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Back pain is very common, affecting most people at some time in their life. In most people it is short lived but in some the pain can last for longer periods of time. Most patients are able to manage their pain with painkillers. Other treatments that may be helpful include manipulation therapy such as physiotherapy, osteopathy or chiropractors. Acupuncture and TENS are sometimes useful. If these simple measures do not bring relief it is appropriate to consider surgical treatments. Your specialist will arrange an MRI to look for specific abnormalities which may be helped by surgery. If particular wear is seen within the facet joints then they may recommend an injection of steroid into the joints to help with your symptoms. If the discs appear to be the worn then they may recommend further investigations including discography to identify whether surgery such as spinal fusion may be of benefit.
Spinal fusion can be used to treat back pain associated with degenerative disc disease. If you have chronic back pain which has not responded to non-operative treatments then your specialist may discuss this with you. If only a single disc is worn on your MRI scan then removing that disc and fusing the spine may help with the pain. If multiple discs are affected then a procedure called discography may be used to help identify which disc is responsible for the pain.Spinal fusion for back pain improves the symptoms in between 50% to 90% of patients. When used to treat loosening or slippage of the vertebrae; (spondylolisthesis) fusing the spine has high success rates with 90% of patients noticing relief from their sciatic leg pains and over two thirds of patients noticing an improvement in their back pain.Various routes may be used to gain access to the affected area. Most commonly an incision is made in the middle of the lower back but sometimes an incision is made in the lower abdomen.Usually screws and rods are inserted to hold the vertebrae in position. Bone removed during the operation may be reinserted along with artificial bone in order to fuse the bones together. Sometimes the whole disc at the affected level is removed and small cages or spacers are inserted. Although most commonly used to treat conditions related to wear and tear (degenerative conditions) this procedure is also regularly used to treat fractures and tumours of the spine.The common risks of the procedure include infection and spinal fluid leakage. Major complications such as nerve injury and paralysis are very rare occurring in less than one in 200 cases.
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This is neurosurgery in children, and requires dedicated paediatric neurosurgeons with experience of operating on the developing nervous system working in close collaboration with paediatricians to achieve the best outcome for each child. The London Neurosurgery Partnership has assembled just such a group.
Although brain tumours are rare in childhood, they are now the commonest solid cancer seen in children in the UK. There are 300 new cases in the UK every year and thanks to ongoing research, advances in both survival and quality of life continue.
