The human spine is the body’s main upright support and the spinal column gives the body its form. Segmented from the neck to the waist, the human spine is comprised of 24 articulating spinal bones. The upper part of the spine consists of seven vertebrae in the neck, called the cervical spine (C1-C7), 12 vertebrae in the thoracic spine (T1-T12), and five vertebrae in the lumbar spine (L1-L5). The lower nine are fused, five in the sacrum and four in coccyx or tailbone. Each vertebrae has facet joints that make you flexible and enable you to bend and twist. All 33 vertebrae are separated from each other by inter-vertebral discs. When the outer lining that surrounds a disc tears, the jelly-like center in the disc can squeeze out and press on the nerve through the opening, leading to a herniated disc and back pain.
A common source of back pain is the lumbar spine L1-L5. This is commonly found in older adults or working-aged people. The patient may experience pain from the waist down. There are two types of back pain:
When the fibrous outer covering of the disk loosens, breaks or tears to the point where the disc moves and presses on the spinal nerve, the result is a herniated disc.
Warning signs that require immediate medical attention are pain running down the back of the legs lasting for more than two weeks, numbness beginning at the waist and continuing down the legs or the instep of the foot, leg muscle weakness, and loss of control in the bladder. When experiencing these symptoms, you can assume that you likely have a herniated disc. You should see a doctor to receive a professional diagnosis and identify the cause of the symptoms. The likely causes include age-related degenerative disc disease, a disc injury after an accident, and possibly damage caused by improper movement in daily activities, such as lifting heavy objects the wrong way or exercising the wrong way.
There are several treatment options, depending on each patient’s decision. If the symptoms are mild, surgery is not necessary and non-surgical treatments may be sufficient, such as medications for pain and inflammation, physical therapy, or epidural steroid injections. In the case of severe nerve compression, the doctor may suggest surgery. The latest medical technologies and advanced surgical techniques for treating a herniated disc make patients feel safer. With Minimally Invasive Surgery (MIS), a C-Arm fluoroscope x-ray and microscope are used to identify the optimal position to place a small incision of only 1–1.5cm. Microsurgical instruments are inserted through a small tube and the segment of the herniated disc compressing the nerves is removed. Patients undergoing this procedure experience less pain and only need to stay in hospital for one to two days.
Chronic back pain can be treated once the diagnosis is completed and the exact cause of the pain is identified. Today, there is no longer as much need to worry about the surgery due to the advances in medical technologies. There are several safe surgical techniques for chronic back pain that are less painful and with a shorter recovery time than traditional surgery.
|Minimally Invasive Surgery (MIS) – New standard of care for surgical procedures|
M.D., Faculty of Medicine, Siriraj Hospital, Mahidol University, 1991.