Guest Column
Monday 18th October, 2021 | Dr B K S Sanjay
Dr BKS Sanjay
World Spine Day is held with the aim of motivating people and creating awareness about the burden of spinal pain and disability and it also recognizes the lack of access to quality spine care and rehabilitation in under-served communities, which results in chronicity and permanent spine deformity. The day also aims to increase awareness for the prevention, diagnosis, and treatment of back pain and other spine issues.
The importance of our back can be gauged from the commonly used adage about a particular person being the backbone of that organization or society. The backbone plays an important role in maintaining and functioning our body. The human spine is a complex structure spanning from the head to the tailbone. The spinal column protects the spinal cord and the nerve roots and allows the body movements in three dimensions. It also maintains the balance of the head, the trunk and the pelvis through the various intervertebral discs, facet joints, muscles and adjacent ligaments.
Backache is the second most common health problem a person experiences after a headache. Low back pain is the leading cause of disability all over the world and it prevents many people from engaging in their domestic and office work and this makes them seek help from healthcare providers. Back pain can affect people of all ages from adult to the elderly. In my personal experience I have noticed more than half the number of patients are related to back pain. The main causes of back pain are muscular spasm, slip disc in young patients and degenerative spinal stenosis and facet joints arthritis in elderly patients.
The world wide data shows that disability caused by back pain is increasing. This disability is more relevant and the impact is more in low income and middle-income people. The social impact of back pain is tremendous on society. Because of back pain the families are getting indirect mental stress. The psychological and social impact on the patients’ health leads to depression, insomnia, anxiety and various psychosomatic disorders.
In pre-industrialization times the main cause of back pain was lifting or carrying of heavy loads but in recent times, people having sedentary lifestyles are more prone to develop back pain due to weakness in the surrounding muscles.
If we consider the degenerative problem related to the back and its disability. Then the spine joints which are called the facet joints are similar to the synovial knee joints. It is to be understood that as age advances so does various joint arthritis.
The symptoms and signs of facet joint arthritis are similar to that of joint arthritis. Arthritis of any joint presents with pain and stiffness of the joint particularly in the morning time or after prolonged rest. Swelling of the knee joint can be appreciated easily because the joint is superficial and large. But in contrast to the knee joints, the facet joints are smaller in size and deep surrounded by strong and thick ligaments. The facet joint bears the stress bearing forces, many times more per capita area in comparison to the knee joints. Sometimes due to degeneration of facet joints and break of the pars inter articularis. The body of one vertebra slips over the other vertebra ,causing spinal canal compression and leading to spinal cord and spinal nerve compression which presents with the radicular nerve pain with symptoms of dull pain in the calf, around the back, numbness in the legs, difficulty in proper walking and standing. Sometimes even any change of posture, particularly rotational, twisting, or bending can increase the pain.
Mechanical back pain can be managed with the rest, heat therapy, physiotherapy, use of analgesic, chiropractic manipulation. If the problem doesn’t subside, then the patient should consult a qualified spine surgeon and should go through the investigations like x-ray, CT scan and MRI of the spine. If the patient is having only back pain but no other comorbidities like diabetes , hypertension, hypothyroidism ,varicose veins of the legs then problems can usually be managed simply. Patients who smoke tobacco and consume alcohol are tougher to deal with.
If the pressure on the spinal cord or on the nerve roots remains for a prolonged time, then patients may develop difficulty in passing the urine and feces. These symptoms show that the problem is very serious and patients often need the emergency surgical intervention like decompression or fixation of the spine as the condition exists.
If in any case surgery cannot be performed because of any reason, especially in non-traumatic spinal cord compression then injection of epidural steroid, or transforaminal nerve blocks are better options. In the author’s experience, injection epidural steroids gives reasonable and acceptable results especially in high risk patients.
Bad posture can cause pain and can increase the existing back pain. Lack of awareness, neglect of pain, poverty, lack of trained doctors and the shortage of good hospitals accentuates this simple problem to a serious problem in about 20 per cent of back pain patients. Spine surgeries are difficult and risky but its success completely depends on the skill of the surgeon and standard of medical facilities available in the hospital. Spine surgery, like any surgery, has very good results if done in a well selected patient, on time and before landing up in complications due to the neglect of treatment. After the surgery, the patient has to follow a definite protocol for a certain time to get the ideal result. The author himself has done thousands of spine surgeries, varying from simple to most complicated high-risk spine surgeries in more than 20 years in the past and none of them has resulted in paralysis after surgery. In fact, the author’s name has been recorded in the Limca book of records for doing spine surgery in an 88 years old male.
(A Padma Shri recipient, the author is an orthopaedic surgeon based in Dehradun)
