Ensuring that you are fully informed is vital to what we do and how we practice medicine. We have created information links below for common spinal problems and their treatment. We have also created a referral form so that we can capture all the information we need to know about you, both before and after treatment.
Measurement of outcome scores is the keystone of delivering quality patient care at OneSpine and assists planning not only the care we provide you but also future patients. We also continuously assess how we are doing. Patient feedback is vital to providing a tailored reactive and forward thinking service to you now and in the future.
Please use the links below for a summary of common spinal conditions regularly managed by OneSpine. Our therapists and doctors will provide further information tailored to your individual situation following consultation.
For further information on spinal conditions, their management and spinal surgery consent please visit: British Association of Spine Surgeons Click Link below
Please ask your GP to refer to your most convenient OneSpine treatment centre for a consultation (Exeter, Torquay or Cornwall).
Patient feedback is important to us. If you can spare a moment please click on this link to tell us how we are doing: firstname.lastname@example.org
Back and neck pain are extremely common. Approximately 80% of adults will experience lower back pain at some point in their lives which also includes us at OneSpine so we know what you’re going through. In the majority of situations pain improves quickly but unfortunately this is not always the case. We are here to get you through to the other side and have experts with a proven track record in managing even the most complex of situations. This is one of the most common symptoms that we see and treat at OneSpine.
While the cause of pain is often clear, an injury on the sports field or sudden movement at work, that is not always the case. Pain can be sudden (acute) and treated appropriately will settle or become chronic with ongoing pain symptoms for a variety of reasons.
A great many factors can cause or contribute to back and neck pain which in itself is a large and increasingly specialist topic. That is why we have experts on hand to thoroughly assess and examine you, to request imaging where needed and more importantly plan a strategy to get you back onto your feet again. Any structure in the back can be responsible for pain including the discs and joints in the back, the tendons and muscles that move us and the ligaments that help support and stabilise. Occasionally pain can be from elsewhere including the kidneys, blood vessels and abdomen and rarely it can be caused by the unexpected including infection and cancer. We also consider other factors that are frequently responsible for making back and neck pain worse including psychological factors which our experts seek to identify at an early stage. Fortunately, in the vast majority the pain is due to the moving parts and managed by physical therapy with our experts dedicating their practice to spinal pain so you know you’re in good hands.
Our approach to managing back and neck pain is entirely team led. Following assessment and where required imaging many patients can be quickly and successfully treated with physical therapy rehabilitating your spine and restoring normal movement. The expertise of our OneSpine therapists is vital to this approach with each case being different and requiring a tailored individual plan. In some instances our pain physicians will help through pharmacy or occasionally targeted injections to settle pain symptoms down so our therapists can get to work.
In the majority of cases non-surgical treatment is successful in treating pain symptoms in the lower back and neck. Surgery is rarely indicated or indeed needed however in some situations it is considered by our team. This is usually where a clear anatomical source of pain has been identified such is instability within a segment of the spine or when a nerve pain is associated.
Managing back and neck pain in most cases is rapid and effective with simple strategies used by our team to get you back to health. In those situations where progress is less quick or symptoms persist our team of specialists including pain doctors, surgeons and imaging specialists will be on hand to further investigate and treat your symptoms or at the very least provide reassurance.
OneSpine specialises in the treatment of acute and chronic disc herniation (disc prolapse). This can occur at any level in the spine but most commonly affects the lumbar and cervical spine. A disc herniation can cause severe pain and depending on the location of the disc, symptoms can radiate to the arms, legs and include the back and neck. We have the expertise required to reach a diagnosis quickly and manage the symptoms. While in some circumstances surgery is recommended, with a broad range of experience within our team, other strategies can bring rapid relief of symptoms.
The intervertebral disc is essentially a load-bearing “shock absorber”. There are 23 intervertebral discs in the spine, some are more susceptible to degeneration (wear and tear) than others, particularly those in the lower back and middle of the neck. The disc has a soft centre (nucleus pulposus) surrounded by a fibrous lining. A rupture to the lining of the disc in close proximity to the passing spinal nerves can cause pressure and inflammation often resulting in severe pain.
While it can be a consequence of a sudden movement or abnormal load placed through the spine often it can occur without any clear causative event. We all develop degeneration within our discs over time and some of us will inevitably suffer a disc herniation at some point. Typically a sudden pain in the spine will be experienced, sometimes associated with a “popping” sensation and often with rapid pain in either legs or arms. This can also be accompanied by numbness and paraesthesia (pins and needles) and occasionally weakness of the muscle supplied by the particular nerve affected.
Rarely a large disc herniation in the lower back can cause pain in both legs and result in a change in nerve supply to the bladder and bowel with altered feeling to the skin between the legs. This is because all the nerves passing through the spine in the lower back, the cauda equina (the horses tail) are affected. Any suggestion of this combination of symptoms can not wait for assessment and we would recommend urgent examination in a nearby Doctors surgery or Emergency Department to exclude Cauda Equina Syndrome.
The first step is to be assessed by one of our team allowing us to talk to you and examine for clinical signs. The diagnostic process then often requires imaging of the spine to determine the exact nature of the underlying problem and provide a detailed map of the anatomy. In some situations an X-Ray will be helpful to look at the bony architecture of the spine while an MRI scan can help to evaluate the soft tissues in more detail. On occasion other specialist imaging techniques, guided by our experienced Musculo-Skeletal Radiologists, are used to gather more information.
Once the underlying cause of symptoms is known and a full assessment has been made a management plan is prepared. In the majority of cases, in the right hands, disc herniations can be managed without the need for surgery. This can include specialist pain medication, targeted spinal injections performed under either local anaesthetic or sedation and specialist physiotherapy. In some instances, in fact less than 10%, spinal surgery is recommended to treat the disc herniation and in particular the symptoms from the nerve itself. Surgery is a minimally invasive surgery performed through a small incision using a microscope. This approach is designed to limit the disturbance of tissues in the spine and the pain experienced during recovery, so you can get back on your feet on the day of surgery in most cases. The surgeon will carefully explain the risks of operating and the alternative treatment options to you so that you can make the risk decision for you.
Through working as a group combining surgical, therapy, imaging and pain expertise we can help determine the best approach for you. Should your situation change we can adapt our approach to ensure the right specialist is looking after you. Why see one specialist when you can be treated by a team?
The spinal column is a supportive bony structure consisting of bones (vertebra) and connected by disc, ligaments, tendon and muscles that spans the trunk of the body from head pelvis. It is responsible for safely carrying nerves through an intricate system of tunnels and corridors and protecting them from everything we get up to in the world outside. These tunnels can narrow, or become stenotic, for a number of reasons which most commonly happens due to degenerative (wear and tear) processes throughout the spine over time.
Depending on what part of the spine is narrowed a number of symptoms can follow. Higher up the spine in the neck and occasionally the thoracic spine, the spinal cord is housed in the central spinal canal travelling from the base of the brain to the beginning of the lumbar spine. Stenosis at these levels can result in changes to the spinal cord itself resulting in a change to balance, dexterity and clumsiness. Where it is only a smaller tunnel affected in these regions, where a nerve has already left the spinal cord and is exiting the spine, stenosis can cause the same symptoms as a disc herniation with pain in the arm, numbness and sometimes weakness experienced.
In the lumbar spine stenosis can narrow spinal tunnels in a number of ways, ranging from the central main corridor to the sides of the spinal tunnel or the smaller exiting tunnels (foramen). Symptoms can themselves range from those affecting a single nerve including pain commonly experienced in the leg, numbness and weakness or one or several muscles. When the main corridor is narrowed in the centre of the spine more nerves can be affected. This can cause heaviness or early fatigue in the legs when walking such that they may “turn to jelly” and often relieved with rest.
A thorough clinical assessment is vital and often combined with specialist imaging including MRI of the spine. In some circumstances a more direct assessment of the nerves and muscles themselves is recommended and nerve conduction studies requested before planning the best and safest way forward for your. Through our clinical expertise and with the guidance of our Radiology experts a cause of the symptoms is identified and treatment recommendations made.
In many cases it is possible to manage spinal stenosis without surgery and the combined input of our therapy and pain team used to help manage your symptoms. Every cases is different and therefore our treatment is planned for your individually.
Surgery is recommended in selected cases and indicated to make more room for the nerves and decompress the area of the spine involved. The nature of surgery depends very much on the part of the spine affected, the pattern of stenosis on imaging and the symptoms involved. Your surgeon will spend time carefully explaining the situation to you and the treatment options available, so you can together decide the best way ahead.
Spondylo- refers to the spine and listhesis means to slip or slide. There are a number of reasons for vertebra to change position in the spine which is most common in the lower lumbar spine and middle of the neck.
The reasons for spondylolisthesis range from variations in anatomy during foetal development (congenital causes) to fractures that can occur in the growing spine (spondylolytic) to the most common occurrence being due to osteoarthrosis of the facet joints (degenerative). Other rare causes do exist for spondylolisthesis which our experts will always consider during assessment.
A spondylolisthesis is often asymptomatic for some time before patients present to clinic with recent, or increasingly troublesome symptoms. Frequently a change in position of vertebra will alter the amount of room for nerves passing through the spine causing narrowing of tunnels and nerve symptoms including pain, altered sensation and in some instances weakness. This can happen on one or both sides of the spine and cause the symptoms of spinal stenosis (link). It is also possible for some of the lumbar (back pain) symptoms to be due to movement occurring in the spine.
During assessment a detailed history and examination is performed and often imaging organised including X-Ray of the spine in the upright position to assess the position of the vertebra under load and MRI. The latter is useful for evaluating the spinal tunnels and areas where nerves may be pinched or trapped. It also provides information about other parts of the spine and the health of the joints. Underlying causes including degenerative joints or pre-existing weakness within the spine are usually identified with the help of our specialist radiologists. In some cases further imaging with CT to image bony anatomy in more detail is helpful.
Do I need an operation? The benefit of having a spinal surgeon involved in your care through OneSpine is that often their role is to reassure and allow other modes of treatment to proceed. Conservative (non-surgical) management is frequently successful at restoring spinal muscle strength, relieving pain and getting you mobile again through a program of physical therapy and where required assisted by our pain specialists. Surgery is generally reserved for the minority who fail to return to their expected level of function, where pain does not settle fully or where symptoms are extreme.
While a spondylolisthesis involves a movement of one vertebra in relation to another it is not always necessary to stabilise the spine surgically. In many situations a slipped vertebra will stabilise and where surgery is being considered a decompression surgery to make more room for nerves is appropriate. In some scenarios placing instrumentation in the spine (screws into the bone, rods between them, cages between the bones) is carefully considered and planned by your surgical team. The surgeon will discuss at length the benefits versus the risks of surgery before you proceed in a dedicated consent clinic ensuring you have all the information you need.