Dr Bias Dev
As number of questions are encountered by many of medical professionals dealing with
treatment of ailments related with spine , it’s important to clear the false beliefs associated with spine disorders to address the fear and anxiety caused by the myths.
MYTH : All Low back /neck pains are Disc Diseases Reality:
In actual the disc disease causing low back and leg pain is around 15 % only.
In majority of times patients has a mechanical back ache or neck pain . The mechanical back ache / neck pain is the term used for the backache/ neck pain which has not caused any permanent structural change in the back or neck to be visible on radiological investigation .
Majority of these patients will get relief with right kind of exercises, care of posture and
correcting the inciting factors in approximately two weeks . The patients with back/ neck pain will need investigations and further treatment if symptoms last for more than two weeks, is associated with leg /arm pain , has numbness or weakness in the limbs or associated with fever, loss of weight /appetite or any change in bowel and bladder habits .
Myth : Sciatica do not need medical treatment as it responds to faith healers treatment
Reality : Sciatica in common language refers to the pain along the sciatic nerve which on getting irritated anywhere in its path produces pain and numbness from lower back to anywhere in posterior, outer or inner aspect of leg. The commonest cause of its irritation is at an area near intervertebral disc , any pressure if gets exerted on the nerve root by protruding intervertebral disc will cause pain along the nerve . Approximately 75 % of the patients from group of patients with mild to moderate pressure over their nerve roots because of prolapsed intervertebral disc will get pain relief by 6-8 weeks with nature’s mechanism of healing. The medical treatment during this phase hasten the process of the pain relief. For achieving pain relief if oral drugs do not gives the desired relief a procedure called as Selective Nerve Root Block can be tried to achieve pain relief. This is a short procedure in which the drug is delivered in the vicinity of compression under the guidance of a radiological medical device under local anaesthesia which displays the real time image of the needle placed around the nerve root under compression .
MYTH : Disc disease is not corrected for ever Reality
In reality all back aches are not arising from prolapsed intervertebral disc . The mechanical backache / neck pain in majority, will get settle in a short duration. . The other causes of backache can be from spine , abdomen , pelvis , hips or other surrounding structures and need to be evaluated to find a lasting solution . Only a smaller set of patients which do not respond to medical treatment or are associated with neurological loss needs surgical treatment.
Myth : One should not chose the surgical option in Disc disease /spine ailment.
Reality
All spine surgeries are not similar . Depending on the underlying pathology different surgical procedures are offered to address the primary pathology . The currently available options for surgical treatments for different spine ailments are safe and rewarding to the patients . Only a small subset of patients in whom disc prolapse is severe , and there is danger of having a permanent loss of nerve function or more than 6 -8 weeks has elapsed without any pain relief the surgical procedure need to be considered.
The commonly done surgical procedure for prolapsed intervertebral disc disease and other ailments are aimed at quick mobilisation of the patients . These surgical procedures are done without causing any significant harm to existing spine structure letting patient move out of bed and resume activities of daily living with in a day or two .
Myth : Spine injury patient do not recover
In reality the spine injuries are of two types . In one group after the injury some power in the limbs is preserved and in another there is complete loss of power .The patients in which some power is preserved has good chances of neurological recovery provided the patients vertebra are stabilised at the earliest .
The patients who has suffered complete loss of power can also become independent with proper rehabilitation and using assisting devices after the surgical stabilisation of injured vertebra but in these, the neurological recovery is not predictable. In both the groups , the fate of future neurological recovery gets decided at time of injury.
The idea of stabilising the injured vertebra is to prevent further injury to the neurological tissue and help the patient sit immediately after the surgery to prevent complications of staying lying down. Such injured patients should not be transported long distances as the movements further increases the damage. The surgery for stabilising the vertebra should be undertaken at the earliest and at the nearest possible centre for preventing further damage through movements .
Spine as other parts of the body is susceptible to get afflictions related with injuries, infections, tumours etc and patients need to report their symptoms to a qualified person to have a diagnosis for correct treatment plan.
Myth : “CERVICAL ” as Disease
In fact there is no medical condition “Cervical ” as disease is described in medical literature. This word somehow has crept into the vocabulary of laymen in society and each one understands it differently as per their own judgement . Since this word “Cervical ” is invariably used by laymen to describe neck pain and associated symptoms with a notion that it is something which may not find cure , this word’s usage to describe the neck ailments should not be encouraged. This notion about the neck pain is not true and majority of the causes are similar to lower back pain and will get addressed to correct treatment after having a diagnosis.
CONCLUSION
In conclusion, spine ailments are not to be feared and they can be managed by right approach and correct treatment . Many of the spine conditions can be prevented by observing correct posture , adopting correct technique of lifting the objects , regular exercises and by having balanced nutritional intake . By working on prevention of injuries and osteoporosis , the burden of spine ailments and consequential effects can be further lowered in the society.
(The author is Associate professor and head of unit Orthopedics GMC Jammu)
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