What spine injuries require surgery?

Spinal cord injuries may result from damage to the vertebrae, ligaments or disks of the spinal column or to the spinal cord itself. A traumatic spinal cord injury may stem from a sudden, traumatic blow to your spine that fractures, dislocates, crushes or compresses one or more of your vertebrae.

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Dr. Ramesh Sahjpaul, MD, MSc, FRCSC, Neurosurgeon, discusses what spinal conditions may be helped by surgery.

Quiz: Do You Understand Lumbar Spine Surgery?

Test your knowledge by answering the following questions:

Questions
True
False
1

Lumbar back pain is the most common type of back pain.

Explanation:
Back pain can be cervical (neck pain), thoracic (middle back pain), lumbar (lower back pain) or tailbone or sacral (coccydynia). Lumbar back pain is the most common type.
2

Lumbar back pain symptoms include shooting or stabbing pain.

Explanation:
Lumbar back pain symptoms include shooting or stabbing pain, pain that radiates down the leg, muscle aches, pain that worsens when you walk, lift something, bend or stand and/or improves when you recline.
3

Lumbar back surgery may be used to treat a slipped disc and sciatica.

Explanation:
Lumbar back surgery may be used to treat a slipped disc and sciatica, which occurs when a spinal disc presses down on a nerve; spinal stenosis, a narrowing of a section of the spinal column that puts pressure on nerves and spinal injuries including a fracture.
4

If you and your orthopedic surgeon decide that lumbar decompression surgery is right for you, he or she will perform all of these procedures.

Explanation:
If you and your orthopedic surgeon decide that lumbar decompression surgery is right for you, he or she will perform one or more of these procedures: discectomy to remove part of a damaged disc to relieve pressure on a nerve; laminectomy to remove bone from one of your vertebrae to relieve pressure on a nerve and/or spinal fusion to join together two or more vertebrae with a section of bone to strengthen the spine.
5

Following your lumbar spine surgery, you’ll leave the hospital within five to ten days.

Explanation:
Following your lumbar spine surgery, you’ll leave the hospital within one to four days. You’ll start walking in the hospital, and will be able to return to work after four to six weeks with some restrictions.
(Answer all questions to activate)

Dr. Ramesh Sahjpaul, MD, MSc, FRCSC, Neurosurgeon, discusses post spinal surgery recovery.

Post Spinal Surgery Recovery

Proper care of the back after surgery is crucial to both short-term and long-term success.

A good surgical result can be ruined by improper care of your back after surgery, and the role of physiotherapy is crucial. Well, typically patients will experience significant improvement in their symptoms immediately after the surgery.

However, it’s not uncommon to experience some degree of ongoing symptoms especially some incisional pain, or sometimes some nerve pain. It’s usually fairly mild and can be managed conservatively or with over-the-counter medications.

It often requires some reassurance, but the important thing is that the relief from the surgery is fairly significant and fairly quick. However, that does require some compliance from patients post-operatively as far as doing some physiotherapy, some stretching exercises that are provided to them.

Physiotherapy really becomes important at approximately six weeks after surgery, and at that time the patient then learns proper lifting techniques, avoidance of prolonged sitting because we know that sitting tends to aggravate lumbar pain.

And there may be some situations in which individuals may have to make some changes in their workplace for ergonomic improvements to try to prevent further back pain episodes or further recurrent disc herniations.

Even though disc surgery is very successful, it’s important to recognize that there is a small but definite chance of running into problems down the road. So patients can sometimes experience recurrent disc herniation and may require further treatment sometimes surgical.

However, with appropriate physiotherapy, back care, back exercises, strengthening exercises, especially things such as core strength done with a guidance of appropriate individuals, the risk of running into problems in the future can be kept at an absolute minimum.

Presenter: Dr. Ramesh Sahjpaul, Neurosurgeon, Vancouver, BC

Local Practitioners: Neurosurgeon

MRI scans for lumbar spine injuries and pain related conditions

The injuries that we see in the lumbar spine include ligamentous injuries, and most commonly herniations of the discs.

That can be seen in many different sports and just in everyday life as well. I would say that the most common sports that would be involved would include racquet sports, any sort of lifting sport and golfing with twisting and just carrying your sport equipment maybe would be a common way to get a lumbar spine herniation.

The MRI is the best way to look at disc herniations and to see the effect of the herniation on the nerve roots. We can see disc herniations with CT as well but we can’t identify the exact relationship to the nerve roots, or to the spinal cord higher up in the spine.

So there is much greater detail with MRI. This is an example of a lumbar spine MRI on an ahtlete who plays hockey and there are the normal disc spaces within the spine.

At this level the disc space is lost and we can see disc material extending into the spinal canal. This is a very large disc herniation that is pressing on the nerve roots within the spinal canal. The CT scan demonstrates the bones nicely and is very helpful if we’re concerned of a spine fracture.

What we don’t see as well on CT are the soft tissues, particularly in the lower lumbar spine there can be quite a bit of artifact and the detail within the disc herniation is not as well seen.

In particular we don’t see the impingement or compression of the nerve roots with CT, nor do we see the spinal cord with CT, so MRI gives us much better resolution.

The other benefit of MRI, we can view the anatomy in multiple planes. This is an axial image of the same area the disc herniation can be seen here. It’s a very large disc herniation. What MRI can do for us is identify the nerve roots which are not seen specifically with CT. We can identify the degree of compression of the nerve roots.

The detail shown with MRI helps the surgeon decide whether surgery is needed for disc herniation or just if conservative management is sufficient. If you have any questions about lumbar spine MRI contact your family doctor or an imaging center. Local Physiotherapist

Presenter: Dr. Audrey Spielmann, Radiologist, Vancouver, BC

Local Practitioners: Radiologist

Audrey Spielmann, MD FRCP(C), discusses lumbar spine MRI scans

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