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Back Pain
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Dr Bhisham Singh is a Sydney-based Orthopaedic Surgeon with a special interest in spine surgery. He is experienced in treating cervical, thoracic and lumbar spine issues. -
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Dr Bhishampal Singh
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Dr Bhisham Singh is an orthopaedic surgeon with a special interest in spine surgery. He is experienced in treating cervical, thoracic and lumbar spine issues. … View Profile
Why do we get back pain?
80% of the adult population will develop a significant episode of back pain sometime during their life. Fortunately, most of these will spontaneously resolve. However, approximately 10% to 20% will develop into significant chronic and/or recurrent episodes of back pain.
Wear and tear conditions are some of the most common causes. Muscle pulls and tears are short-lived. Weak muscles, poor flexibility and poor posture all aggravate the underlying conditions and worsen symptoms. Uncommon causes of pain include trauma, infection, tumours and fractures.
What is a herniated disc? How is it different from degenerative disc disease (DDD)?A disc is the shock absorber between adjacent vertebrae. When it deteriorates it may "slip" or "herniate" and press on the spinal cord or the nerve roots.
Bulging discs are extremely common. For example, if one hundred 40-year old patients underwent MRIs of the cervical spine, approximately 40% of them would show some degenerative disc changes. While these changes are technically abnormal, they are extremely common and occur as a consequence of the normal ageing process.
Degenerative Disc Disease: With age, stress and strain, the disc can become arthritic and “wear out.” In this situation, these discs are termed degenerative. The first line of treatment is conservative. The aim is to strengthen and stabilize the spine, and how to avoid stresses
What is spinal stenosis?In this condition, the spinal canal is narrowed to a degree where the spinal cord or nerve roots may be compromised. These symptoms are more diffuse than those associated with disc herniations and are aggravated by standing and walking.
What are the different non-surgical options for spine-related conditions?• Acupuncture or massage, 2 alternative treatment options that some patients have found helpful.
• Easy exercises to strengthen the muscles around your spine so that it's better supported—that could help reduce the pain eg swimming.
• Over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs) that will help reduce the inflammation and pain.
• physical therapy.
• Your doctor may use an epidural steroid injection into the area around your spinal cord and nerve roots. An injection puts anti-inflammatory medicine into the epidural space to decrease the inflammation of the nerve roots.
How do you know if you need a surgery?• If pain is progressive, severe, and disabling
• Before nerve damage becomes permanent.
• Pressure on the spinal cord can be very dangerous and may require surgery.
• If the spinal cord is at risk of being damaged.
• If there is significant deformity
What exactly is done during spine surgery?There are two types of surgery: decompressing the nerves if the pain is related to their compression; and stabilizing the spine, when it’s required, which consists of placing hardware into bony elements of the spine to keep them stable and to achieve healing. Our surgeries are often a combination of those two categories.
What is scoliosis and deformity surgery?
When the body is viewed from behind, a normal spine appears straight. However, when a spine with a scoliosis is viewed from behind, a lateral, or side-to-side, curvature may be apparent. This gives the appearance of leaning to one side. Increased round back in the chest area is called hyperkyphosis, while increased swayback is termed hyperlordosis.
Scoliosis is a condition that causes the spine to bend in a C-shaped curve or S-shaped curve. About 80 percent of cases are adolescent idiopathic scoliosis (AIS), which means of unknown cause. AIS affects 2-3 percent of children. It's most common in girls age 10 and older, yet boys get AIS, as well.
Surgical treatment is reserved for curves which are generally greater than 50 degrees. The goals of surgical treatment are to obtain curve correction and to prevent curve progression by fusing the spine. This is generally achieved by placing metal implants onto the spine that is then attached to rods, which correct the spine curvature and hold it in the corrected position until fusion, or knitting of the spine elements together.
