This is a general catch-all for spinal conditions that could present at any part of your spine.
Rheumatoid arthritis is an inflammatory disease which can affect almost all the joints of your body, including the neck and the back and long-term is debilitating and very painful.
Damage to the spine by rheumatoid arthritis leads to neck or back pain and sometimes to nerve or spinal cord compression. The symptoms of nerve compression are shooting pains with numbness, tingling and weakness your arms or legs. If your spinal cord is directly impacted you could also experience numbness in your hands, clumsiness of your fingers and unsteadiness in your legs.
Surgical management of such problems is a delicate one because of associated systemic disease and the powerful medications used to treat rheumatoid arthritis. Fusion procedures can be effective in relieving most symptoms, but the risks are higher than with the more common degenerative conditions.
Spinal fractures often result from major trauma. In emergency cases after major trauma, surgery is often necessary to stabilise the broken spine.
At Prince of Wales Hospital, we specialise in treatment of fractures that are associated with paralysis due to spinal cord injury. Unfortunately, in only a small proportion of cases can surgery improve recovery of paralysis. The surgeons work as a team with the specialist rehabilitation service at the Prince of Wales spinal cord injury unit to maximise recovery and support transition back into normal life.
Older people with osteoporosis can experience so called ‘crush fractures which often occur from minimal injury, Spinal crush fractures in older people are often very painful, but do not cause paralysis.
Treatment is based on giving pain killers and supportive care whilst the fracture heals. It is very rare for surgery to be used in these cases. The most important thing is to treat osteoporosis, which is proven to reduce the chance of another fracture.
Post-operative infection is a risk with any spinal procedure. Symptoms are increasing and unrelenting pain a week or two after surgery, when normally pain should be improving. The wound itself may become red and swollen and sometimes infected fluid may discharge (but not all fluid discharges are infected).
If this occurs it is important you see the original treating surgeon urgently, as intensive treatment will be required. Secondary surgery to drain the infection is often needed, as well as long term antibiotic therapy.
Thoracic Disc Herniation
Disc herniation in the thoracic spine (mid-back) is quite distinct from lumbar disc herniation by being much less common and causes very different symptoms. Whereas lumbar disc herniation commonly causes sciatic pain in a leg, thoracic disc herniation more typically causes girdle pain around your chest and/or lack of coordination in your legs due to spinal cord compression.
Treatment is based on the severity of symptoms and may include exercises, medication, injection of cortisone and very occasionally surgery.
The most common type of spinal tumour is due to spread of a cancer from another part of the body (metastatic disease). Tumours arising from the spine itself are rare.
Both forms of tumour cause spinal pain and if advanced, can lead to instability of the spine and pressure on the nerves and/or spinal cord.
First line treatment involves cancer specialists and chemotherapy or radiation therapy.
Only if pain is unrelieved or the spinal cord is threatened is surgery considered. The role of surgery in metastatic disease is to control the spinal tumour and prevent paralysis, but surgery cannot improve the overall prognosis. The role of the surgeon is as part of a team that includes radiation and medical cancer specialists.