiologist performing the technique under CT guidance injects the local anaesthetic and steroid onto the nerve root that is inflamed. This often occurs when a disc has herniated after rupturing, and there is often a very nasty degree of referred 'sciatica' experienced down the person's leg (or arm if there is a cervical disc).
- Pain Clinics and Rehabilitation Programs
These are available to patients who have either complex pain syndromes in the acute phase or more chronic pain conditions after all of the above mentioned modalities have failed. Often psychological and educational aspects are covered in such programs and clinics. The refinement and simplification of analgesia (pain killer) regimes is also very important.
- Surgical Operations
Fortunately, this option is only required by a minority of patients with spinal problems. Surgery may be required if the above mentioned non-surgical methods have been tried and have not adequately controlled the pain or 'instability' or the patient has a more unusual spinal condition such as a deformity (scoliosis/kyphosis), infection, or spinal tumour.
Dr Labrom will carefully explain the reasons why such a surgery may be required. In the same way, a careful explanation of the risks involved with surgery will be offered to such patients.
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