Back pain - Physical therapy & Surgery

A physical therapist can apply a variety of treatments, such as heat, ice, ultrasound, electrical stimulation and muscle-release techniques, to your back muscles and soft tissues to reduce pain. As pain improves, the therapist can teach you specific exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques will help prevent pain from returning.

Injections
If other measures don't relieve your pain and if your pain radiates down your leg, your doctor may inject cortisone — an anti-inflammatory medication — into the space around your spinal cord (epidural space).
Surgery
Types of back surgery include:

• Spine navigation surgery. It is a new techniques that can enhance the precision in the surgical regions, reduce the surgical time, reduce radiation exposures to patients and surgeon. Increase safety and accuracy through more precise screw placement and enables minimally invasive approaches.
• Partial removal of disk. If disk material is pressing or squeezing a nerve, your orthopaedics doctor may be able to remove just the portion of the disk that's causing the problem.
• Partial removal of a vertebra. If your spine has developed bony growths that are pinching your spinal cord or nerves, orthopaedics surgeons can remove a small section of the offending vertebra, to open up the passage.
• Fusion. This surgery involves joining two vertebrae to eliminate painful movement. A drawback to the procedure is that it increases the chances of arthritis developing in adjoining vertebrae.

Reference information: knowyourback.org, ispine.com.hk

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your personal physician.

頸的脊椎病

治療這類退化性頸脊髓病的方法，我會建議神經減壓，在前路切除椎間盤，並作出融合。或者，在後路進行椎板擴張術。做何種手術、多少節段，會由醫生因應病情而決定。

在面對病人時，如何說服病人接受此手術為最大的挑戰。因為，在病人的角度，他／她並沒有感受到強烈的痛楚，因此，會比較容易輕視其嚴重性。但是，作為醫生，我很清楚如果病人不及時接受手術的話，他／她的情況很大機會會轉差。這個手術就像是一個拆除炸彈的過程，所以必須要讓病人瞭解背後的原因。

另外，在亞洲，除了退化及椎間盤突出外，另一種比較常見的頸脊髓病的病因是後縱韌帶骨化。在日本，特別常見，每50人裡面便有1個人有此情況。
在中國，大約每200人裡面便有1個人有此情況。當然，並不是每個有此情況的人都有臨床病徵。所以，很多頸椎手術都是日本人發明的。但是為何在日本特別多發？直到現時仍未證實。

資料表明，糖尿病患者比較容易患此病，所以推斷與碳水化合物的新陳代謝可能有關，因此有一個講法是大概與亞洲人比較常吃米飯有關。

不過，這只是一個學術性的推斷，尚沒有證據證實。我相信大家並不會因而戒吃米飯吧！

參考資料:  www.info.gov.hk

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向自己的骨科醫生查詢，而不應單倚賴以上提供的資料。

甚麼是脊椎導航手術？

脊椎導航手術在2000年已開始推出市場，香港亦引入這種技術超過五年。其實類似的導航技術已在日常車輛駕駛、電子遊戲機（例如wii）中廣泛應用。脊椎導航技術能幫助骨科醫生提高脊椎手術的精確度，而且能減低手術中X光輻射攝取量。

 

手術前，骨科醫生會進行適當的診斷和評估病人是否適合脊椎導航手術。

- 除一般因脊椎受傷而需要進行手術的病人外，亦特別適合一些手術位置較微細的病人使用：

- 曾經接受脊椎手術而需要複修的病人；

- 因骨骼退化而骨骼較脆弱的病人，如骨質疏鬆症的病人；

- 受傷位置較難處理，手術風險難高的位置，如位置接近椎動脈的頸骨、嚴重變形的脊椎、椎弓根較狹窄等等。

- 手術前骨科醫生會為病人作3D影像掃描，然後將掃描的3D影像與病人脊椎位置進行電腦配對。手術期間，骨科醫生可透過導航技術，即時分析3D配對影像，提高手術的精確度，例如手術螺絲入骨的深度。

參考資料:  www.hkcos.org.hk , http://www.ispine.com.hk/

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向自己的骨科醫生查詢，而不應單倚賴以上提供的資料。

Back pain - Physical therapy & Surgery

A physical therapist can apply a variety of treatments, such as heat, ice, ultrasound, electrical stimulation and muscle-release techniques, to your back muscles and soft tissues to reduce pain. As pain improves, the therapist can teach you specific exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques will help prevent pain from returning.

Injections
If other measures don't relieve your pain and if your pain radiates down your leg, your doctor may inject cortisone — an anti-inflammatory medication — into the space around your spinal cord (epidural space).
Surgery
Types of back surgery include:

• Spine navigation surgery. It is a new techniques that can enhance the precision in the surgical regions, reduce the surgical time, reduce radiation exposures to patients and surgeon. Increase safety and accuracy through more precise screw placement and enables minimally invasive approaches.
• Partial removal of disk. If disk material is pressing or squeezing a nerve, your orthopaedics doctor may be able to remove just the portion of the disk that's causing the problem.
• Partial removal of a vertebra. If your spine has developed bony growths that are pinching your spinal cord or nerves, orthopaedics surgeons can remove a small section of the offending vertebra, to open up the passage.
• Fusion. This surgery involves joining two vertebrae to eliminate painful movement. A drawback to the procedure is that it increases the chances of arthritis developing in adjoining vertebrae.

Reference information: knowyourback.org, ispine.com.hk

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your personal physician.

Intervertebral Disc

The ANNULUS FIBROSUS makes up the outer part of the disc. It consists of collagen fibers containing significant amounts of water and proteoglycans. These fibers are arranged in concentric layers called LAMELLAE. The lamellae are thicker and more numerous in the anterior part of the disc.

Within each lamella, the collagen fibres are oriented obliquely about 30º to the horizontal. The orientation is reversed in each contiguous layer, resulting in a 120º change from layer to layer. This interstriation of fibers imparts great tensile strength and allows for multiplanar motion. The structure of the disc is similar to a radial automobile tire, which also has great strength and simultaneous compression and tension capabilities.

The NUCLEUS PULPOSUS is the internal substance of the disc. The inner fibers of the annulus fibrosus gradually blend with the nucleus pulposus.

The nucleus pulposus is more gelatinous than the annulus and has a higher water and proteoglycan content. The water content can be 85% in young people; in older people, the water content of the nucleus pulposus may be less than 25%. The nucleus pulposus acts to resist compression in axial loading forces.

Besides allowing for motion, the discs act as shock absorbers to prevent injury to the vertebral bodies and neurological struc-tures. However, the discs are so strong that in compression, the vertebral body will fail before the discs fail.

Reference information: ispine.com.hk

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.