Disc Protrusion

This protrusion, or bulge, can occur anywhere along the length of the spinal column from the neck (cervical spine) to the lower back (lumbar spine).

Doctors pay close attention to the patient's symptoms before more focussed procedures because sometimes the pain may occur in one part of the body but the actual cause lies in a different part of the spine.

If the pain is in the lower back (lumbar spine), leg or the groin, this could be irritation on the disc itself or irritation of the nerves next to the spine.

When the slipped disc presses on a nerve in the lumbar spine causing pain to spread below the knee (known as Sciatica), this can cause numbness or pins and needles or even a difficulty in lifting the toes and the foot.

The causes of disc protrusion or a slipped disc are when the outer case of the disc splits leaving the gel inside bulging out of the disc. This can then then put pressure on the spinal cord or a single nerve root, as explained above.

Age can sometimes play a part as the spinal discs start to lose their water content which makes them more flexible.

Recovery from a slipped disc can take around four to six weeks with treatment usually including a combination of physical therapy and medication.

In many cases, a slipped disc will eventually shrink back away from the nerve and the pain will ease as the disc stops pressing on the nerve.

Girdlestone Procedure

This is an operation, also known as resection arthroplasty of the hip, which involves removing part of the ball of the thigh bone (femur).

This allows it to fuse with the hip socket (acetabulum) into the straight leg position.

The patient's leg is then left straight as it cannot bend at the hip, meaning the hip is stiff but pain-free.

The procedure was named after Gathorne Girdlestone, a professor of orthopaedic surgery in Oxford, who devised it for treating tuberculosis of the hip before joint replacement became possible. Click here to find out more.

Laminectomy

This is one of the most common back surgeries where a surgeon removes the rear portion of one or more spinal bones (vertebrae).

Ligaments and bones that are pressing on the nerves may be removed at the same time during surgery.

People with arthritis in their spine can sometimes develop bony overgrowths within the spinal canal which can cause the pressure.

As with any form of surgery, there can be complications during a laminectomy including:

• Bleeding,
• Infection blood clots,
• Nerve injury

Orthopaedic injuries can also occur during surgery in which case a clinical negligence claim may be brought against the hospital.

Most people who undergo a laminectomy see an improvement in their symptoms but, as the spine ages over time, the benefit may lessen.

Microdiscectomy

This is a form of spinal surgery to decompress the spine using a microscope to view the spine and the lumbar disc.

A small portion of the bone over the nerve root is removed to relieve neural impingement and to provide the nerve with more room to heal.

Compression of the spine can cause substantial leg pain and a microdiscectomy is usually performed for a herniated lumbar disc which is said to be more effective for treating leg pain than lower back pain.

The success rate of a microdiscectomy is approximately 90-95% with 5-10% of patients developing a recurrent disc herniation at some point in the future.

In any spinal surgery, there is the risk of a cerebrospinal fluid leak which occurs in 1-2% of these procedures. This means the patient will have to lay horizontally for one or two days to allow the leak to seal. Other complications can include; nerve root damage, bleeding or infection.

Scaphoid Fracture

The scaphoid bone is one of the carpal bones around the area of the wrist. Fractures of scaphoids can occur with direct compression or hyperextension of the wrist. The symptoms often include pain and swelling around the wrist and tenderness over the thumb side of the wrist.

Scaphoid fractures are categorised by location. They are often diagnosed by X-rays but it is important to remember that scaphoid fractures are not always apparent on the initial X-rays. Treatment usually consists of providing a cast.

If there has been some movement of the bone fragment(s), the scaphoid bone can heal in an incorrect position and you might need surgery to correct this. In some circumstances, a bone graft may also be needed to correct the deformity and to promote healing.

However, an important possible complication in scaphoid fractures is avascular necrosis. Avascular necrosis is usually visible on X-rays.

This complication and the risk depends upon the location of the fracture. This is more common where a fracture occurs at the narrowest part of the scaphoid which is where the blood supply enters to the scaphoid bone.

If the blood supply is interrupted, it can leave part of the bone without a blood supply.

Sometimes scaphoid fractures are mistakenly assumed to be a sprain and it may be that you are unknowingly applying pressure to the injured wrist.

We have a more detailed summary on this type of fracture in our orthopaedic injuries section as well as a blog from Helen Shaw on why these fractures are so common and frequently missed.

Here you can read how a client suffered scaphoid injuries, as well as a spinal cord injury, after being in a motorcycle accident.

Spinal Cord Abscess

Spinal cord abscess is a rare condition capable of causing permanent damage to the spinal cord.

Abscesses are caused when injured tissue becomes infected. The body’s immune system sends white blood cells to help fight off the infection. They begin to fill the damaged tissue, causing pus to build up. Pus is made up of the dying tissue, immune cells, dead cells, and bacteria.

The cause of Spinal cord abscess is generally due to the introduction of bacteria into the spinal cord. Once inside the body, it is able to find a place to live and grow. The pressure of the abscess on the spinal cord will sometimes cause neurological problems, such as lower-body paralysis and loss of sensation below the area of the abscess.

Doctors will try to find the presence of an infection by testing body fluids. They may also look at an image of the abscess. Once the diagnosis is confirmed, they will have to either drain or remove the abscess.

Patients will generally receive antibiotics to take after they leave to avoid getting an infection. Since antibiotics have come into common medical use, Spinal cord abscess has become extremely rare. In fact, fewer than 100 cases have been reported in modern medical history

Quick recognition of spinal cord abscess is important in effectively treatment. Left alone, the abscess could burst, letting millions of bacteria spread throughout the body. Once the problem is identified, treatment for spinal cord abscescan include:

• Laminectomy

The patient is put under anesthesia before the surgery. Surgeons open the abscess carefully and drain all the fluid. They then rinse sanitary saline fluid through the abscess to assure all bacteria are gone.

• Intraoperative Pus Collection.

During this procedure, fluid is collected from the abscess for testing.

• Closure of Dermal Sinus

Doctors who find a dermal sinus will typically close the gap. The hope is there will be one less place for bacteria to gather and form an infection.

The earlier a spinal cord abscess is treated, the more positive the outlook. Patients who have a leaking abscess are unleashing bacteria into the bloodstream. They could end up with abscesses on the brain or liver.

Patients who get treatment after the start of neurological symptoms generally will need a form of rehabilitation. The hope is that over time the neurological symptoms will get better or disappear.

Spinal Cord Compression

This happens when there is pressure on the spinal cord. This may be caused by cancer growing in or spreading into the bones of the spine, which occurs in 5% of people with advanced cancer.

Spinal cord compression may also occur when the spinal cord becomes injured through a trauma such as a car collision, or when the bones become weak (osteoporosis) or infection.

The pressure on the spinal cord stops the nerves working normally which causes a variety of symptoms including; pain or tenderness in the back which may be worse when coughing or sneezing, numbness or weakness in the legs and changes in sensation in parts of the body e.g. pins and needles.

Symptoms vary from person to person depending on the location of the compression on the spine but they may also include bowel functionality problems, erectile problems in men and a band of pain down your arm or leg.

Recovery of spinal cord compression also varies between patients; from complete recovery to complete paralysis.

Those diagnosed with a spinal cord compression would be referred to a neurosurgeon. Patients with regional spinal cord lesions would have an emergency decompression of the spine.

The patient, however, would have to have surgery if the spinal nerves were impinged or if there was neurological deterioration.

Long term treatment would include rehabilitation including physiotherapy and occupational therapy.

Spinal epidural haematoma - Over Anti-coagulation

This injury can be caused by a number of factors including childbirth or surgery where bleeding into the epidural space in the spine can occur.

However, here we are focusing on epidural haematoma caused by over anti-coagulation.

In the spine, the epidural space contains loose fatty tissue and a network of large, thin-walled veins. This means that bleeding is likely to be venous.

Anatomical abnormalities and bleeding disorders make these lesions more likely. They may cause pressure on the spinal cord or cauda equina. The diagnosis may be made on clinical appearance and time course of symptoms. It usually requires MRI scanning to confirm. The treatment is surgical decompression.

However, when epidural haematoma is caused by over anti-coagulation, the sufferer will be on anticoagulant medication which prevents the blood from clotting.

Over anti-coagulation is when the patient has taken too many anticoagulant drugs which can result in bleeding or bruising easily. This can then affect the epidural space and can lead to haematoma and even paraplegia.

Read about a case of Helen Dolan's which settled for a lump sum of £2.3 million after an elderly woman suffered an epidural haematoma due to over anti-coagulation.

Spondylitis

This is an inflammation of the vertebra and is a form of chronic arthritis which affects the bone, muscles and ligaments.

The spine is made up of 24 individual vertebrae which are separated by soft pads that act as shock absorber which allow the spine to bend. The vertebrae are also held together by ligaments and spinal muscles, giving the back its strength.

The symptoms of spondylitis can vary between each patient but generally people suffer from back pain and stiffness, usually taking a long time to develop, and fatigue if let untreated. The back pain in sufferers usually gets worse with rest and can often wake them up during the night.

This condition can be severe, with one in 10 people at risk of a long term disability.

The causes of spondylitis are not fully understood but a particular gene (HLA-B27) has been identified that is closely linked to the condition. However, if you have the gene then you may not necessarily have the condition.

In order to diagnose spondylitis, you may have blood tests to measure how much swelling you have in your body.

Further tests may include x-rays to see if there is any damage to the joints in your spine.

Unfortunately, there is no cure for spondylitis but there are treatments available to help ease the symptoms and slow the process of the spine stiffening, which include; physiotherapy, painkillers and other medicines.

As Spondylitis is such a complex condition, it can also lead to additional health problems; including Cauda Equina Syndrome.