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Procedures

Lumbar microdiscectomy

Lumbar microdiscectomy is a procedure that refers to the removal of part of the lumbar spinal disc that compresses the nerve roots. In some cases the whole disc needs to be removed. Typically this is done using a surgical microscope. Surgery requires a small incision on your or the back (2-4cm), and is carried out under a General anaesthetic and usually involves a 1-2 stay in hospital.

 

Spinal decompression/ fusion

Spinal decompression surgery  refers to the removal of parts of the spine that cause compression such as bone, bonny spurs, overgrown ligaments, cysts etc. Terms such  as laminectomy, hemilaminectomy, partial hemilaminectomy are often used and refer to the removal of part of the vertebrae called lamina from an incision on your back. This can be performed on any part of the spine but more commonly on the  lumbar spine. On cervical spine decompression is performed in vast majority from the front and involves removal of the whole disc with overgrown bone. Removed disc is than replaced with artificial cage and bone like material and sometimes reinforced with plate and screws. This will cause bone fusion between affected vertebrae. In some cases fusion is also necessary in the lumbar spine mostly if there is instability due to spondylolisthesis.

http://www.nhs.uk/conditions/lumbardecompressivesurgery/Pages/Whatisitpage.aspx

 Cervical spine decompression is performed in the vast majority of patients from the front and involves removal of the whole disc with overgrown bone. Removed disc is than replaced with an artificial cage and bone like material and sometimes reinforced with plate and screws. This will cause bone fusion between affected vertebrae.

http://www.nhs.uk/Conditions/Cervical-spondylosis/Pages/Treatment.aspx

 

Nerve root injection

A nerve root injection is an injection of local anaesthetic and steroid (anti-inflammatory) medication around a nerve in the lower back as it leaves the spine under X-ray guidance. Your specialist thinks that the symptoms in your lower back and/or leg are due to irritation of a nerve by a damaged disc or bony spur. The aim of the injection is to establish if this nerve is the source of your symptoms and to relieve those symptoms by reducing inflammation around the nerve. The procedure is performed under X-ray or CT guidance by a specialist consultant.

Facet Joint injection

A facet joint injection may be done to help diagnose the facet joints as the source of the patient’s pain, as well as to provide pain relief.

Facet joints are pairs of small joints in between the vertebrae in the back of the spine. These joints have opposing surfaces of cartilage, which limits friction between the bones. The joint is surrounded by a capsule filled with a small amount of synovial fluid. The synovial fluid acts as an additional lubricant to reduce friction between bones that rub together.

Healthy facet joints support the spine while also allowing a wide range of twisting and bending motion. These joints may become inflamed and painful due to a variety of conditions, such as osteoarthritis, degenerated discs, spinal stenosis, or from a trauma such as a car accident. A lumbar facet joint injection is an injection of local anaesthetic and steroid (anti-inflammatory) medication inside or around a facet joint in the lower back under X-ray or CT guidance. The aim of the injection is to establish if this facet joint is the source of your symptoms and to relieve those symptoms by reducing inflammation around the joint.

Spinal cord stimulation for intractable back and leg pain

Spinal cord stimulator (SCS) is a well-established pain treatment. Usually it is reserved for patients with chronic back and leg pain who failed other traditional treatment options.

It delivers electrical pulses to the spinal cord to mask or interrupt the transmission of abnormal pain signals to the brain. The pulses are sent by small electrodes placed near the spinal cord that connect to a compact battery-powered generator, which is implanted under the skin.

A common side effect of most SCS therapies is a tingling or buzzing sensation, known as paresthesia. For many patients, this tingling masks their pain, but it is always present.

Recently new type of SCS has been proven to provide more patients more relief in both back pain and leg pain compared with traditional SCS. Unlike traditional SCS, new therapy relieves pain without tingling or buzzing and it won’t give you an unexpected shock when you bend, twist, or engage in other daily activities.

http://www.nevro.com/English/Patients/Chronic-Pain-and-Treatments/default.aspx

Any risks or complications will be discussed in advance of your treatment with your consultant.