All for Life
Back pain and recovery
Article by Dr Karunagaran
(Consultant Orthopedics, Spine Surgeon, Specialist in Joint Replacement & Sports Medicine)
- Back pain is common and often results from bad posture. How can we avoid this?
90% of back pain is non-structural (or) postural, associated with poor posture at work or home. The most common mistake is to sit with a bent posture for a long time. Repetitive bending forward and/or lifting heavy objects can also cause back pain. The best way to prevent back pain is to sit up straight in a chair with good back support to match the curvature of the spine. If you are sitting in a chair for more than an hour, you are strongly advised to stand up every 45 minutes to one hour and go for a walk or stretch yourself for 3- 5 minutes before sitting again. Avoid bending forward and lifting weight. If you are carrying heavy shopping bags, always ensure you distribute the weight evenly in both hands.
- Can abdominal and back exercises help to prevent back pain?
Prevention is always better than cure. Proper posture and regular back and abdominal muscle strengthening exercises will often help prevent back pain to a great extent. Other forms of exercise including aerobics, aqua gym or yoga are also beneficial. It is important to note that sufferers of back pain are advised to take great care when performing strenuous physical activity. One should consult a spine surgeon who will guide you regarding the most appropriate exercises for your particular back problem. It is good practice for everyone to perform back exercises, more so for people who sit at a work-station for a prolonged time, and/or people who use heavy machinery in the workplace.
- What are the consequences of bad posture in the long run?
Bad posture in the long term will almost certainly cause back pain. The current working environment usually means that we often sit and work in one position for a long time. Using modern day technology notably laptops, tablets and smartphones, whilst sitting in the wrong position or lying down can have long-term health consequences on the spine. Sitting on the sofa with a hunched back, the so-called ‘couch-potato’ position can also cause back pain. At first bad posture causes non-structural back pain or sprain, but in the long run it may lead to disc dehydration, disc prolapse, and arthritis of the joints in the spine. This will eventually lead to severe and persistent back pain with nerve problems.
- Under what circumstances does back pain require surgery?
90% of back pain will get better with-in 2 – 4 weeks, following prescribed medications, physiotherapy and exercises, and most cases are non-structural. 10% of patients may have a severe back problem requiring some kind of intervention in one or more of the following situations:
- If the back pain is consistently very severe and persistent, even after use of medications and physiotherapy for a considerable period.
- If the pain is severe enough to affect your daily routine.
- If there is radiating pain to one or both legs with numbness and/or weakness.
- If there is an inability to sit, stand or walk for a reasonable period.
- If there is a disturbance in your usual bowel and/or bladder habits.
- What are the types of interventions that are practiced for disc problems?
Types of spine interventions:-
- Epidural injection – This procedure can be useful in individuals with early disc problem not affecting the nerves. The combination of steroid plus anaesthetic medication can help to decrease the pain.
- Micro-discectomy – This surgery is selective for young individuals with significant disc prolapse compressing the nerve. The remaining disc should be normal and without any arthritis of joints of the spine. Micro-discectomy is done by removing the portion of the disc that has prolapsed and pressing against the nerve. Sometimes these patients can have a recurrent disc prolapse from the remaining disc.
- Laminectomy – The procedure involves removing the bone coverage and the thickened ligament which presses against the spinal cord and nerves. The disc is not removed; more room is made for the cord and nerves. It is done for elderly patients with a stable spine and a reduced life expectancy. Laminectomy can also be useful in a severely compressed spine needing surgery, where the patient is not anesthetically fit to undergo a long surgery.
- PLIF – Posterior lumbar interbody fusion and TLIF – Transforminal Lumbar interbody fusion: These surgical procedures involve both decompression of the spine and also address the stability of the spine by placing pedicle screws connected by rods. The disc is removed completely and the space is filled with a spacer device and bone graft. The procedure will ensure that the spine is not only decompressed but also stabilised.
- Other interventions like endoscopic spine surgery, minimally invasive spine surgery and Robot-assisted spine surgery essentially give the same result as more traditional procedures, but the surgeries are done with the latest equipments.
- Is surgery helpful for disc problem, and what are the post-operative results?
Yes, surgery really does work wonders for the quality of life of the patient. If patients are selected carefully, and the appropriate procedure is performed at the right time, as per the condition demands and by a specialized spine surgeon, 99% of cases can stand and walk the next day following surgery, and even go home after 3 days. Successful surgery, carried out at the right time, makes a huge difference to the quality of life of both patients and close family members, and it can even avert paralysis.
- What are the risks or complications associated with such surgical procedures?
There are predictable and unpredictable risks in all types of surgeries. The associated risk of any possible infection can be avoided by following standard sterile precautionary measures and clean operating room practices. Antibiotics also help to prevent infection. The patient’s age and other medical illness related factors can be well controlled following advice of experts.
The most feared complication amongst the public is neurological paralysis following surgery, and it is the main deterrent that prevents many patients from having a timely intervention.
Sometimes patients end up with paralysis prior to even seeing a specialist since their fear of paralysis is such that they want to avoid surgery altogether. It is extremely important to consult a spine surgeon as early as possible, in order to avoid any such complications. Please be assured that if surgery is done by a well-trained, professional and competent spine surgeon, paralysis can be avoided and almost all of our patients go home walking.
- How much time is needed before the patient can resume daily activities?
Normally the patient can walk as from the first day after surgery. They can go to the toilet unaided and eat independently. It is strongly advised for the patient not to bend forward nor lift weights for 6 weeks to 3 months, depending on the type of surgery they have undergone. Generally, one can resume light work after 6 weeks. They can drive for short distances as from 6 weeks post-surgery. After 3 months they can resume their normal activities, such as working and driving. It is always advisable to continue good back care practices and exercises to prevent disc problems in other parts of the spine in the future.