Understanding the problem
The spine is a highly complex structure composed of vertebrae, joints, intervertebral discs, muscles and ligaments. Because these hard-working components endure significant wear and tear during the course of daily activity, they are susceptible to deterioration over time. The discs, in particular, are under continual stress because they serve as shock absorbers between the bony vertebrae. The spine’s facet joints, which are located in between individual vertebrae, are also prone to degeneration as they support the many movements that the neck and back perform. The cumulative effect of this ongoing pressure can sometimes result in degenerative spine disorders like degenerative disc disease and spinal osteoarthritis.
Degenerative spine is a collective term for a range of age-related effects that can happen to the spinal anatomy with time. Common degenerative spine conditions include degenerative disc disease, disc herniation, osteoarthritis, bone spurs and spinal stenosis. These disorders can also manifest at one or more levels of the spine, such as:
Cervical level — symptoms in the neck might radiate through the shoulders, arms, hands and fingers
Thoracic level — symptoms in the middle back and around the rib cage, kidneys and chest
Lumbar level. — symptoms that travel from the lower back through the hips, buttocks, legs and feet
Multilevel — degeneration in two or more areas of the spine
Understanding who suffers
Degenerative changes in the spine are common and occur in most people, with varying degrees of severity. There are several contributing factors for these degenerative changes, but aging is the most common cause.
Other causes of degenerative changes in the spine are:
- Trauma - Any form of traumatic injury can cause the spine to degenerate and weaken faster than it should. Lifting heavy objects, twisting or bending in an awkward way, and absorbing impact in a car accident or fall can damage the bone, cartilage, muscles, nerves and ligaments of the spine. Enduring the constant trauma of a job that requires continuous standing, bending and/or lifting may also cause damage to the neck or back. Any damage to the spine can take time to heal and may lead to permanent structural changes.
- Genetic predisposition - Some people are more likely to exhibit degenerative changes in the spine due to their genetics. For instance, a person may inherit a condition such as a narrow spinal canal, also known as spinal stenosis, or curvature of the spine, also known as scoliosis. Certain individuals may also be more prone to bulging discs, herniated discs or osteoarthritis.
- Smoking, diet, weight and other lifestyle factors - The toxins in cigarette smoke can damage the cartilage in the spine, which may lead to an earlier onset of degenerative spinal changes. Poor nutrition and excess weight can also cause the spine to wear out and weaken faster.
Potential Signs and Symptoms
Symptoms of a degenerative spine vary based on which specific condition a patient has. However, there are several symptoms that are common among all degenerative spine conditions, such as:
- Localized or radiating pain
- Numbness or tingling in the extremities
- Muscle weakness
- Stiffness in the neck or back
- A reduced range of motion
Additionally, the location of a patient’s symptoms depends on the area of their spine in which degeneration occurs. Degeneration in the cervical (upper) spine can affect the neck, shoulders, arms, hands and also the legs if the spinal cord is affected. Thoracic (middle spine) level degeneration can cause symptoms around the chest and ribs. Lumbar (lower) spine degeneration impacts the hips, legs and feet. Multilevel symptoms may occur when there is degeneration in two or more areas of the spine.
Examinations Usually Required
To diagnose if a degenerative spine condition is the source of pain, a doctor can perform a full exam. An MRI or CT scan may aid in pinpointing exactly where degenerative changes in the spine are taking place.
Proposing Treatment and Why AIMIS
Following the diagnosis of a degenerative spine, conservative non-surgical treatment will initially be proposed. If conservative treatment fails to provide relief, your physician might recommend surgery. Treatments can vary depending on the severity of your symptoms and how much they limit your everyday activities and your level of pain.
AIMIS is an expert in spine surgery and can provide minimally invasive procedures for degenerative spine and can review and propose your type and course of treatment.
- Discectomy - involves the partial removal of a damaged disc that is causing symptoms. In removing the damaged part of the disc, pain can be alleviated, as well as the potential weakness and numbness caused by its impingement on a surrounding nerve.
- Laminotomy - to remove the bony roof of a vertebra so as to provide more space to compressed nerves and relieving the symptoms caused by impingement.
- Foraminotomy – involved the widening a vertebral opening to allow nerves to pass through to innervate the other areas of the body, providing more room for compressed relieving the symptoms ranging from localized pain to radiating weakness.
- Fusions – in the case where the collapsed disc has lost significant height and can no longer support the surrounding vertebrae, spinal fusion involves the removal of the collapsed intervertebral disc, followed by a repositioning and fusing of the two neighbouring vertebrae.
However, for more severe cases there are a range of treatment options which AIMIS perform and include:
- Minimally Invasive Decompression Surgery
- Minimally Invasive Fusion Surgery,
- Minimally Invasive Stabilization Surgery Discectomy
- Artificial Disc Replacement Surgery,
- Total Disk Replacement (TDR),
- Anterior Cervical Discectomy & Fusion,
- Decompressor Discectomy,
- Lumbar Disc Microsurgery Treatment
- AxiaLIF or Axial Lumbar Interbody Fusion
- Stem cell transplantation – see page on Degenerative Disc Disease for more information
Why minimally invasive spine surgery?
Minimally invasive spine surgery was developed to treat spine problems with less injury to the muscles and other normal structures in the spine. It also assists the surgeon to see where the problem exists in the spine. Minimally invasive spine surgery (MISS), does not involve a long incision as is open surgery which helps to avoid damage to the muscles surrounding the spine. In most cases, this results in less pain after surgery and a significant faster recovery.
Spine surgery is normally recommended once a period of nonsurgical treatment likely including medications and physical therapy has not provided pain relief caused by the back problem. Surgery is considered when the source of your pain and underlying cause can be identified and surgical procedure proposed. Minimally invasive techniques today are common and being used for a wide range of spine procedures.
Benefits of minimal invasive spine surgery include:
- Small incisions
- Less pain. Often less pain than open procedures because less of the natural anatomy is disrupted
- Shorter Hospital stay
- Quicker return to daily activities
- Lower infection and complication rate
- Less blood loss. Smaller incisions also mean less blood loss, which can ultimately improve outcomes.
Minimally invasive procedures take a surgery that could be a dramatic event and makes it have less of an impact!
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Reputable and Prestigious Surgeons
AIMIS' skilled team of neurosurgeons, orthopaedic surgeons and ancillary professionals has one of the leading experiences in the world for minimally invasive spine surgery. Our full team are consulted with each case to find the most suitable experienced doctor for the patient’s exact issue, to ensure the maximum potential outcome of treatment
Getting More Information Before Moving Forward
You may have questions like:
- Can I get more information before I commit to this?
- Can I get a second opinion from you before I commit to this?
- How can I find out the cost before I have any obligation?
What AIMIS Can do:
AIMIS will provide a full review, diagnosis and potential surgical options for your condition, after receiving the relevant examinations and information from you. They will also provide an estimate for your surgical procedure before you decide. AIMIS’s mission is to the provision of “true” healthcare for those who require it. It provides world leading surgeons using state of the art procedures to optimize potential surgical outcomes, whilst taking care of all arrangements so as to allow concentration on recovery.
AIMIS provide competitive prices for state of the art procedures. We also work with a large range of Insurance companies where your policy allows you to have surgery abroad.
Further information on the problem:
The most common degenerative spine conditions are:
- Spinal osteoarthritis — Also referred to as degenerative spinal arthritis, this condition involves the breakdown of cartilage located on the spinal facet joints. When osteoarthritis occurs, cartilage wears away, allowing bone-on-bone contact to occur within the joint. This can cause inflammation, the formation of bone spurs and nerve irritation.
- Degenerative disc disease — A condition that describes the breakdown of intervertebral discs. As we grow older, the intervertebral discs dehydrate and the proteins that keep them healthy break down. As the discs deteriorate, they become less effective at supporting the vertebrae. This can cause the vertebrae to become slightly displaced and put pressure on the nerve roots that travel in between the vertebrae, or press on the spinal cord itself.
- Bulging discs — A bulging disc refers to an intervertebral disc that has swelled beyond its normal parameters between adjacent vertebral bodies. The enlarged disc remains structurally intact but, due to increased pressure, has expanded into the spinal column. A bulging disc is not inherently symptomatic, but when the disc wall comes in contact with the spinal cord or any nearby nerve infrastructure, painful symptoms can develop.
- Herniated discs — A herniated disc refers to an intervertebral disc that has ruptured, allowing the inner gel-like disc material to seep into the spinal canal through a tear in the disc wall. This condition can be painful if the nerves that innervate the disc become irritated as a result of the rupture or if the extruded disc material irritates the spinal nerves. Herniated discs might develop as a result of an injury, but can also be caused by disc weakening that comes with age.
- Spondylolisthesis — Spondylolisthesis is a condition indicated by the presence of vertebral misalignment. In an otherwise healthy spine, the spinal column has a natural s-curve that evenly distributes weight along its length. With spondylolisthesis, one of the vertebral bodies in the spinal column slides out of its normal position. This condition is described in degrees of severity, with Grade 1 spondylolisthesis representing 0-25 % slippage and Grade IV spondylolisthesis indicating 75-100 % vertebral slippage.
- Degenerative scoliosis — While most people equate scoliosis with adolescence, degenerative scoliosis is a spine condition that can develop later in life. When scoliosis occurs, it causes a side-to-side curvature of the spine, which can result in a hunched posture and a change in gait, among other symptoms.
- Bone spurs — Bone spurs are smooth protrusions of excess bone that frequently accompany arthritic deterioration. While these growths of bone are asymptomatic in and of themselves, the excess material can become problematic if it comes in contact with a nearby nerve. Bone spurs also often form in the aftermath of an injury.
- Spinal stenosis — Spinal stenosis describes the narrowing of the spinal canal. This isn’t necessarily problematic by itself, but when the canal space becomes constricted, the spinal cord and other nerve structures can be irritated. Common causes of spinal stenosis include the presence of herniated disc material, bone spurs and other tissue.
- Foraminal stenosis — Foraminal stenosis describes the narrowing of the passageways through which nerve roots enter and exit the spinal canal. Like spinal stenosis, this condition isn’t symptomatic by itself, but if the space becomes so narrowed that the nerves are irritated, a variety of painful symptoms may develop. Often, this condition causes discomfort to travel the length of the affected nerve, potentially causing pain to develop in areas seemingly unrelated to the spine.
- Pinched nerves — A pinched spinal nerve is a common condition that most people will experience on occasion as they grow older. When the symptoms of a pinched nerve don’t abate on their own over several days, they could be the byproduct of one of the aforementioned degenerative spine conditions. Alleviating the symptoms is contingent on identifying and addressing the cause of the nerve constriction.
- Sciatica — Sciatica is a term that is frequently used as a catch-all to describe the symptoms that arise from the inflammation and irritation of the sciatic nerve. This nerve originates at the base of the spinal cord and extends downward through the lower body before ending near the feet. Most commonly, sciatica is associated with chronic lower back and leg pain.
Further Information on Increased Risk Groups
The two main degenerative spine risk factors are virtually unavoidable: an aging body and traumatic injury. The natural aging process can dehydrate the spinal discs, making them lose elasticity. Aging also causes the spinal facet joints, where vertebrae meet and flex, to wear out. An injury, such as a compression fracture, can shift the spinal anatomy and worsen an existing degenerative condition. In addition to age and injury, lifestyle factors like smoking, poor diet, excessive weight and overuse may speed up spine degeneration.
While not every degenerative condition causes symptoms, disc or joint deterioration can lead to nerve compression - which can cause pain, tingling, numbness or muscle weakness. These symptoms can have a big impact on life if they happen, turning even simple tasks into painful ordeals. While there is no way to completely prevent a degenerative spine condition, knowing as much as possible about the risk factors that can lead to them offers the best chance of avoiding painful symptoms.
There are many lifestyle decisions that have a serious impact on overall health, which in turn can affect the spine health and the risk level for degenerative conditions like disc disease or spinal arthritis. Here are three practical things anyone can do to limit their onset:
- Modify activities to avoid back stress - If there are particular exercises or activities that seem to trigger back pain, it makes sense to avoid those activities if possible. In addition to practicing good posture at all times, it is important to also use proper technique when lifting heavy objects and participating in sports.
- Stay active - An active lifestyle, with regular, physician-approved exercise, helps the discs retain water and keeps the bones and muscles in the neck and back strong. This, in turn, improves spinal stability and may slow degeneration.
- Eat well - A lower calorie, nutrient-rich diet helps with weight loss. Extra weight means the vertebrae and discs from have to support more weight than they were designed to carry. Good nutrition also helps support spinal strength. Drinking plenty of water keeps the discs hydrated and helps joints stay lubricated.
Why AIMIS for this Surgery
AIMIS strives for excellence in delivering the best surgical outcomes, via the extensive expertise of its prestige surgeons, its technologies, its highly trained staff and superior facilities to provide an individualized and compassionate experience in a comfortable environment. All patients are treated with the individual care they deserve in an effort to provide the best chance of successful treatment.
Other Services Provided by AIMIS
In addition to its Innovative Healthcare, AIMIS provides seamless service along the way. From the start of your journey you'll know the best flights to take, where you'll be staying, what paperwork you will need. You will have a personal assistant assigned; from your pick up at the airport, to your accommodation, continuous assistance at your pre-consultation, through surgery and in your postsurgical care. Our Patients have said that they feel they have become "part of our family" and some even asked to stay a little longer! AIMIS is here to assist you in an all you requirements, allowing you to focus on your health and recovery.