Procedures & Practice

SPINE

Michael Foy is a member of the British Association of Spinal Surgeons (BASS) and the European Society of Spinal Surgeons (Eurospine). Actively involved with the assessment and surgical management of nerve compression in the neck and back with cervical and lumbar decompression and fusion procedures. Familiar with instrumented procedures in the cervical and lumbar spine using systems such as Xia, Dynesys, Solis, Coflex etc. Good liaison both in NHS and private sector with spinal physiotherapists and aware of the important place of the non surgical management of spinal problems.

Procedures:

Low Back Pain

70-80% of the population experience Low Back Pain as a result of degenerative (wear & tear) change in the discs and facet joints. Most people do not require surgical treatment for the problem. The natural history is generally good with improvement and stabilisation of symptoms as the spine ages. The mainstay of treatment is rehabilitation under the supervision of a Spinal Physiotherapist to improve core stability. If symptoms fail to resolve with rehabilitation then there are surgical options with stabilisation (Dynesys) or formal fusion to abolish painful movement. This type of surgery is successful in 65-70% of patients. However, the great majority of patients with low back pain do not require an operation. On occasions injections into the facet joints can be helpful in calming symptoms down to facilitate more effective rehabilitation.

Sciatica (Disc Prolapse)

Worn discs on occasions slip or prolapse, and therefore as well as causing back pain may compress one of the roots of the sciatic nerve causing pain in the leg (sciatica). The body has a fairly good capacity for resolving this problem and only 10-15% patients with disc prolapse require surgical treatment. Resolution of symptoms may be speeded up by physiotherapy, anti-inflammatories, epidural injection of cortisone or x-Ray guided nerve root block. Results of surgery, if required, are usually good with around 85% to 90% of patients having a very satisfactory outcome in terms of relief of sciatica.

Neck Pain / Brachial Neuralgia (Arm pain)

Less commonly nerves can be compressed by a disc prolapse in the neck resulting in arm pain. This usually resolves with time, anti-inflammatories, physiotherapy treatment or on occasions x-Ray or CT guided nerve root block. If the symptoms persist they can be relieved by an operation through the front of the neck to remove the disc and replace it with a bone graft and/or synthetic cage or disc replacement. Success rate of this type of surgery is around 90%. On occasions the spinal cord itself can be compressed resulting in bilateral symptoms and weakness (myelopathy), similar surgery may be required. However on occasion more radical surgery to remove the vertebra may be necessary (vertebrectomy).

Spinal Stenosis

With increasing age everyones spinal column becomes arthritic. This is a normal part of aging. In some people the arthritic process causes narrowing of the spinal canal with compression of the nerves resulting in pain,weakness,easy fatigueability of the legs, numbness or pins & needles (or a combination of these symptoms.) Management generally consists of activity modification and on occasion steroid/cortisone injections. If the symptoms are very troublesome despite these measures surgery is possible by way of less invasive distraction decompression (Wallis ligament or X Stop, Coflex) or formal spinal decompression to increase the size of the spinal canal. Results of the distraction decompressions is encouraging but the procedures are still relatively experimental at this stage. Decompression surgery is tailored to the problem, depending on the symptoms and signs exhibited by the patient and the nature of the MRI findings.

Cauda Equina Syndrome

Approximately 1-2% of patients with a prolapsed intervertebral disc go on to develop compression of the Cauda Equina. THE VAST MAJORITY DO NOT. The nerve roots below the termination of the spinal cord around L1 are known as the Cauda Equina because of their resemblance to a horses tail. A massive disc prolapse can cause pressure on these roots leading to loss of bladder and bowel sensation with pain and/or weakness in the legs and numbness in the genital/perineal region. The significance of this condition is that the pressure on the nerve roots needs to be relieved relatively quickly (within 24-48 hours) by surgery, otherwise the damage to bladder, bowel and genital function may become permanent. Therefore this is one area where urgent/emergency surgery needs to be considered.

Kyphoplasty / Vertebroplasty

Recently introduced treatment for symptomatic osteoporotic vertebral fractures where bone cement is injected into the vertebra under X Ray guidance to restore vertebral height and reduce pain.