NECK
Cervical spondylosis (Testimonial 6):

This is a very common condition especially among Asians, with narrower spinal canals than Caucasians. It should be emphasized that degenerative changes on MRI scan in normal people without problems are very common. In one study, over 50% of normal population older than 50 year old have had degenerative changes in the neck. Obviously they do not need any treatment
or surgery. In these patients it will be wrong and damaging to do surgery on their spine.

On the other hand, severe cervical spondylosis can cause problems in 2 different ways:

a. Compression of a nerve root (radiculopathy, Figure 9), resulting in pain in neck, shoulder blade, arm, forearm or even in the fingers. This may be associated with numbness or pins and needles in the arm or fingers. In late stage there may be weakness of
the limbs as well.

b. Compression of the main nerve, ie spinal cord (myelopathy, Figure 10), resulting in numbness of both hands, weakness of the
arms and commonly weakness of the legs (walking unsteadily, problems in climbing stairs or even falling down). When severe,
urination, bowel movement and sexual functions may be affected too.

Chapter4_Figure10-before

A patient with a disc prolapse at C5/6 level.

A 89 year old man from Surabaya was unable to walk for 6 months due to compression at C1/2 level. After decompression he is able to walk now.

Cervical spondylosis with multi-levels compression by disc and osteophytes. A 3-levels plating with
screws was needed to relieve the compression

The treatment is usually straightforward. When severe, removal of the compression (herniated disc, herniated
nucleus pulposis HNP or bone spur, osteophytes) frequently gives good relief and improvement. But if
significant damage is present before surgery, there may be some mild residual numbness. Overall, such surgery when
performed with microscope, high speed drill and care is very safe and the risk is very low (See Testimonial 6).

After removal of the compression (discs or osteophytes), one can replace the empty disc space with one’s own bone,
PEEK cage or artificial joint. Sometimes one may need to use plates and screws (pins) to fix the bone together (Figure 11).

LOW BACK PAIN

Lumbar spondylosis

Degeneration of the low back (Testimonial 7) can cause three different clinical problems:

a. Herniated Nucleus Pulposis (HNP):

Due to degeneration, injury or strain, a piece of cartilage disc is pushed out of place and presses on the nerve running down to the leg. This results in severe back and leg pain, and sometimes in a pulling sensation. The pain may be worse on coughing, sneezing or straining. Complete bed rest often relieves the pain. Physiotherapy should be the initial treatment, but if after several weeks of treatment the pain is still severe, a MRI scan should be done and consultation to neurosurgeon made. A microdiscectomy often solves the problem. Patients usually stay in hospital for only 1-2 days (Figure 12).

A Caucasian man complained of sudden leg pain from a huge disc prolapse (HNP) betweeen L4/5.

b. Spinal stenosis:

As one grows older, the ligaments in the spine become thicker. There are joint over-growth and bone spurs. These narrow the diameter of the spine and compress on the nerve roots. The patient often complains of pain or numbness mainly when they walk or stand. The symptoms improve once the patient sits down. For some patients, when they bend forward, they can
walk further before the pain starts. Low back pain, when present, is often not severe. Simple decompression procedure may be enough to relieve the pressure on the nerves.

c. Spondylolithesis (alignment of the spine not straight).

Patients suffering from this problem have a lot of low back pain, especially during movement such as when getting out of bed in the morning. A simple x-ray of the spine from the side in bending forward and bending backward position (lateral lumbar spine x-ray in flexion and extension view) reveals this problem. For severe cases, a spinal fusion using pins (screws) and rods will fix this
problem. Although this used to be a major operation, with modern instruments it is relatively simple and very safe now. There is no significant risk at all of getting paralyzed from this operation (See Testimonial 8 and Figure 13,14).

Chapter4_Figure14-before

 

Slipping of L4 over L5 (spondylolithesis) resulted in A 3-levels lumbar fusion was needed for this compressing of the nerves to the leg. Fusion with screws elderly patient and rods was needed to solve this problem.