From the Jakarta Post, this is very interesting
Procedures to give you fast and effective relief from back pain
Dr. Bernard Lee | Wed, 09/30/2009 1:17 PM | Body & Soul
Persistent aches and pains in the lower back are among the most common sources of pain and disability and affect two-thirds of adults at some point in their lives.
In most cases the pain can be managed with simple treatments and over-the-counter medications. But for some patients, unfortunately, the pain persists due to a slipped disc.
The prospect of costly open-back surgery coupled with the possibility of paralysis should the operation fail would only make matters worse. But thanks to medical advancements, now there are two procedures available to remedy the problem - quickly and cheaply.
In recent years the popular trend in spinal surgery has been toward reduction and minimalization. Minimally invasive procedures are preferred by surgeons because they eliminate the destructive effect on bony structures and reduce scar formation.
Dr Bernard Lee, founder and director of Singapore Paincare Center, is one of the few pioneering pain specialists in Singapore who offers both procedures: nucleoplasty and epidural adhesiolysis.
"Both minimally invasive techniques can be completed in just one or two hours," says Dr. Lee.
"They are comparatively safe and there is very little down time. In fact, the patient could do the procedure today and be well enough to go dancing tomorrow!"
Nucleoplasty (which literally means removing the nucleus) is a minimally invasive therapeutic option that has been used for spinal procedures since July 2000. It is designed to decompress slipped discs. The procedure is done under fluoroscopic guidance.
Using a thin catheter to gain access to the bulging disc, a tiny radio transmitter is inserted into the disc nucleus through the catheter. This transmitter emits radio waves that break up the material in the nucleus, decreasing the amount of nucleus material putting pressure on the bulging disc wall.
"The patient will be sedated. A wand-like device is inserted into the center of the disc to relieve the pressure exerted by the disc on the nearby nerve root. When the pressure lifts, the pain will be reduced," explains Dr. Lee, who received his training in Sydney, Australia. Dr Lee is also a medical acupuncturist.
Compared with open back surgery, which can cost anywhere between S$10,000 and S$15,000, nucleoplasty is a safe and cheap option. With the cost between S$4,000 and S$6,000, patients are paying just half as much for a highly effective procedure.
The operation is extremely precise and average pain reduction is significant - about 55 to 60 percent. Patients' satisfaction is also high - around 90 percent - for several reasons: the simplicity of the procedure, the lack of trauma or painful downtime and the lack of the possible risks of failure of open surgery.
To boost the success of nucleoplasty, a diagnostic discography is normally performed to identify the exact disc or discs involved and the correct level of disc-generated pain. A test solution needs to be first injected into each suspected disc while the patient is conscious, to elicit a response when the troubled disc is breached.
"To put it simply, I need the patient to say *Ouch!' when I correctly identify the problem disc. The discomfort won't last too long and it's important we treat the right spot the first time around," says Dr Lee.
Despite its effectiveness and success rate, it is important to note that nucleoplasty is not for everyone.
"Where slipped discs are concerned, size really matters," Dr. Lee says. "How far they have slipped makes a difference in determining the type of procedure to use. For nucleoplasty, the disc must not have slipped more than 25 percent into the spinal canal."
For a more severe slipped disc condition - between 25 percent and 50 percent - nucleoplasty is not recommended. A second procedure called epidural adhesiolysis may be more useful.
"When a disc slips significantly, it will cause severe inflammation to the surrounding nerves. This in turn may lead to scarring of the nerves, which will harden and stick together. Such a scenario is especially likely if the slipped disc goes ignored for a month or two," says Dr Lee.
"The process is much like in angioplasty, where you balloon the blocked heart vessels. Here, we try to free the scarred nerves that are stuck down by opening up some space."
The epidural adhesiolysis procedure is done using a special catheter introduced through a needle in the patient's buttock. Patients suffering from chronic low back pain and who are unable to undergo open-back surgery can benefit from this procedure.
Like nucleoplasty, epidural adhesiolysis is a simple procedure; patients will be lightly sedated and able to perform daily routines within hours after the procedure. Nevertheless, Dr Lee cautions that neither procedure may be a lifetime solution.
"Patients need to do their part in recovery," he says. "The procedure acts to free up the stuck nerves, but the nerves, once freed, must stay free. To ensure this, the nerves must be regularly stretched and the patient will have to take up some form of exercise."
Exercise is an important tool for building a strong body. Muscular back pain can be prevented, or reduced, using a comprehensive program of specific back exercises.
"A lot of people these days are far too sedentary. They push paper around at work, lounge about at home, and rarely exercise. Then they go on holiday and suddenly carry a backpack or try to lift heavy luggage. Their backs are not conditioned to take the sudden stress and the result is either a pulled back muscle or a slipped disc," Dr. Lee says.
A slipped disc is the result of accidents and improper habits of lifting, bending, twisting and turning, causing direct or indirect pressure on the spinal cords.
It might come to a surprise to many but simple everyday activities such as carrying a flowerpot or lifting a heavy load off the floor could cause a slip and could be costly - both physically and financially.
"Studies have shown that eight out of every 10 people will experience back pain at least once in their lives. A lot of time at work is lost to back pain every day because people simply cannot function when even sitting down or standing up causes pain," says Dr Lee.
"Your body is designed to be flexible, but you have to constantly move the parts. Stretching daily and simple exercises will help keep back pain away."
cFlyFreeForHealth2009.
For more information, please goto www.backpainloss.com
Paul
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