Dr Adriaan Liebenberg My Spine Explained | Page 35

My Spine Explained
Treatment that does not require intervention – Courses of painkillers and
anti-inflammatory drugs can be combined with therapeutic treatments to con-
trol symptoms. This is appropriate for patients with limited spinal claudica-
tion and radicular symptoms, and for patients who are medically unfit to
undergo more invasive treatment.
Limited intervention – This include procedures such as caudal or sacral
block, radiofrequency rhizotomy and other non-surgical procedures. These
treatments may be highly effective, have very few side-effects or complica-
tions and are performed as day procedures.
Intervention (surgery) – The indications for surgery are:
1. Failed conservative management. This is when painkillers, anti-inflamma-
tory medication and manual therapy such as physiotherapy and chiropractic
treatment have been utilised for at least six weeks without improvement.
2. Pain, including local lower back pain, referred pain and radicular pain that
does not respond to any other treatment modality and is sufficiently severe to
the extent that it limits your daily activities and quality of life.
3. Muscle weakness due to nerve compression (radicular weakness).
4. Cauda Equina syndrome and Conus Medullaris syndrome (see the chapter
Slipped Disc).
Does this treatment have any complications?
The most common surgery complications are that of infection and wound
haematoma (bleeding under the skin). The most feared complication is that of
nerve damage, but this is very rare. The outer layer of the nerves (the dura)
can also be torn and this will lead to leakage of spinal fluid (cerebrospinal
fluid). For a comprehensive list of possible surgery risks – you should discuss
the matter with your specialist.
What are the long-term expectations?
This progressive disease can be treated without surgery up to a point, but
mostly ends up in surgery. Surgery is successful in halting deterioration and
is effective in reducing pain in most patients. Older people, who have diffi-
culty walking, may not completely recover, due to the long-standing nerve
compression that may have caused nerve damage prior to surgery.
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