• Cheltenham Clinics: 01242 246530 Winfield Clinic: 01452 337288

Treatments

These are some of the most common spinal conditions that I treat – if you are suffering from a spine problem, even if it isn’t on the list, please get in touch to see how I can help.

T&O Spine
Dear Mr Sundaram, without your intervention my prognosis would have been very poor. With gratefully thanks for saving my life.

Spinal Injections


Facet Joint Blocks

Patients with facet joint arthritic pain often have a low level of back pain which they can cope with on a day-to-day basis. Sometimes they can experience an increased episode of their low back pain, significantly affecting their quality of life. In cases like this, facet joint blocks are often performed

The procedure

This is a day case local anaesthetic procedure. The procedure is done in the operating room under sterile conditions and using X-ray. Fine needles are inserted into the facet joints and steroid and local anaesthetic are inserted into and around the joints.

Recovery

Patients usually go home about one hour after the procedure. Patients are encouraged to have physiotherapy following the procedure to help reduce their back pain.

Risks

Thousands of spinal injection procedures are done throughout the world every year and it is a low-risk, safe treatment. However, nothing is completely risk-free.

Complications associated with spinal injections include:

  • Infection (less than 0.1%)
  • Nerve damage (less than 0.1%)
  • Motor weakness (less than 0.1%)
  • Sensory loss (less than 0.1%)
  • Abscess formation (less than 0.1%)
  • Problem becoming worse (less than 0.1%)

I will discuss the procedure and any associated risks with you in detail before going ahead. There’ll be plenty of time for you to ask any questions that you may have.

Next steps

Contact me for a consultation. I will discuss your medical history with you, carry out a physical examination and talk you through the treatment options.

Further information

  • http://www.spine-health.com/treatment/injections/cervical-thoracic-and-lumbar-facet-joint-injections
Radiofrequency Ablation

Patients whose facet joint pain has been relieved somewhat with facet joint injections may benefit from radiofrequency ablation of the nerves which supply the affected facet joints.

The procedure

This is a day case local anaesthetic procedure and the patient is under light sedation.

The procedure is done in the operating room under sterile conditions and using X-ray. Fine special needles with heat probes are inserted around the nerves which supply the affected facet joints. These needles are heated to literally fry the affected nerves.

The procedure can be a little uncomfortable and that’s why sedation is used.

Recovery

Patients usually go home about two hours after the procedure when the sedation has worn off.

Next steps

Contact me for a consultation. I will discuss your medical history with you, carry out a physical examination and talk you through the treatment options.

Further information

• http://www.spine-health.com/treatment/injections/radiofrequency-neurotomy-facet-and-sacroiliac-joint-pain

Nerve Root Blocks

Often if a nerve is trapped, usually in the lumbar spine, it is due to a disc prolapse or spinal stenosis. A nerve root block may help.

The procedure

This is a day case local anaesthetic procedure. The procedure is done in the operating room under sterile conditions and using X-ray.

Fine needles are inserted around the affected nerve and a dye is used to highlight the nerve so that local anaesthetic and steroid can be administered.

Recovery

Patients usually go home about one hour after the procedure. A significant number of patients who undergo a nerve root block may avoid surgery.

Risks

Thousands of spinal injection procedures are done throughout the world every year and it is a low-risk, safe treatment. However, nothing is completely risk-free.

Complications associated spinal injections include:

• Infection (less than 0.1%)
• Nerve damage (less than 0.1%)
• Motor weakness (less than 0.1%)
• Sensory loss (less than 0.1%)
• Abscess formation (less than 0.1%)
• Problem becoming worse (less than 0.1%)

I will discuss the procedure and any associated risks with you in detail before going ahead. There’ll be plenty of time for you to ask any questions that you may have.

Next steps

Contact me for a consultation. I will discuss your medical history with you, carry out a physical examination and talk you through the treatment options.

Further information

• http://spinesurgeons.ac.uk/article.asp?article=30

Caudal Epidural Injections

Patients who have severe discogenic back pain or spinal stenosis may benefit from a caudal epidural injection.

The procedure

This is a day case local anaesthetic procedure.

The procedure is done in the operating room under sterile conditions and using X-ray. A needle is inserted into the base of the spine and a large volume of steroid and local anaesthetic is inserted into the epidural space.

Recovery

Patients usually go home about one hour after the procedure.

Risks

Thousands of spinal injection procedures are done throughout the world every year and it is a low-risk, safe treatment. However, nothing is completely risk-free.

Complications associated with spinal injections include:

  • Infection (less than 0.1%)
  • Nerve damage (less than 0.1%)
  • Motor weakness (less than 0.1%)%
  • Sensory loss (less than 0.1%)
  • Abscess formation (less than 0.1%)
  • Problem becoming worse (less than 0.1%)

I will discuss the procedure and any associated risks with you in detail before going ahead. There’ll be plenty of time for you to ask any questions that you may have.

Next steps

Contact me for a consultation. I will discuss your medical history with you, carry out a physical examination and talk you through the treatment options.

Further information

• http://www.spine-health.com/treatment/injections/lumbar-epidural-steroid-injections-low-back-pain-and-sciatica

Spinal Surgery


Kyphoplasty

This operation is often performed in patients who are osteoporotic and have sustained vertebral compression fractures.

The procedure

The operation is performed under general anaesthetic. Keyhole-size incisions are created over the fracture site and special pencil-size diameter instruments are inserted into the vertebrae. A balloon is then inserted into the vertebrae and inflated to create a cavity. This cavity allows cement to be inserted into the vertebrae to stabilise the fracture.

Recovery

Patients usually go home the following day.

I will discuss the procedure and any associated risks with you in detail before going ahead. There’ll be plenty of time for you to ask any questions that you may have.

Next steps

Contact me for a consultation. I will discuss your medical history with you, carry out a physical examination and talk you through the treatment options.

Further information

• http://www.spine-health.com/treatment/back-surgery/kyphoplasty-osteoporosis-fracture

Anterior Cervical Discectomy and Fusion

This procedure is performed for cervical radiculopathy or myelopathy, where the affected cervical disc is pressing on the spinal cord or nerve root.

The procedure

The operation is performed under general anaesthetic. The affected disc is removed and an artificial cage with bone graft is inserted in its place. The cage is usually supported by a small plate attached to the vertebrae.

Recovery

You will wake up with a drain coming from the neck and this is usually removed the following day. Post-operative analgesia is given by the anaesthetist.

Patients can usually go home one or two days after surgery.

Risks

Anterior cervical spine surgery is a very common procedure. Fortunately complications are rare and if they do occur they are usually minor. However, in a minority of cases they can be serious.

The complications associated with anterior cervical spine surgery include:

  • Infection
  • Nerve damage
  • Motor weakness
  • Sensory loss
  • Paralysis
  • Sexual disturbance
  • Bladder and bowel disturbance
  • Dural tear
  • Leakage of ferebrospinal fluid
  • Headache
  • Meningitis
  • Change of voice
  • Hoarse voice
  • Recurrent laryngeal nerve injury
  • Difficulty in swallowing
  • Scar formation
  • Recurrence of symptoms
  • Failure of metal work
  • Non-union
  • Adjacent segment degeneration
  • Further surgery
  • Deep venous thrombosis
  • Pulmonary embolism
  • Myocardial infarction
  • Stroke
  • Tracheal injury
  • Vascular Injury
  • Oesophageal injury
  • Death

I will discuss the procedure and any associated risks with you in detail before going ahead. There’ll be plenty of time for you to ask any questions that you may have.

Next steps

Contact me for a consultation. I will discuss your medical history with you, carry out a physical examination and talk you through the treatment options.

Further information

• http://www.spine-health.com/treatment/back-surgery/acdf-anterior-cervical-discectomy-and-fusion

Posterior Cervical Laminectomy and Decompression

Sometimes patients with cervical myelopathy have compression of the cervical spinal cord from the back of the spine. Most often it is due arthritis and thickening and bunching up of the ligaments in the back of the spine, causing pressure on the spinal cord.

The procedure

The decompression procedure is done from the back of the spine, where the pressure on the spinal cord is removed. Sometimes small rods and screws need to be inserted into the cervical spine.

This is a general anaesthetic procedure.

Recovery

You will wake up with a drain coming from the back of your neck, and this is usually removed after one or two days. Most patients can go home two to four days after surgery.

Variations of the procedure include posterior cervical foraminotomy and cervical split laminectomy.

Risks

Posterior cervical spine surgery is a very common procedure. Fortunately complications are rare and if they do occur they are usually minor. However, in a minority of cases they can be serious.

The complications associated with anterior cervical spine surgery include:

  • Pain
  • Infection
  • Nerve damage
  • Motor weakness
  • Sensory loss
  • Paralysis
  • Sexual disturbance
  • Bladder and bowel disturbance
  • Dural tear
  • Leakage of cerebrospinal fluid
  • Headache
  • Meningitis
  • Recurrence of symptoms
  • Scar formation
  • Failure of metal work
  • Non-union
  • Adjacent segment degeneration
  • Further deformity of the spine
  • Further surgery
  • Deep venous thrombosis
  • Pulmonary embolism
  • Myocardial infarction
  • Stroke
  • Death

I will discuss the procedure and any associated risks with you in detail before going ahead. There’ll be plenty of time for you to ask any questions that you may have.

Next steps

Contact me for a consultation. I will discuss your medical history with you, carry out a physical examination and talk you through the treatment options.

Further information

• http://www.spine-health.com/treatment/back-surgery/posterior-cervical-laminectomy

Lumbar Microdiscectomy and Lumbar Microdecompression

Patients with sciatica-type symptoms which are not settling may undergo a lumbar microdiscectomy or decompression procedure. Several years ago this procedure would leave a big scar up to six inches long. However, with modern technology and instrumentation this procedure can be done with just a one-inch long incision and minimal damage to the tissues around the spine.

The procedure

The disc prolapsed or the arthritis compressing on the nerve is removed. 75-80% of patients see an almost immediate significant improvement in their symptoms.

This is a general anaesthetic procedure.

Recovery

After the procedure patients are up and about when the anaesthetic wears off. Patients can usually go home the following day but can expect to have six weeks off work before getting back to full fitness.

Risks

Lumbar and thoracic spine surgery is a very common procedure. Fortunately complications are rare and if they do occur they are usually minor. However, in a minority of cases they can be serious.

The complications associated with lumbar and thoracic spine surgery include:

  • Pain
  • Infection
  • Nerve damage
  • Motor weakness
  • Sensory loss
  • Paralysis
  • Sexual disturbance
  • Bladder and bowel disturbance
  • Dural tear
  • Leakage of cerebrospinal fluid
  • Headache
  • Meningitis
  • Scar formation
  • Recurrence of symptoms
  • Failure of metal work
  • Non-union
  • Adjacent segment degeneration
  • Further deformity of the spine
  • Further surgery
  • Deep venous thrombosis
  • Pulmonary embolism
  • Myocardial infarction
  • Stroke
  • Death

I will discuss the procedure and any associated risks with you in detail before going ahead. There’ll be plenty of time for you to ask any questions that you may have.

Next steps

Contact me for a consultation. I will discuss your medical history with you, carry out a physical examination and talk you through the treatment options.

Further information

• http://spinesurgeons.ac.uk/article.asp?article=28
• http://www.spine-health.com/treatment/back-surgery/microdiscectomy-microdecompression-spine-surgery

Lumbar Laminectomy

This procedure is usually performed for spinal stenosis where more than one nerve is trapped, causing pain.

This procedure is most often performed in older people where there is more degeneration of the spine.

The procedure

This is a general anaesthetic procedure.

The back part of the spine at the affected level is removed to make more room for the affected nerve.

Recovery

After the procedure patients are up and about when the anaesthetic wears off and they can usually go home a couple of days after surgery.

A variation of a lumbar laminectomy is a lumbar segmental decompression.

Risks

Lumbar and thoracic spine surgery is a very common procedure. Fortunately complications are rare and if they do occur they are usually minor. However, in a minority of cases they can be serious.

The complications associated with lumbar and thoracic spine surgery include:

  • Pain
  • Infection
  • Nerve damage
  • Motor weakness
  • Sensory loss
  • Paralysis
  • Sexual disturbance
  • Bladder and bowel disturbance
  • Dural tear
  • Leakage of cerebrospinal fluid
  • Headache
  • Meningitis
  • Scar formation
  • Recurrence of symptoms
  • Failure of metal work
  • Non-union
  • Adjacent segment degeneration
  • Further deformity of the spine
  • Further surgery
  • Deep venous thrombosis
  • Pulmonary embolism
  • Myocardial infarction
  • Stroke
  • Death

I will discuss the procedure and any associated risks with you in detail before going ahead. There’ll be plenty of time for you to ask any questions that you may have.

Next steps

Contact me for a consultation. I will discuss your medical history with you, carry out a physical examination and talk you through the treatment options.

Further information

• http://www.spine-health.com/treatment/back-surgery/lumbar-laminectomy-surgery-spinal-stenosis-open-decompression

Instrumented Postero-lateral Fusion

In many cases where there is spinal instability or if an operation is done where a lot of bone needs to be removed to decompress the spine, this will make the spine unstable. Therefore the spine may need to be stabilised and fused with rods and screws and bone graft.

The procedure

This is a general anaesthetic procedure.

Rods and screws are inserted into the spine to hold the spine in place and allow the spine to fuse together with the help of bone graft.

Recovery

Patients are up and about when the anaesthetic wears off and they can usually go home three or four days after surgery, although some patients can be well enough to go home the next day.

It can take up to three months after this procedure to get back to full fitness.

Next steps

Contact me for a consultation. I will discuss your medical history with you, carry out a physical examination and talk you through the treatment options.

Further information

• http://www.spine-health.com/treatment/spinal-fusion/lumbar-spinal-fusion-surgery

TLIF (Transforaminal Lumbar Interbody Fusion) and PLIF (Posterior Lumbar Interbody Fusion)

These procedures are a modification of the posterolateral fusion. Sometimes a posterolateral fusion may not be enough to support the spine. Therefore artificial cages may need to be inserted to the disc space further support the spine.

This is a general anaesthetic procedure.

Recovery

After the procedure patients are up and about when the anaesthetic wears off and they can usually go home three or four days after surgery, although some patients can be well enough to go home the next day.

It can take up to three months after this procedure to get back to full fitness.

Next steps

Contact me for a consultation. I will discuss your medical history with you, carry out a physical examination and talk you through the treatment options.

Further information

• http://www.spine-health.com/treatment/spinal-fusion/posterior-lumbar-interbody-fusion-plif-surgery
• http://www.spine-health.com/treatment/spinal-fusion/transforaminal-lumbar-interbody-fusion-tlif-back-surgery

ALIF (Anterior Lumbar Interbody Fusion)

Sometimes patients with back symptoms may require surgery from the front of the spine.

An incision is made into the abdomen to get access to the spine. With the development of spinal technology, most spinal procedures are performed from the back of the spine.

Further information

• http://www.spine-health.com/treatment/spinal-fusion/anterior-lumbar-interbody-fusion-alif-surgery

Minimally Invasive Procedures

Spinal surgical technology is advancing at an amazing rate. A lot of the procedures mentioned can be performed using minimally invasive techniques.

Often the incisions are smaller and there is less soft tissue muscle dissection. Patients can be in less pain and have a quicker recovery.

However, for various reasons, not all patients are suitable. I will perform minimally invasive surgery if I think it is suitable.

Next steps

Contact me for a consultation. I will discuss your medical history with you, carry out a physical examination and talk you through the treatment options.
Further information

• http://www.spine-health.com/treatment/spinal-fusion/update-minimally-invasive-spinal-fusion-surgery

Complications of Spinal Interventions and Surgery


These are the complications that you are expected to be told about by your surgeon when undergoing a spinal procedure.

Spinal Injections

Facet Joint Blocks, Nerve Root Blocks, Caudal Epidural Injections

Hundreds and thousands of spinal injections procedures are done throughout the world every year and they are a low risk, very safe procedure. However nothing is risk free.

Complications associated with are:-

  • Infection – less than 0.1%
  • Nerve damage – less than 0.1%
  • Motor Weakness – less than 0.1%
  • Sensory Loss – less than 0.1%
  • Abscess formation – less than 0.1%
  • Becoming worse off – less than 0.1%
Anterior Cervical Spinal Surgery

Anterior cervical spine surgery is a very common procedure. Fortunately complications are rare and if occur are usually minor and they recover. However rarely they can be serious.

The complications associated with anterior cervical spine surgery are:-

  • Infection
  • Nerve damage
  • Motor Weakness
  • Sensory Loss
  • Parallysis
  • Sexual Dysturbance
  • Bladder and Bowel Disturbance
  • Dural Tear
  • Leakage of Cerebro-spinal Fluid
  • Headache
  • Meningitis
  • Change of Voice
  • Hoarse Voice
  • Recurrent Laryngeal Nerve Injury
  • Difficulty in Swallowing
  • Scar Formation
  • Recurrence of Symptoms
  • Failure of Metal Work
  • Non-Union
  • Adjacent segment degeneration
  • Further Surgery
  • Deep Venous Thrombosis
  • Pulmonary Embolism
  • Myocardial Infarction
  • Stroke
  • Tracheal Injury
  • Vascular Injury
  • Oesophageal Injury
  • Death
Posterior Cervical Spinal Surgery

Posterior cervical spine surgery is a very common procedure. Fortunately complications are rare and if occur are usually minor and they recover. However rarely they can be serious.

The complications associated with anterior cervical spine surgery are:-

  • Pain
  • Infection
  • Nerve damage
  • Motor Weakness
  • Sensory Loss
  • Parallysis
  • Sexual Dysturbance
  • Bladder and Bowel Disturbance
  • Dural Tear
  • Leakage of Cerebro-spinal Fluid
  • Headache
  • Meningitis
  • Recurrence of Symptoms
  • Scar Formation
  • Failure of Metal Work
  • Non-Union
  • Adjacent Segment Degeneration
  • Further deformity of the spine
  • Further Surgery
  • Deep Venous Thrombosis
  • Pulmonary Embolism
  • Myocardial Infarction
  • Stroke
  • Death
Lumbar and Thoracic Spinal Surgery

Lumbar and Thoracic spine surgery is a very common procedure. Fortunately complications are rare and if occur are usually minor and they recover. However rarely they can be serious.

The complications associated with Lumbar and Thoracic spine surgery are:-

  • Pain
  • Infection
  • Nerve damage
  • Motor Weakness
  • Sensory Loss
  • Parallysis
  • Sexual Dysturbance
  • Bladder and Bowel Disturbance
  • Dural Tear
  • Leakage of Cerebro-spinal Fluid
  • Headache
  • Meningitis
  • Scar Formation
  • Recurrence of Symptoms
  • Failure of Metal Work
  • Non-Union
  • Adjacent Segment Degeneration
  • Further deformity of the spine
  • Further Surgery
  • Deep Venous Thrombosis
  • Pulmonary Embolism
  • Myocardial Infarction
  • Stroke
  • Death