Spinal Surgeon in Liverpool & Wirral

TREATMENT OF SPINAL CONDITIONS

PAIN MANAGEMENT-Non-operative Treatment

Spinal Injections

Spinal injections have two purposes. They have a diagnostic value and help physicians to identify the source of pain and which spinal structure is the cause of the problem. They are also used to treat swelling and inflammation in a specified area which provides pain relief.

Preparing For Your Injections

A spinal injection is an outpatient procedure. Before your injection, you will be asked questions about your health and given instructions on how to prepare for the procedure, for example:
Provide a list of the medicines you take, including blood thinners, aspirin, anti-inflammatory medication. You may need to stop taking some of these before the procedure.

Provide a list of any allergies you may have to medicines, latex or contrast dye.

Have someone available to drive you home after the procedure.

Risks and Complications

All medical interventions have risks and benefits. Spinal injections have certain risks and complications that include:

• Failure to improve symptoms
• Allergic reaction
• Spinal headache(rare)
• Bleeding (rare)
• Infection (rare)

During the Procedure

The procedure is usually brief.  Your skin will be cleaned with a sterilizing solution. Conscious sedation (use of a calming drug while you are awake) may be used if your doctor feels it is appropriate. Local anesthetic (lidocaine) is usually given near the injection site to numb the skin. This typically feels like a pin prick and some burning, like a bee sting.

 The procedure is performed under Fluoroscopy (X-ray imaging) for precise placement of the needle. Contrast dye may be injected to confirm the correct placement of the needle. A local anesthetic for numbing (for example, lidocaine, bupivicaine) and/or steroids (to reduce inflammation) is injected.

After the procedure a small bandage may be placed at the injection site. You may spend time in a recovery area after the injection procedure.

It takes a few days, even a week or longer, for the steroid medicine to reduce inflammation and pain.

Your doctor will follow-up with you in 6 weeks following the injection.
 

Nerve root injections

A nerve root injection targets individual nerves in your spine.

Example of L5 Selective Nerve Root Injection (SNRI)

Example of S1 Selective Nerve Root Injection (SNRI)

Facet Joint injections

Injections can be inserted into the facet joints, which are located in the back and neck.

Sacro-iliac Joint injections

A Sacro-iliac joint injection is inserted into a joint at the base of the spine where it joins the pelvis, where it is known as the Sacro-iliac joint. 

                                                                        Example of SI Joint injections

For more information, please contact me at my spinal surgery in Liverpool.

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SURGICAL TREATMENTS

Microdiscectomy/Discectomy

Microdiscectomy or Discectomy is the treatment of choice for the treatment of the lumbar herniated discs. The surgeon will remove portions of the herniated disc to relieve pressure on the spinal nerves. This is generally an effective procedure in removing sciatica pain, which has resulted from a compression of the spinal nerve. More than 90% of patients report good or excellent results after surgery. Typically, patients are discharged from the hospital within 24 hours and return to their activities within a few weeks.

Laminectomy-Laminotomy-Lumbar Decompression

• Laminectomy involves removal of bone from the vertebra (laminae) bilaterally to increase space within the spinal canal and relieve pressure.
• Laminotomy involves unilateral or bilateral removal of a portion of the vertebral arch (lamina)

This procedure is indicated for the treatment of lumbar spinal stenosis. The surgery occurs under general anesthetic and can be effective in improving pain and helping people walk. Patients are usually discharged from the hospital within 1-2 days.

POSTERIOR LUMBAR FUSION SURGERY

This surgical technique is used to fuse (join) two vertebrae. Spinal fusion may include the use of instrumentation (e.g., rods, screws) with or without bone graft.

A Posterior Lumbar Interbody Fusion involves placement of an interbody cage (graft to replace the disc) to increase fusion rates but also to improve local alignment. This fusion technique can be accomplished by different approaches:

ALIF, PLIF, TLIF: All involve the placement of lumbar interbody fusion device (cage) used to stabilize the spinal vertebrae and eliminate movement between the bones.

• Anterior Lumbar Interbody Fusion (ALIF)
• Posterior Lumbar Interbody Fusion (PLIF)
• Transforaminal Lumbar Interbody Fusion indicates a surgical approach through the foramen. (TLIF)

Please get in touch for a discussion about lower back surgery options at my spinal surgery in Liverpool.

Posterior Transforaminal Lumbar Interbody Fusion (TLIF)

Interbody fusion involves placement of fusion implants and bone graft into the area between two vertebral bodies and is an effective method for achieving fusion. The procedure can be performed through a traditional open incision or a minimally invasive technique depending on the patient and the condition to be treated. Transforaminal lumbar interbody fusion is performed under general anesthesia. Patients usually remain in the hospital for 2-3 days.

Indications for surgery include:

• Isthmic and degenerative spondylolisthesis,
• Recurrent disc herniations with disc collapse and nerve narrowing
• Foraminal stenosis
• Degenerative disc disease

                                                    Antero-posterior and Lateral X Rays of an Open TLIF?

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SPINAL DEFORMITY SURGERY

Scoliosis/Kyphosis Correction

When non-operative treatment is ineffective in relieving pain and improving daily activities, spinal surgery to correct scoliosis and kyphosis is an option. Performed under general anesthetic the aims of surgery can be to restore normal curvature of the spine, to prevent a curve from worsening or to protect the nerves and spine from further impairment.

Spinal decompression is when the surgery relieves pressure on the nerve roots travelling through the spine. Spinal correction is intended to restore as much of the normal alignment of the spine as possible. Spinal fusion is part of the procedure in reconstructive surgery for those with kyphosis and scoliosis.

  See Case Study 2  

Spondylolisthesis Correction

If conservative means have failed to improve back and leg symptoms, surgery may help in increasing a person's ability to function, relieving the pain from an impacted nerve or stabilizing the spine.

Please get in touch for a discussion about spinal deformity surgery at my spinal surgery in Liverpool.

  See Case Study 1  

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Minimal Invasive Surgery (MIS)

MIS Transforaminal Interbody Fusion (TLIF)

Minimally invasive techniques can be more effective in terms of pain relief and recovery after the procedure. Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS TLIF) can to restore disc height, which helps decompress surrounding nerve roots.

The surgery is indicated to treat spondylolisthesis, degenerative disc disease or nerve compression.

Please contact me for a consultation, at my spinal surgery in Liverpool.

                                                                    Antero-posterior and Lateral X Rays of an MIS TLIF?

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NECK SURGERY

Anterior Cervical Discectomy Fusion (ACDF)

Anterior cervical discectomy and fusion (ACDF) is a surgery to remove a herniated or degenerative disc in the neck. Surgery is indicated when physiotherapy or medications fail to relieve your neck or arm pain caused by pinched nerves.  A small incision is made in the throat area. The disc is removed and a graft is inserted to allow the bones above and below to fuse.Patients typically go home within 24 hours.

Common indications are:

• Cervical radiculopathy
• Degenerative disc disease in the neck
• Herniated disc in the neck
• Cervical Spondylotic Myelopathy

Posterior Cervical Decompression and Fusion

This is a common procedure aimed at treating the narrowing of the cervical spine. The operation can relieve pressure on the spinal cord and nerve roots and help stabilise the neck.

Common indication

• Multi-level cervical spondylitis myelopathy 
• Multi-level cervical stenosis

For more information, please schedule a spinal consultation with me.

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Spinal Fractures

Vertebroplasty/Kyphoplasty

Both of these procedures are designed to treat vertebrae compression fractures of the spine which have arisen from osteoporosis or a traumatic injury. Vertebroplasty injects cement into the fractured bone, whereas kyphoplasty aims to restore height by utilising a balloon.

Percutaneous Fracture Fixation

This is a minimally invasive procedure to treat spinal fractures.

Please get in touch and schedule a consultation with me to discuss your spinal fractures.

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