Neurosurgery specialist Dr Clarence Leung is Clinical Director of the Minimally Invasive Spine Surgery Center at Hong Kong Adventist Hospital – Stubbs Road. We spoke with him about back pain and recent improvements in treatment.
Why are our spines so susceptible to injury?
Because the spine is the single bony component with the most numbers of joints, and it sustains about 80 percent of our body weight.
What is meant by a “slipped disc”?
A slipped disc is a broad term mostly referring to the herniation of the intervertebral disc, when part of that disc protrudes into the spinal canal and compresses either the spinal cord, the nerve root or the nerve bundle known as the cauda equina. This is the back problem we see in patients most commonly from day to day. Then there are structural problems, such as lumbar discogenic pain, spondylolisthesis, lumbar stenosis, spine fracture and so on.
Back pain is very common, and can be relatively mild. At what point should a person see their doctor about it?
Most back pain resolves without treatment. But you should seek medical advice if the pain lasts more than four to six weeks, or when any of the following red flags are present:
- difficulty passing urine or having a bowel movement
- numbness in the “saddle area”
- progressive weakness in the legs
- severe, continuous abdominal and low back pain
- a fever of 38ºC or above
- unexplained weight loss
- constant back pain that doesn’t ease after lying down
- pain in your chest or high up in your back, or down your legs and below the knees
- pain caused by a recent trauma or injury to your back
- pain that is worse at night
What typically happens at the initial appointment for someone with a back complaint?
After the patient has filled out a questionnaire about the problem, the treating physician will take a detailed history, carrying out a thorough clinical examination to check for location of pain, restriction of movement and any neurological deficits in the limbs. By this stage, the physician should have a rough idea of the problem and may order further investigations such as x-rays or MRI scans.
What kinds of treatments are available?
The treatment of spine diseases can be divided into non-invasive and invasive treatments. The former include medication such as non-steroidal anti-inflammatory drugs, narcotics and muscle relaxants. Invasive treatments include injection therapy, such as epidural steroid injection, and surgical decompression with or without fusion and fixation.
Have spinal surgical techniques changed over time?
They’re evolving every year. The most ground-breaking advancement has been the introduction of a minimally invasive approach to most spinal operations, with the required incision reduced significantly to 8mm from 6 to 10cm in the old days. This has reduced operating times and intraoperative muscle damage and, in turn, post-operative pain, thereby shortening hospital stays significantly.
Are there any spinal problems you see more specifically among expats?
Most expats we see have a disc prolapse compressing the nerve root and causing arm pain, numbness or tingling. This may well be due to the frequent use of smart phones and laptops, especially on planes. We also see lumbar spine problems such as sciatica among patients who travel frequently.
What’s your advice for someone who is prone to mild back pain from time to time?
Pay attention to your sitting and standing posture, and the ergonomics of your work environment, and do regular exercise to benefit the spine, such as swimming. If necessary, seek help from a personal trainer or physical therapist for core stability training.
This article first appeared in the December/January 2017/18 issue of Expat Living magazine. Subscribe now so you never miss an issue.