Whiplash Injury

Spine and Orthopaedic Centre Spine Specialist
What is Whiplash Injury?

Whiplash is a term that describes injury to the neck that occurs as a result of a motor vehicle or car accident. The most common type of car accident is the rear impact, and most typically, the occupant in the vehicle that gets “rear-ended” (hit from behind) is at the greatest risk of injury, including whiplash.

Whiplash injuries can be quite complex and may include a variety of related problems, such as:

  • Joint dysfunction. As a result of the whiplash, one of the joints in the spine or limbs may lose its normal resiliency and shock absorption (referred to as the joint play), possibly leading to restricted range of movement and pain.
  • Disc herniation. A whiplash accident may injure the discs between the vertebrae, lead to small tears and cause the inner core of the disc to extrude through its outer core. If the disc’s inner core comes in contact with and irritates a nearby spinal nerve root, a herniated disc occurs, with symptoms possibly including sharp, shooting pain down the arm and even neurological symptoms like numbness, tingling and muscle weakness.
  • Faulty movement patterns. It is believed that the nervous system may change the way in which it controls the coordinated function of muscles as a result of a barrage of intense pain signals from the whiplash injury.
  • Chronic pain. While often resulting in minor muscle sprains and strains that heal with time, more severe whiplash injuries may produce neck pain and other symptoms that are persistent and long-lasting (chronic).
  • Cognitive and higher center dysfunction. In some instances, whiplash may affect the patient’s mental functioning, possibly leading to difficulties concentrating, as just one example.

How does Whiplash Occur?

A whiplash accident occurs when one motor vehicle strikes another from behind, causing certain forces to be transmitted from the striking vehicle to the struck vehicle. These forces are then transmitted to the occupant(s) of the struck vehicle, where they have the potential to cause whiplash injury.

Cervical Spine reaction to a Whiplash Accident

There is an inherent stabilization response in the cervical spine that helps protect it from potential whiplash injury:

  • The nervous system detects the presence of the impact
  • The muscles of the cervical spine, under the direction of the nervous system, contract quickly to try to minimize the affects of the impact on the ligaments and discs.

If this stabilization response is working efficiently following the whiplash accident, there is a greater likelihood of protection and less potential for whiplash injury.

But if the response is inefficient, an injury is more likely, with various types of whiplash pain possibly resulting and whiplash treatment potentially necessary.

Factors affecting the Whiplash Injury

There are several factors that affect the efficiency of the stabilization response to whiplash injury, including:

  • Posture at impact
  • Overall physical condition
  • Awareness of coming impact
  • Gender

It should be known that some of these stabilization responses to whiplash are within the patient’s capacity to control, while others are not.

Lower Back Pain

Patient Education Spine Conditions Lower Back Pain

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Low back pain refers to pain that you feel in your lower back. You may also have back stiffness, decreased movement of the lower back, and difficulty standing straight.

Acute back pain can last for a few days to a few weeks.

Causes of Low Back Pain

Most people will have at least one backache in their life. Although this pain or discomfort can happen anywhere in your back, the most common area affected is your low back. This is because the low back supports most of your body’s weight.

Many back-related injuries happen at work. There are many things you can do to lower your chances of getting back pain.

You’ll usually first feel back pain just after you lift a heavy object, move suddenly, sit in one position for a long time, or have an injury or accident.

Acute low back pain is most often caused by a sudden injury to the muscles and ligaments supporting the back. The pain may be caused by muscle spasms or a strain or tear in the muscles and ligaments.

Lower Back Pain

Causes of sudden low back pain include:

  • Compression fractures to the spine from osteoporosis
  • Cancer involving the spine
  • Fracture of the spinal cord
  • Muscle spasm (very tense muscles)
  • Ruptured or herniated disk
  • Sciatica
  • Spinal stenosis (narrowing of the spinal canal)
  • Spine curvatures (like scoliosis or kyphosis), which may be inherited and seen in children or teens
  • Strain or tears to the muscles or ligaments supporting the back

Low back pain may also be due to:

  • An abnormal aortic aneurysm that is leaking
  • Arthritis conditions, such as osteoarthritis, psoriatic arthritis, and rheumatoid arthritis
  • Infection of the spine (osteomyelitis, diskitis, abscess)
  • Kidney infection or kidney stones
  • Problems related to pregnancy
  • Medical conditions that affect the female reproductive organs, including endometriosis, ovarian cysts,ovarian cancer, or uterine fibroids

Symptoms of Low Back Pain

You may feel a variety of symptoms if you’ve hurt your back. You may have a tingling or burning sensation, a dull achy feeling, or sharp pain. Depending on the cause and severity, you also may have weakness in your legs or feet.

Low back pain can vary widely. The pain may be mild, or it can be so severe that you are unable to move.

Depending on the cause of your back pain, you may also have pain in your leg, hip, or the bottom of your foot.

Diagnosis of Low Back Pain

When you first see your health care provider, you will be asked questions about your back pain, including how often it occurs and how severe it is.

Your health care provider will try to determine the cause of your back pain and whether it is likely to quickly get better with simple measures such as ice, mild painkillers, physical therapy, and proper exercises. Most of the time, back pain will get better using these approaches.

During the physical exam, your health care provider will try to pinpoint the location of the pain and figure out how it affects your movement.

Most people with back pain improve or recover within 4 – 6 weeks. Therefore, your health care provider will probably not order any tests during the first visit unless you have certain symptoms.

Tests that might be ordered include:

  • CT scan of the lower spine
  • MRI of the lower spine
  • X-ray

Treatment of Lower Back Pain

Minor low back pain will improve after resting for a day or two.

Other treatments for your low back pain includes:

  • Anti-inflammatory and Muscle Relaxant Medicines
  • Back Support
  • Physiotherapy. Strengthening to your back muscles
  • Epidural injection
  • Spinal manipulation
  • Back surgery for disc problem that may lead to nerve problem

When to see a Spine Specialist

Consult a Spine Specialist right away if you have:

  • Back pain after a severe blow or fall
  • Burning with urination or blood in your urine
  • History of cancer
  • Loss of control over urine or stool (incontinence)
  • Pain traveling down your legs below the knee
  • Pain that is worse when you lie down or that wakes you up at night
  • Redness or swelling on the back or spine
  • Severe pain that does not allow you to get comfortable
  • Unexplained fever with back pain
  • Weakness or numbness in your buttocks, thigh, leg, or pelvis

Prevention of Lower Back Pain

Exercise is important for preventing back pain. Through exercise you can:

  • Improve your posture
  • Strengthen your back and improve flexibility
  • Lose weight
  • Avoid falls

It is also very important to learn to lift and bend properly. Follow these tips:

  • If an object is too heavy or awkward, get help.
  • Spread your feet apart to give you a wide base of support.
  • Stand as close to the object you are lifting as possible.
  • Bend at your knees, not at your waist.
  • Tighten your stomach muscles as you lift the object or lower it down.
  • Hold the object as close to your body as you can.
  • Lift using your leg muscles.
  • As you stand up with the object, DO NOT bend forward.
  • DO NOT twist while you are bending for the object, lifting it up, or carrying it.

Other measures to prevent back pain include:

  • Avoid standing for long periods of time. If you must stand for your work, try using a stool. Alternate resting each foot on it.
  • DO NOT wear high heels. Use cushioned soles when walking.
  • When sitting for work, especially if using a computer, make sure that your chair has a straight back with an adjustable seat and back, armrests, and a swivel seat.
  • Use a stool under your feet while sitting so that your knees are higher than your hips.
  • Place a small pillow or rolled towel behind your lower back while sitting or driving for long periods of time.
  • If you drive long distance, stop and walk around every hour. Bring your seat as far forward as possible to avoid bending. Don’t lift heavy objects just after a ride.
  • Quit smoking.
  • Lose weight.
  • Do exercises to strengthen your abdominal muscles on a regular basis. This will strengthen your core to decrease the risk of further injuries.

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Tailbone pain (Coccydynia)

Patient Education Spine Conditions Lower Back Pain
 What is Coccydynia?

Coccydynia, commonly called tailbone pain or coccyx pain, is a fairly rare and relatively poorly understood condition that can cause persistent pain at the very bottom of the spine. This part of the spine is the coccyx, or tailbone. Coccydynia is felt as a localized pain and will generally feel worse when sitting or with any activity that puts pressure on the bottom area of the spine.

The condition is much more common in women than men. It is usually caused by local trauma (e.g. a fall) or giving birth. On rare occasions, an infection or tumor can also cause pain in the coccyx.

Coccydynia Symptoms and Treatments?

Coccydynia symptoms may consist of one or all of the following:

  • Pain that is markedly worse when sitting
  • Local pain in the tailbone area that is worse when touched or when any pressure is placed on it
  • Pain that is worse when moving from a sitting to standing position
  • Pain that is worse with constipation and feels better after a bowel movement.

A combination of treatments to reduce the pain and activity modification to keep pressure off the tailbone usually suffices to control or alleviate the pain. In very rare cases, surgery to remove the coccyx may be recommended, but the surgery (a coccygectomy) will typically only be considered if the pain is severe and at least several months of non-surgical treatment and activity modification has not been effective in relieving the pain.

Coccydynia (Tailbone Pain) causes?

 It is not clearly understood which portions of the anatomy can cause coccyx pain. In many cases the exact cause of the pain is not known (called idiopathic coccydynia), and in these cases the symptoms are managed.

In general, pain can by caused in the coccyx if an injury or some type of excess pressure on the area causes the bones to move beyond their normal very limited range of motion, resulting in inflammation and localized pain. An injury to either the ligaments or the vestigial disc may be a cause of pain. Rarely, the bones of the coccyx can fracture and cause pain. Also, in rare cases a tumor or infection in the coccyx can be a primary cause of tailbone pain.

Generally, a diagnosis of the cause of coccydynia will identify one of the following underlying causes of pain:

  • Local trauma. A fall on the tailbone can inflame the ligaments or injure the coccyx or the coccygeal attachment to the sacrum. This is probably the most common cause of coccydynia.
  • Childbirth. During delivery, the baby’s head passes over the top of the coccyx, and the pressure created against the coccyx can sometimes result in injury to the coccyx structures (the disc, ligaments and bones). While uncommon, the pressure can also cause a fracture in the coccyx.
  • Pressure. Certain activities that put prolonged pressure on the tailbone, such as horseback riding and sitting on hard surface for long periods of time, may cause the onset of coccyx pain. Tailbone pain due to these causes usually is not permanent, but if the inflammation and symptoms are not managed, the pain may become chronic.
  • Tumor or infection. Rarely, coccydynia is due to a tumor or infection in the coccyx area that puts pressure on the coccyx.

Diagnosis of Coccydynia (Tailbone Pain)

A health professional diagnoses coccydynia by taking a thorough medical history from the patient and completing a physical examination.

Diagnostic tests, such as x-ray or MRI, are also commonly performed in order to rule out other potential causes of the pain.

Treatment of Coccydynia (Tailbone Pain)

Treatments for coccydynia are usually noninvasive and local. The first line of treatment typically includes:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) help reduce the inflammation around the coccyx that is usually a cause of the pain.
  • Applying ice or a cold pack to the area several times a day for the first few days after the pain starts.
  • Applying heat or a hot pack to the area after the first few days.
  • Avoiding sitting for prolonged periods, or placing any pressure on the area, as much as possible.
  • A custom pillow to help take pressure off the coccyx when sitting. Some find a donut-shaped pillow works well, and for others it is not the right shape and still puts pressure on the coccyx. Many prefer a foam pillow that is more of a U-shape or V-shape (with the back open so nothing touches the coccyx). Any type of pillow or sitting arrangement that keeps pressure off the coccyx is ideal.
  • If the tailbone pain is caused or increased with bowel movements or constipation, then stool softeners and increased fiber and water intake is recommended.

If the pain is persistent or severe, additional non-surgical treatment options for coccydynia (tailbone pain) include:

  • Injection. A local injection of anti-inflammatory medicine can provide some relief.
  • Manipulation. Some patients find pain relief through manual manipulation.
  • Stretching. Gently stretching the ligaments attached to the coccyx can be helpful. A physical therapist or other appropriately trained healthcare practitioner can provide instruction on the appropriate stretches.
  • Ultrasound. Physical therapy with ultrasound can also be helpful for pain relief.

Provided that infection and tumor has been ruled out as a cause of pain (through exam, x-ray and MRI scan), then prolonged non-surgical treatment for pain relief and activity modification is a reasonable option.

After attaining sufficient pain relief so that movement is not too painful, daily low-impact aerobic activity is beneficial, as the increased blood flow brings healing nutrients to the area and encourages the body’s natural healing abilities. The additional benefit of aerobic activity is the release of endorphins, the body’s inherent pain relieving process.

For people who have persistent pain that is not alleviated or well-controlled with non-surgical treatment and activity modification, surgical removal of all or a portion of the coccyx (coccygectomy) is an option.

This surgery is rarely performed, and the procedure is not even included in most spine surgery textbooks. While the surgery itself is a relatively straight-forward operation, recovery from the surgery is a long and uncomfortable process for the patient.

Scoliosis

Patient Education Spine Conditions Lower Back Pain
What is Scoliosis?

Scoliosis is an abnormal curve in the spine. There are several types of scoliosis based on the cause and age when the curve develops. Depending on the severity of the curve and the risk for it getting worse, scoliosis can be treated with observation, bracing, or surgery.

Scoliosis is a disorder that causes an abnormal curve of the spine, or backbone. The spine has normal curves when looking from the side, but it should appear straight when looking from the front. Kyphosis is a curve seen from the side in which the spine is bent forward. There is a normal kyphosis in the middle (thoracic) spine. Lordosis is a curve seen from the side in which the spine is bent backward. There is a normal lordosis in the upper (cervical) spine and the lower (lumbar) spine. People with scoliosis develop additional curves to either side, and the bones of the spine twist on each other, forming a “C” or an “S” shape in the spine.

Scoliosis is about two times more common in girls than boys. It can be seen at any age, but it is most common in those over 10 years of age. Scoliosis is hereditary in that people with scoliosis are more likely to have children with scoliosis; however, there is no correlation between the severity of the curve from one generation to the next.

What Causes Scoliosis?

Scoliosis can affect about 2% of females and 0.5% of males. In most cases, the cause of scoliosis is unknown (idiopathic). This type of scoliosis is described based on the age when scoliosis develops. If the person is less than 3 years old, it is called infantile idiopathic scoliosis. Scoliosis that develops between 3 and 10 years of age is called juvenile idiopathic scoliosis, and people that are over 10 years old have adolescent idiopathic scoliosis. More than 80% of people with scoliosis have idiopathic scoliosis, and the majority of those are adolescent girls.

There are three other main types of scoliosis:

  • Functional: In this type of scoliosis, the spine is normal, but an abnormal curve develops because of a problem somewhere else in the body. This could be caused by one leg being shorter than the other or by muscle spasms in the back.
  • Neuromuscular: In this type of scoliosis, there is a problem when the bones of the spine are formed. Either the bones of the spine fail to form completely or they fail to separate from each other during fetal development. This type of scoliosis develops in people with other disorders, including birth defects, muscular dystrophy, cerebral palsy, or Marfan’s disease. People with these conditions often develop a long C-shaped curve and have weak muscles that are unable to hold them up straight. If the curve is present at birth, it is called congenital. This type of scoliosis is often much more severe and needs more aggressive treatment than other forms of scoliosis.
  • Degenerative: Unlike the other forms of scoliosis that are found in children and teens, degenerative scoliosis occurs in older adults. It is caused by changes in the spine due to arthritis known as spondylosis. Weakening of the normal ligaments and other soft tissues of the spine combined with abnormal bone spurs can lead to an abnormal curvature of the spine. The spine can also be affected by osteoporosis, vertebral compression fractures, and disc degeneration.
  • Others: There are other potential causes of scoliosis, including spine tumors such as osteoid osteoma. This is a benign tumor that can occur in the spine and cause pain. The pain causes people to lean to the opposite side to reduce the amount of pressure applied to the tumor. This can lead to a spinal deformity.

What are the symptoms and signs of Scoliosis?

The most common symptom of scoliosis is an abnormal curve of the spine. Often this is a mild change and may be first noticed by a friend or family member. The change in the curve of the spine typically occurs very slowly so it is easy to miss until it becomes more severe. It can also be found on a routine school screening examination for scoliosis. Those affected may notice that their clothes do not fit as they did previously or that pant legs are longer on one side that the other.

Scoliosis may cause the head to appear off center or one hip or shoulder to be higher than the opposite side. You may have a more obvious curve on one side of the rib cage on your back from twisting of the vertebrae and ribs. If the scoliosis is more severe, it can make it more difficult for the heart and lungs to work properly. This can cause shortness of breath and chest pain.

In most cases, scoliosis is not painful, but there are certain types of scoliosis can cause back pain.

How is Scoliosis diagnosed?

The physical examination involves looking at the curve of the spine from the sides, front, and back. The person will be asked to undress from the waist up to better see any abnormal curves. The person will then bend over trying to touch their toes. This position can make the curve more obvious. The doctor will also look at the symmetry of the body to see if the hips and shoulders are at the same height. Any skin changes will also be identified that can suggest scoliosis due to a birth defect. The doctor may check your range of motion, muscle strength, and reflexes.

The more growth that a person has remaining increases the chances of scoliosis getting worse. As a result, the doctor may measure the person’s height and weight for comparison with future visits. Other clues to the amount of growth remaining are signs of puberty such as the presence of breasts or pubic hair and whether menstrual periods have begun in girls.

If the doctor believes you have scoliosis, you could either be asked to return for an additional examination in several months to see if there is any change, or the doctor may obtain X-rays of your back. If X-rays are obtained, the doctor can make measurements from them to determine how large of a curve is present. This can help decide what treatment, if any, is necessary. Measurements from future visits can be compared to see if the curve is getting worse.

It is important that your doctor knows how much further growth you have left. Additional X-rays of the hand and wrist or pelvis can help determine how much more you have to grow. If your doctor finds any changes in the function of your nerves, he or she may order other imaging tests of your spine including an MRI or CT scan to look more closely at the bones and nerves of your spine.

What is the treatment of Scoliosis?

Treatment of scoliosis is based on the severity of the curve and the chances of the curve getting worse. Certain types of scoliosis have a greater chance of getting worse, so the type of scoliosis also helps to determine the proper treatment. There are three main categories of treatment: observation, bracing, and surgery.

Sciatica

Patient Education Spine Conditions Lower Back Pain
The term sciatica describes the symptoms of leg pain and possibly tingling, numbness or weakness that originates in the low back and travels through the buttock and down the large sciatic nerve in the back of the leg.

The vast majority of people who experience sciatica get better with time (usually a few weeks or months) and find pain relief with non-surgical sciatica treatment. For others, however, sciatic nerve pain can be severe and debilitating.

Sciatica is often characterized by the following symptoms:

  • Pain on one side of the buttock or in one leg that is worse when sitting
  • Burning or tingling down the leg
  • Weakness, numbness or difficulty moving the leg or foot
  • A constant pain on one side of the rear
  • A sharp pain that may make it difficult to stand up or to walk

What are the causes of Sciatica Symptoms?

The main cause of sciatica is generally a result of a disc herniation directly pressing on the nerve. However any cause of irritation or inflammation of this nerve can reproduce the symptoms of sciatica. These causes include irritation of the nerve from adjacent bone, tumors, muscle, internal bleeding, infections, injury, and many others.

Sciatica Symptoms

For some people, the pain from sciatica can be severe and debilitating. For others, the pain might be infrequent and irritating, but has the potential to get worse.

While sciatica can be very painful, it is rare that permanent sciatic nerve damage (tissue damage) will result. Most sciatica symptoms result from inflammation and will get better within two weeks to a few months. Also, because the spinal cord is not present in the lower (lumbar) spine, a herniated disc in this area of the anatomy does not present a danger of paralysis.

While relatively rare, two sciatica-related symptoms that warrant prompt medical attention and possibly emergency surgery, include: progressive weakness in the leg, and either bladder or bowel incontinence or dysfunction. Patients with either of these symptoms may have cauda equina syndromeand should seek immediate medical attention.

What are the treatment options available?

Sciatica nerve pain is caused by a combination of pressure and inflammation on the nerve root, and treatment is centered on relieving both of these factors.Typical sciatica treatment include:

  • Non-surgical sciatica treatments, which may include one or a combination of medical treatments and alternative (non-medical) treatments, and almost always includes some form of back exercises and stretching. The goals of non-surgical sciatica treatment, such as sciatica exercises, should include both relief of sciatica pain and prevention of future sciatica pain.
  • Sciatica surgery, such as microdiscectomy or lumbar laminectomyand discectomy, to remove the portion of the disc that is irritating the nerve root. This surgery is designed to help relieve both the pressure and inflammation and may be warranted if the sciatic nerve pain is severe and has not been relieved with appropriate manual or medical treatments.

Spondylolisthesis

Patient Education Spine Conditions Lower Back Pain
What is Spondylolisthesis?

Spondylolisthesis (spon + dee + lo + lis + thee + sis) is a condition of the spine whereby one of the vertebra slips forward or backward compared to the next vertebra. Forward slippage of one vertebra on another is referred to as anterolisthesis, while backward slippage is referred to as retrolisthesis. Spondylolisthesis can lead to a deformity of the spine as well as a narrowing of the spinal canal (central spinal stenosis) or compression of the exiting nerve roots (foraminal stenosis).

What are the Causes of Spondylolisthesis?

There are five major types of lumbar spondylolisthesis.

  1. Dysplastic spondylolisthesis: Dysplastic spondylolisthesis is caused by a defect in the formation of part of the vertebra called the facet that allows it to slip forward. This is a condition that a patient is born with (congenital).
  2. Isthmic spondylolisthesis: In Isthmic spondylolisthesis, there is a defect in a portion of the vertebra called the pars interarticularis. If there is a defect without a slip, the patient has spondylolysis. Isthmic spondylolisthesis can be caused by repetitive trauma and is more common in athletes exposed to hyperextension motions including gymnasts, and football linemen.
  3. Degenerative spondylolisthesis: Degenerative spondylolisthesis occurs due to arthritic changes in the joints of the vertebrae due to cartilage degeneration. Degenerative spondylolisthesis is more common in older patients.
  4. Traumatic spondylolisthesis: Traumatic spondylolisthesis is due to direct trauma or injury to the vertebrae. This can be caused by a fracture of the pedicle, lamina or facet joints that allows the front portion of the vertebra to slip forward with respect to the back portion of the vertebra.
  5. Pathologic spondylolisthesis: Pathologic spondylolisthesis is caused by a defect in the bone caused by abnormal bone, such as from a tumor.

What are the Risk Factors of Spondylolisthesis?

Risk factors for spondylolisthesis include a family history of back problems. Other risk factors include a history of repetitive trauma or hyperextension of the lower back or lumbar spine. Athletes such as gymnasts, weight lifters, and football linemen who have large forces applied to the spine during extension are at greater risk for developing isthmic spondylolisthesis.

What are the symptoms of Spondylolisthesis?

The most common symptom of spondylolisthesis is lower back pain. This is often worse after exercise especially with extension of the lumbar spine. Other symptoms include tightness of the hamstrings and decreased range of motion of the lower back. Some patients can develop pain, numbness, tingling or weakness in the legs due to nerve compression. Severe compression of the nerves can cause loss of control of bowel or bladder function, or cauda equina syndrome.

How is Spondylolisthesis diagnosed?

In most cases it is not possible to see visible signs of spondylolisthesis by examining a patient. Patients typically have complaints of pain in the back with intermittent pain to the legs. Spondylolisthesis can often cause muscle spasms, or tightness in the hamstrings.

Spondylolisthesis is easily identified using plain radiographs. A lateral X-ray (from the side) will show if one of the vertebra has slipped forward compared to the adjacent vertebrae. Spondylolisthesis is graded according the percentage of slip of the vertebra compared to the neighboring vertebra.

  1. Grade I is a slip of up to 25%,
  2. grade II is between 26%-50%,
  3. grade III is between 51%-75%,
  4. grade IV is between 76% and 100%, and
  5. Grade V, or spondyloptosis occurs when the vertebra has completely fallen off the next vertebra.

If the patient has complaints of pain, numbness, tingling or weakness in the legs, additional studies may be ordered. These symptoms could be caused by stenosis or narrowing of the space for the nerve roots to the legs. A CT scan or MRI scan can help identify compression of the nerves associated with spondylolisthesis. Occasionally, a PET scan can help determine if the bone at the site of the defect is active. This can play a role in treatment options for spondylolisthesis as described below.

What is the treatment of Spondylolisthesis?

The initial treatment for spondylolisthesis is conservative and based on the symptoms.

  • A short period of rest or avoiding activities such as lifting and bending and athletics may help reduce symptoms.
  • Physical therapy can help to increase range of motion of the lumbar spine and hamstrings as well as strengthen the core abdominal muscles.
  • Anti-inflammatory medications can help reduce pain by decreasing the inflammation of the muscles and nerves.
  • Patients with pain, numbness and tingling in the legs may benefit from an epidural injection.
  • Patients with isthmic spondylolisthesis may benefit from a hyperextension brace. This extends the lumbar spine bringing the two portions of the bone at the defect closer together and may allow for healing to occur.

For patients whose symptoms fail to improve with conservative treatment surgery may be an option. The type of surgery is based on the type of spondylolisthesis. Patients with isthmic spondylolisthesis may benefit from a repair of the defective portion of the vertebra, or a pars repair. If an MRI scan or PET scan shows that the bone is active at the site of the defect it is more likely to heal with a pars repair. This involves removing any scar tissue from the defect and placing some bone graft in the area followed by placement of screws across the defect.

If there are symptoms in the legs the surgery may include a decompression to create more room for the exiting nerve roots. This is often combined with a fusion that may be performed either with or without screws to hold the bone together. In some cases the vertebrae are moved back to the normal position prior to performing the fusion, and in others the vertebrae are fused where they are after the slip. There is some increased risk of injury to the nerve with moving the vertebra back to the normal position.

Can Spondylolisthesis be prevented?

Spondylolisthesis cannot be completely prevented. Certain activities such as gymnastics, weight-lifting and football are known to increase the stress on the vertebrae and increase the risk of developing spondylolisthesis.

What are the complications of Spondylolisthesis?

Complications of spondylolisthesis include chronic pain in the lower back or legs, as well as numbness, tingling or weakness in the legs. Severe compression of the nerve can cause problems with bowel or bladder control, but this is very uncommon.

What is the prognosis for Spondylolisthesis?

The prognosis for patients with spondylolisthesis is good. In most cases patients respond well to a conservative treatment plan. For those with continued severe symptoms, surgery can help alleviate the leg symptoms by creating more space for the nerve roots. The back pain can be helped through a lumbar fusion.

Herniated Disc / Slipped Disc

Patient Education Spine Conditions Lower Back Pain

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What is Herniated Disc / Slipped Disc?

Your spinal column is made of up 26 bones (vertebrae) that are cushioned by disks. The discs protect the bones by absorbing the shocks from daily activities like walking, lifting, and twisting.

Each disc has two parts a soft, gelatinous inner portion and a tough outer ring. Injury or weakness can cause the inner portion of the disc to protrude through the outer ring. This is known as a slipped or herniated disc. This causes pain and discomfort. If the slipped disc compresses one of your spinal nerves, you may also experience numbness and pain along the affected nerve. In severe instances, you may require surgery to remove or repair the slipped disc.

Slip Disc

What are the symptoms of Herniated Disc / Slipped Disc?

You can have a slipped disc in any part of your spine, from your neck to your lower back. The lower back is the most common area for slipped discs. Your spinal column is an intricate network of nerves and blood vessels. A slipped disc can place extra pressure on the nerves and muscles around it.

Symptoms of a slipped disc include:

  • pain and numbness, most commonly on one side of the body
  • pain that extends to your arms or legs
  • pain that worsens at night
  • pain that worsens after standing or sitting
  • pain when walking short distances
  • unexplained muscle weakness
  • tingling, aching, or burning sensations in the affected area

The types of pain can vary from person to person. Please consult a Spine Specialist if your pain results in numbness or tingling that affects your ability to control your muscles.

What causes Herniated Disc / Slipped Disc?
A slipped disc occurs when the outer ring becomes weak or torn and allows the inner portion to slip out. This can happen with age. Certain motions may also cause a slipped disk. A disc can slip out of place while you are twisting or turning to lift an object. Lifting a very large, heavy object can place great strain on the lower back, resulting in a slipped disc. If you have a very physically demanding job that requires a lot of lifting, you may be at increased risk for slipped discs.
Overweight individuals are also at increased risk for a slipped disc because their discs must support the additional weight. Weak muscles and a sedentary lifestyle may also contribute to development of a slipped disc.
People who are 35 to 45 years old are more likely to have a slipped disc. This is because your discs begin to lose some of their protective water content as you age. As a result, they can slip more easily out of place. They are more common in men than women.

What are the effect of the Herniated Disc / Slipped Disc?

An untreated, severe slipped disc can lead to permanent nerve damage. In very rare cases, a slipped disc can cut off nerve impulses to the cauda equina nerves in your lower back and legs. If this occurs, you may lose bowel or bladder control.

Another long-term complication is known as saddle anesthesia. In these cases, the slipped disc compresses nerves and that causes you to lose sensation in your inner thighs, the back of your legs, and around your rectum.

While a slipped disc’s symptoms may improve, they also can worsen. If you cannot perform the activities you once could, it is time to see a spine specialist.

How are Herniated Disc / Slipped Disc diagnosed?

Our spine specialist will first perform a physical exam. He will be looking for the source of your pain and discomfort. This will involve checking your nerve function and muscle strength, and whether you feel pain when moving or touching the affected area. Our spine specialist also will ask you about your medical history and your symptoms. He will be interested in when you first felt symptoms and what activities cause your pain to worsen.

Imaging tests can help the Doctor view the bones and muscles of your spine and identify any damaged areas. Examples of imaging scans include:

  • X-rays
  • CT scans
  • MRI scans

Our spine specialist can combine all these pieces of information to determine what is causing your pain, weakness, or discomfort.

How are Herniated Disc / Slipped Disc treated?

Treatments for a slipped disc range from conservative to surgical. The treatment typically depends on the level of discomfort you are experiencing and how far the disc has slipped out of place.

Most patients can relieve slipped disc pain using an exercise program that stretches and strengthens the back and surrounding muscles. A physical therapist may recommend exercises that can strengthen your back while reducing your pain.

Taking some anti-inflammatory medicines and avoiding heavy lifting and painful positions can also help.

While it may be tempting to refrain from all physical activity while you are experiencing the pain/discomfort of a slipped disc, this can lead to muscle and joint stiffness. Instead, try to remain as active as possible through stretching or low-impact activities such as walking.

If your slipped disc pain does not respond to over-the-counter treatments, our spine specialist may prescribe stronger medications. These include:

  • muscle relaxers to relieve muscle spasms
  • narcotics to relieve pain
  • nerve pain medications like gabapentin or duloxetine

Our spine specialist may recommend surgery if your symptoms do not subside in six weeks or if your slipped disc is affecting your muscle function. Our surgeon may simply remove the damaged or protruding portion of the disc without removing the entire disc. This is called a microdiscectomy.

In more severe cases, our surgeon may replace the disc with an artificial one or remove the disc and fuse your vertebrae together. This procedure, called a laminectomy, adds stability to your spinal column.

Is it possible to prevent a Herniated Disc / Slipped Disc?

It may not be possible to prevent a slipped disc, but you can take steps to reduce your risk of developing a slipped disc. Those steps include:

  • Use safe lifting techniques: Bend and lift from your knees, not your waist.
  • Maintain a healthy weight.
  • Do not remain seated for long periods; get up and stretch periodically.
  • Do exercises to strengthen the muscles in your back, legs, and abdomen.

What is the prognosis for someone with a Herniated Disc / Slipped Disc?

Most people with a slipped disc will respond well to conservative treatment. Within six weeks their pain and discomfort will gradually lessen.

Stop your Back Pain today. Effective Treatment, Non Surgery. Discuss with our Spine Specialist for the Diagnosis, Treatment and Prognosis of your Slipped Disc. Call us +65 97731458 to schedule for an appointment.

Spine and Orthopaedic Centre (Singapore)

Spine and Orthopaedic Centre Spine Specialist
 With Spine and Orthopaedic Centre, you can rest assured you will receive the best possible care and treatment with us, backed by our proven track record. Our Spine Service specialises in precision-oriented diagnosis for individuals with various spinal conditions. We are proud to be recognised as the leading centre for minimally invasive spine surgery, and have over the years established ourselves as a major referral centre for spinal deformity surgery.

Our Services
We provide both surgical and non-surgical services for spinal skeleton problems. These include:

Back Problems (Lumbar Spine):

Neck Problems (Cervical Spine):

Conditions We Treat
For spinal impairment related conditions

  • Numbness and weakness in the arms and hands
  • Low back pain (pinched nerves)
  • Leg pain

Facilities and Technology
With advances in medical care, patients can now enjoy a longer and higher quality life. We are constantly researching and adopting new techniques and technologies to offer superior treatments and care to our patients. Adopting these advancements also mean the same surgeries can now be performed via smaller incisions, benefiting patients with shorter hospitalization periods and an accelerated return to their daily life and work.

At the Department of Orthopaedic Surgery, we are recognized internationally as one of the leading centre for training in minimally invasive spine surgery techniques in the world, being the preferred location for attracting and retaining the best surgeons.

Lower Back Strain

The most common low back injuries are strains, in which lower back muscles or tendons are stretched or torn.

What is Low Back Strain?

The back is made up of bones (vertebrae) of the spinal column, disks between these bones, the spinal cord (which contains nerves), and muscles, tendons, and ligaments. Muscles in the back and belly (abdomen) help support the spine. The lower back (lumbar spine) supports most of the body weight and helps with moving, twisting, and bending. The most common low back injuries are strains, in which lower back muscles or tendons are stretched or torn. Tendons are tough bands of tissues connecting muscles and bones. Anyone can have a low back strain. Athletes, especially football players and gymnasts, are more likely to strain in practice than during competition.

What causes Low Back Strain?

Causes include activities that stress the lower back, such as stretching, bending, improper lifting, too much pulling (weight-lifting), or twisting (basketball, baseball, golf). Playing sports without stretching or warming up back muscles can lead to strains. Other causes are poor conditioning, obesity, smoking, coughing hard, emotional stress, falling, and trauma.

What are Symptoms or Low Back Strain?

Symptoms include sudden lower back pain that becomes worse with activities (bending, stretching, coughing, sneezing). Painful and stiff back, painful buttocks and legs, and lower back spasms are others.

How is Low Back Strain diagnosed?

Diagnosis result from taking a medical history, doing a physical, and maybe doing x-ray studies. Computed tomography (CT) or magnetic resonanse imaging (MRI) may be done if clearer pictures of bones, nerves, or disks between the bones are needed.

A study using electric current, called electromyography (EMG), helps diagnose muscle problems and may be done.

How is Low Back Strain treated?

Treatment involves rest, ice, heat, medicines, and physiotherapy. People should rest for a day or two, but then light physical activity should be started. Apply heat to the back but only after 2 to 3 days of using ice first, after the swelling has gone. Electric heating pads, hot water bottles, or soaking in a hot bath would work. Medicines include muscle relaxants and nonsteroidal anti-inflammatory drugs (NSAIDs) for pain. Physical therapy and exercises can help strengthen muscles in the abdomen and can stretch and strengthen lower back muscles during and after healing.