Dr Chua Soo Yong
Extended sitting, especially with poor posture, can result in back problems, particularly in the lower back.
Studies have shown that lower back pain afflicts around 80% of Singaporeans today. In many cases, this is caused by a strain to the back muscles and ligaments. Back pain can be treated through a mixture of rest, medication, improved posture, using more ergonomic equipment, and physiotherapy.
However, lower back pain, can lead to more serious problems that affect your spine. For example, persistent lower back pain may indicate weaker back muscles, and in turn, the lack of lower back muscular support increases the likelihood of a slipped disc (also known as herniated disc) injury. Weaker back muscles can add excess pressure onto your spinal discs, which may contribute to spine injury. Poor posture can also lead to spinal deformities such as Scheuermann's Disease, commonly known as a hunch back. A deformed spine may cause secondary complications such as herniated discs or pinched nerves. Besides poor posture, weakened bone structure from conditions such as osteoporosis can also lead to spinal fractures.
Dr Chua Soo Yong, an orthopaedic surgeon who specialises in complex spinal surgeries, explains treatments that may help you relieve your back pains.
Your spinal column is made up of 26 bones (vertebrae) that are cushioned by discs. Injury or weakness to the spine or back can cause the inner portion of a spinal disc to protrude through the outer ring. This results in a slipped or herniated disc.
While most patients can relieve slipped disc pain with exercises that stretch and strengthen the back and surrounding muscles, an orthopaedic specialist may recommend surgery if your symptoms do not subside in 6 weeks or if your slipped disc affects your muscular functions. Nucleoplasty is a minimally invasive procedure for people suffering from a slipped disc and a viable option when more conservative methods of care have failed. It involves the use of a small probe that uses radiofrequency to burn away the part of the disc that is pressing on the nerves.
The probe has the thickness of a needle, which means the patient does not need to receive large cuts. This procedure takes less than an hour, and the patient goes home with a small bandage on the back after the day surgery. "If there are no complications, the patient is able to move about immediately after the surgery, and there should be no negative effects on everyday activities," says Dr Chua.
A spinal fusion surgery is designed to stop the motion at a painful vertebral segment, which in turn should decrease pain generated from the joint.
Spinal fusion is recommended for patients who suffer from degenerated discs or other conditions where the spine is moving abnormally. Other conditions that may be treated by a spinal fusion surgery include a weak or unstable spine (caused by infections or tumours), fractures, scoliosis, or deformity.
Interbody fusion is a minimally invasive type of spinal fusion, where the weakened or diseased disc is removed entirely and replaced by a steel cage filled with bone graft. The 2 vertebra bones above and below the disc are then connected using a steel plate and screws. This promotes bone healing and facilitates the fusion of the affected area.
Unlike traditional spinal fusions, which require open surgery that can affect the back muscles, important arteries and other organs, interbody fusion can be done using probes that enter through the side of the back, says Dr Chua. This means that there is lesser risk of affecting other parts of the body, and also lesser risk of infection due to a smaller cut. While the healing process can take up to 8 weeks to complete, the patient is usually allowed to move freely within a couple of days. There will be some restrictions on physical activities during the healing period, but daily activities should not be affected.
It takes about 3 months for fusions to mature and become solid, and post-operatively, the bone graft will continue to heal and become stronger over the following couple of years. After surgery, all of your muscles will be much weaker, so rehabilitation is typically recommended to get you and your back into optimal condition. Full mobility is usually regained after the fusion process is completed.
Spinal deformity correction surgery with osteotomy is an option when non-surgical treatments fail to relieve pain or symptoms. This procedure is typically recommended for patients whose deformity is progressing or the spinal curvature (ie. hunched back) contributes to nerve compression.
A spinal osteotomy is needed for correction in cases of a rigid, fixed and severely spinal deformity to facilitate corrective re-alignment. The aims of an osteotomy are to restore an erect posture so that the patient can stand straight without the need to flex the hips or knees, and to reduce the pain.
Spinal osteotomy is a technically demanding procedure that requires careful consideration with a trusted spinal surgeon, explains Dr Chua. This is because unlike spinal fusions, spinal osteotomy requires precision cutting of the bone so that any misalignment can be fixed. After cutting the bone, the spine may be re-aligned and thereafter fixed with screws and rods and held together in a united construct, similar to spinal fusions. This results in a permanent correction of the spinal alignment or deformity. A successful spinal osteotomy, says Dr Chua, could help in relieving the patient's pain and discomfort as well as postural abnormality and hence lead to a better quality of life in the long run.
You will be able to wake up and walk by the end of the first day after the surgery. You would be able to resume your work within 3 – 6 weeks, depending on your body's healing and the type of work/activity that you intend.