Diagnosis and Non-Surgical Treatment by Dr Tiernan Byrnes Spine Surgeon Dubai

Diagnosis and Non-Surgical Treatment

Comprehensive Investiagtive and Therapeutic Services to meet your needs.

It is our mission and life's work to provide every service with compassion, expertise and to your highest level of satisfaction.

All the services in one place.

We offer a full range of services to meet every type of individual need.

Detailed assessment and comprehensive investigation allows considered advice and individualized treatment planning.

In general non-invasive conservative treatment strategies are advised prior to surgery.

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Conditions

Diagnostics

Non-Surgical Treatment

Surgical Treatment

Low Back Pain / Lumbar Back Pain
Non-Surgical Treatment

Non-Surgical Management of Mechanical Low Back Pain

Mechanical low back pain (MLBP), which accounts for the majority of back pain cases, refers to discomfort resulting from a problem with the muscles, ligaments, joints, or discs of the spine. Unlike other types of back pain stemming from infections, tumors, or other underlying diseases, MLBP typically arises from strains, overuse, or wear and tear. The good news is that most cases of MLBP can be successfully managed without resorting to surgery.

The following treatments should only be considered where the back pain is moderate and no red flag symptoms are evident - Otherwise patients are adivsed to seek the advice of their physician at an early stage.

"Red flag" symptoms in the context of back pain refer to clinical features that may indicate a more serious underlying condition. If someone experiences any of these symptoms in conjunction with back pain, it's important to seek medical attention promptly:

Red Flag Symptoms

Numbness or tingling in the legs, especially in the saddle area (area that would sit on a saddle) which can indicate cauda equina syndrome.
Progressive weakness in the legs.
Difficulty starting or stopping the flow of urine or bowel movements.
History of Trauma: Any recent significant trauma (like a car accident or a high fall) or even minor trauma in individuals over the age of 50.
Unexplained Weight Loss: Losing weight without trying could indicate an underlying medical condition.
Age: Onset of back pain before age 20 or after age 50.
History of Cancer: Particularly if there's a history of a cancer that can metastasize to bone, such as breast, lung, prostate, thyroid, or kidney cancer.
Night Pain: Pain that awakens a person from sleep or is worse at night.
Pain that Persists: Pain that remains constant and doesn't improve, even when lying down.
Fever: Elevated body temperature associated with back pain could be indicative of an infection.
Previous Steroid Use: Long-term corticosteroid use can weaken bones, increasing the risk of fractures.
Drug Abuse: People with a history of intravenous drug use are at an increased risk of spinal infections.
Immune Suppression: Conditions like HIV/AIDS, chemotherapy, or chronic corticosteroid use can suppress the immune system and increase the risk of infections.
Osteoporosis: A history or risk factors for osteoporosis can mean increased susceptibility to compression fractures in the spine.
Structural Deformity: Sudden or progressive change in the shape or alignment of the spine, such as increased kyphosis.
Pain that is Non-mechanical: Pain that doesn't change with movement or position and doesn't improve with rest.
History of Recent Infection: Especially if there's a chance it might have spread to the spine.
Prolonged Steroid Use: This can increase the risk of osteoporotic fractures.

Always consult with a healthcare professional if experiencing back pain associated with any of the above red flags. These signs can help clinicians identify and act on potentially serious conditions early on, optimizing outcomes.

1. Physiotherapy: Physiotherapy is one of the cornerstone treatments for MLBP. A trained physical therapist can provide specific exercises that strengthen the muscles supporting the spine, improving flexibility, and promoting optimal spinal alignment. Techniques like ultrasound, electrical stimulation, and manual manipulation can also be employed to relieve pain and improve function. Other forms of physical therapy, including Chiropractic treatment, can also be of benefit.

2. Medications: Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can help reduce inflammation and alleviate pain. In instances of more intense pain, a physician might prescribe muscle relaxants, stronger NSAIDs, or even narcotics. However, it's crucial to use these medications as directed and be aware of potential side effects.

3. Lifestyle Modifications: The way we lead our lives can have a significant impact on MLBP. Adopting a proper posture, ensuring ergonomic workspaces, maintaining a healthy weight, and integrating regular exercise can all play pivotal roles in managing and preventing pain. Core-stability exercises, in particular, can provide critical support to the spine.

5. Heat and Cold Therapy: These simple, at-home remedies can be quite effective. Cold packs can reduce inflammation by constricting blood vessels, while heat pads can promote blood flow and relax muscles. Alternating between the two can often provide relief from pain and stiffness.

6. Mind-Body Therapies: Techniques like meditation, deep breathing exercises, and biofeedback can help individuals manage the psychological aspects of pain. Chronic pain can lead to stress, anxiety, and depression, and these therapies can help break the cycle by promoting relaxation and reducing muscle tension.

7. Acupuncture: This traditional Chinese medicine technique involves inserting thin needles at specific points on the body. Many patients with MLBP have reported reduced pain and improved function after undergoing acupuncture.

In conclusion, while MLBP can be disruptive and uncomfortable, a combination of the aforementioned non-surgical approaches can help manage and alleviate its symptoms.

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Neck Pain; Non-Surgical Treatment

Pain-relieving medicine – acetaminophen (sample brand name: Panadol) or an Anti-Inflammatory (NSAID) such as ibuprofen (sample brand names: Brufen) or naproxen (sample brand names: Proxen).

Apply ice on the area to reduce pain – A cold gel pack, or bag of ice or frozen vegetable. Do this for 15 minutes at a time, a few times a day. Use a towel between the cold object and your skin to prevent skin damage.

Apply heat on the area to reduce pain and stiffness – Take a hot shower or hot bath, or put a hot towel or heating pad 'on low' on the area. Apply heat for 15 minutes at a time. Don't use anything too hot that could burn your skin.

Physiotherapy

Invariably patients presenting with neck pain will be offered physiotherapy. The exploration of physical therapy and therapeutic exercise under the advice and supervision of a physiotherapist is a mainstay of non-surgical treatment of degenerative spinal disorders.

Xray Guided Therapeutic Cervical Spinal Injections.

These X-ray guided injections are often effective in relieving a patient's severe mechanical neck pain. They do not resolve the underlying degeneration but can be very helpful.

Trigger Point injections

These simple injections, performed in the outpatient's clinic treatment room, are very useful in the management of persistent and severe muscle pain.

Occipital Nerve Blocks

Local anesthetic based injection to treat radiating occipital headache often accompanying severe neck pain

What treatments are not helpful?

The wearing of neck collars, especially for long periods of time. If a collar has been found to help with the pain, patient are advised to limit use if possible to less than 3 hour per day. Wearing a neck collar for too long can potentially weakness the muscles.

Surgery

A variety of surgical interventions are available for the treatment of neck pain. However surgical procedures for neck pain e.g. cervical fusion procedures are only indicated if the pain is refractory to reasonable nonsurgical treatments.

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Occipital Neuralgia & Cervicogenic Headache
Non-Surgical Treatment

Cervicogenic Headache

Physiotherapy — Physical therapy may provide long-term improvement for cervicogenic headache, but the conclusions of different studies have differed on the degree and likelihood of benefit.
Anesthetic blocks — Local Anesthetic injections of the lateral atlanto-axial joint, the C2-3 zygapophyseal joint (and the overlying third occipital nerve), and/or the C3-4 zygapophyseal joint can temporarily reduce or relieve pain and may allow greater participation in physical treatments.
Greater (and lesser) Occipital Nerve Blocks may provide temporary pain relief in some cases, but the benefit of this treatment is not specific for cervicogenic headache.
Facet Joint injection — Results from small retrospective studies suggest that some patients may obtain relief from Steroid injection to the responsible cervical facet joint.
Radiofrequency Denervation — Radiofrequency techniques may offer potential benefit for cervicogenic headache, numbing the cervical facet joint responsible for the source of the pain
Surgery — A variety of surgical interventions have been performed for presumed cases of cervicogenic headache, but surgical procedures for cervicogenic headache are not recommended unless there is compelling evidence of a surgically amenable lesion on imaging causing the cervicogenic headache (ie, confirmed to be the pain generator by local anesthetic diagnostic blocks) that is refractory to all reasonable nonsurgical treatments.

Occipital Neuralgia

For patients with occipital neuralgia who have moderate to severe pain symptoms, an local Occipital Nerve Block often provides pain relief, which is typically prompt, supports the diagnosis and may last several weeks or even months. The procedure is generally safe and can be repeated when pain recurs.
Patients whose pain is not completely sufficiently managed with occipital nerve blocks may benefit from medication.
Patients who are refractory to conservative measures should be evaluated for alternative treatments (eg, botulinum toxin type A injections, pulsed radiofrequency, occipital nerve decompression, or stimulation).

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Cervical Spondylosis - Non-Surgical Treatment

Medicines.

Short courses of Nonsteroidal anti-inflammatory medicines, like ibuprofen / naproxen and simple muscle relaxants may benefit patient and facilitate participation in physical therapy.

Physiotherapy

A physical therapist can teach you stretching and strengthening exercises that may ease symptoms.

Ice and heat

Apply ice on the area to reduce pain – A cold gel pack, or bag of ice or frozen vegetable. Do this for 15 minutes at a time, a few times a day. Use a towel between the cold object and your skin to prevent skin damage.
Apply heat on the area to reduce pain and stiffness – Take a hot shower or hot bath, or put a hot towel or heating pad 'on low' on the area. Apply heat for 15 minutes at a time. Don't use anything too hot that could burn your skin.

X-ray Guided Therapeutic Cervical Spinal Injections

These X-ray guided injections are often effective in relieving a patient's severe mechanical neck pain. Directed at the underlying arthritic Cervical Spine joint s and source of the pain. They do not resolve the underlying degeneration but can be very helpful.

Trigger Point injections

These simple injections, performed in the outpatient's clinic treatment room, are very useful in the management of persistent and severe muscle pain.

Surgery

In most cases, surgery is not needed. However if there are significant neurological symptoms or any progressive neurological dysfunction surgery is likely to be recommended to relieve pressure on the spinal cord or the nerves leaving your spine. A decompression of the areas of nerve / spinal compression is performed with bony fixation / fusion as required depending on the individual mechanics of the patient's cervical spine.

Prevention

Stay physically active
Maintain good posture
Avoid trauma to your neck
Address and treat problems effectively as they arise

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Sciatica / Lumbar Radiculopathy - Non Surgical Treatment

Lumbar Disc ProlapseIntroduction: Lumbar disc prolapse, commonly known as a slipped or herniated disc, occurs when the soft inner part of a spinal disc protrudes through a tear in its outer layer. This can lead to pain, numbness, and weakness in the affected area. Fortunately, many cases of lumbar disc prolapse can be effectively treated without surgery. Here, we discuss various non-surgical treatment options available.

1. Physical Therapy: Physical therapy is often the first line of treatment for lumbar disc prolapse. A licensed physical therapist can guide patients through targeted exercises to strengthen the muscles supporting the spine, improve flexibility, and promote healing. Posture correction techniques and manual therapy, such as spinal manipulation, may also be employed to alleviate pain and restore normal function.

2. Medications: Several types of medications can help manage pain and inflammation associated with lumbar disc prolapse. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can reduce inflammation and provide pain relief. Muscle relaxants may be prescribed to alleviate muscle spasms, while analgesics and nerve pain medications can help with more severe pain.

3. Epidural Steroid Injections: Epidural steroid injections involve injecting a corticosteroid, often in combination with a local anesthetic, into the epidural space around the spinal nerves. This treatment aims to reduce inflammation and provide pain relief. While not a permanent solution, epidural steroid injections can provide temporary relief for several weeks or months.

4. Alternative Therapies: Whilst of uncertain benefit some patients may find relief from lumbar disc prolapse symptoms through alternative therapies. Acupuncture involves inserting thin needles into specific points on the body to stimulate the release of natural pain-relieving chemicals. Chiropractic care focuses on spinal manipulation and alignment, while massage therapy can help relax muscles and improve blood flow.

Conclusion: The majority of lumbar disc prolapse cases can be effectively managed with non-surgical treatments, allowing patients to return to their normal activities. It is crucial to work closely with healthcare professionals to develop a personalized treatment plan that addresses the underlying causes and specific symptoms of the condition. In some cases, if non-surgical treatments fail to provide adequate relief, surgical intervention may be considered and is often very effective.

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Cervical Canal Stenosis & Cervical Myelopathy
- Usually Surgical Treatment

Cervical myelopathy is best treated with Cervical Spine Decompression Surgery.

If at patient presents with Cervical Stenosis but no Symptoms or Signs of Cervical Myelopathy and the Spinal Cord compression on MRI Scanning is mild, only then is non-surgical treatment more appropriate in the first instance. Under these circumstances treatment is similar as for Cervical Spondylosis above.

In order to resolve the mechanical compression of the spinal cord and prevent deterioration of the spinal cord function surgery is required.

There are a number of possible surgical procedures which a generally considered for the treatment of Cervical Stenosis and Compressive Cervical Myelopathy.

Laminoplasty

Involves the partial removal of the bany arches at the back of the cervical spine making space for the spinal cord with reattachment - this spares motion of the cervical spine.

Laminectomy and posterior Fixation

This allows for a clear and thorough decompression but results in a loss of motion across the fused segments

Anterior Cervical Decompression

Decompression via an anterior approach (through the front of the neck). This involves securing an effective decompression by the removal of intervertebral disc(s), osteophytes and if needed more significant bone resection termed Corpectomy

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Cervical Radiculopathy & Cervical Disc Herniation
Radiating Neurological Arm Pain - Non-Surgical Treatment

Introduction: Cervical disc prolapse, or herniated disc in the neck, occurs when the inner part of an intervertebral disc pushes through a tear in the outer layer, compressing nearby nerves or the spinal cord. This can lead to radiating arm pain, numbness, and weakness often with associated symptoms in the neck, shoulders and shoulder blade. In the absence of arm weakness or feeling of real arm dysfunction, many cases of cervical disc prolapse can be effectively managed through non-surgical treatment options.

1. Physical Therapy: Physical therapy plays a crucial role in treating cervical disc prolapse. A qualified physical therapist can develop a personalized exercise program to strengthen neck and shoulder muscles, improve range of motion, and promote proper posture. Manual therapy techniques, such as cervical traction and joint mobilization, may also help alleviate pain and improve function.

2. Medications: Various medications can help manage symptoms associated with cervical disc prolapse. Non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, can reduce inflammation and provide pain relief. Muscle relaxants may be prescribed to relieve muscle spasms, and analgesics or nerve pain medications can help manage more severe pain.

3. Cervical Collars and Traction: A soft cervical collar may be recommended for short-term use to provide support and limit neck motion, allowing the affected area to rest and heal. Cervical traction devices gently stretch the neck, creating space between the vertebrae and alleviating nerve compression.

4. Alternative Therapies: Alternative therapies may offer additional relief from cervical disc prolapse symptoms. Acupuncture can help reduce pain by stimulating the release of natural pain-relieving chemicals. Chiropractic care, focused on spinal manipulation and alignment, and massage therapy, which relaxes muscles and improves circulation, may also be beneficial.

Conclusion: Again most cases of cervical disc prolapse can be effectively managed through non-surgical treatments. Collaborating with healthcare professionals to create a personalized treatment plan is essential for addressing the root causes and specific symptoms of the condition. If non-surgical treatments fail to provide adequate relief, surgical intervention may be considered as a last resort.

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Carpal Tunnel Syndrome - Non-Surgical Treatment

Carpal tunnel syndrome (CTS) is a common nerve compression disorder causing pain, numbness, and weakness in the hand and wrist. Non-surgical treatments are often effective in managing CTS symptoms.

Splints and Braces: Wearing a wrist splint, particularly at night, helps maintain proper alignment and reduces median nerve compression, alleviating symptoms.

Medications: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can reduce inflammation and pain. Corticosteroid injections may provide temporary relief in severe cases.

Activity Modification: Adjusting workstations, using ergonomic tools, and taking breaks can help prevent repetitive strain and alleviate symptoms.

Physical Therapy: Targeted exercises and stretches, guided by a physical therapist, can improve flexibility, strength, and reduce nerve compression.

Conclusion: Some cases of carpal tunnel syndrome can be effectively managed with non-surgical treatments. However many are somewhat advanced at the time of their diagnosis and if symptoms persist despite conservative interventions, surgical options need to be considered.

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Cubital Tunnel Syndrome or Ulnar Neuropathy
- Non-Surgical Treatment

Cubital tunnel syndrome results from compression of the ulnar nerve at the elbow. Non-surgical treatments aim to alleviate this pressure and reduce symptoms.

Bracing or splinting the elbow, especially at night, prevents over-flexing and relieves nerve compression.
Activity modification, such as avoiding prolonged elbow bending or leaning on the elbow, is recommended.
Physical therapy can strengthen and stretch surrounding muscles, improving symptoms and function.
Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation.

These non-surgical approaches often effectively manage and even resolve symptoms for many individuals. If not surgical treatment is recommended.

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Lumbar Facet Joint Injections

Lumbar Facet Joint Injections: Benefits and Uses

Introduction: Lumbar facet joint injections are straightforward injection procedures used to diagnose and treat pain thought to relate to the facet joints in the lower back, often caused by arthritis or injury.

1. Diagnosis: Facet joint injections help determine if the pain is originating from the facet joints by injecting a local anesthetic. Pain relief indicates a positive diagnosis.

2. Pain Relief: Steroids injected into the facet joint reduce inflammation and provide lasting pain relief for weeks or months, allowing patients to engage in physical therapy and daily activities.

3. Minimally Invasive: The procedure involves a small needle, guided by fluoroscopy (xray) making it really truly minimally invasive

4. Short Recovery Time: Patients typically experience rapid recovery, with minor or minimal post-procedure pain and a quick return to prior activities.

Lumbar facet joint injections are valuable diagnostic and therapeutic tool for lower back pain, offering benefits such as pain relief, minimal invasiveness, and short recovery times.

In general however these types of injection provide only a varying degree and time period of improvement and if the pain is not coming from the facets or the inflammation or degeneration too severe there my be no real beneift.

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Lumbar epidural steroid injections

Lumbar epidural steroid injections (LESIs) are a common, minimally invasive treatment for back pain and sciatica, caused by conditions like herniated discs, spinal stenosis, and degenerative disc disease. LESIs deliver anti-inflammatory medication to reduce inflammation and alleviate pain.

1. Types and Approaches: There are three primary approaches for LESIs: interlaminar, transforaminal, and caudal.

a. Interlaminar: The needle is inserted between the vertebrae, directly into the epidural space. This approach targets broader areas of inflammation.

b. Transforaminal: The needle is placed alongside the affected nerve root, allowing for precise medication delivery. This method is particularly effective for radicular pain, such as sciatica.

c. Caudal: The needle is inserted into the sacral hiatus. This is a very straightforward technique of low risk again providing a broad application of the anti-inflammatory streoid.

2. Benefits:

• Pain relief: LESIs can provide significant pain relief, improving patients' quality of life and enabling participation in physical therapy.

• Minimally invasive: LESIs have fewer complications and shorter recovery times compared to surgery.

• Reduced reliance on oral medications: LESIs may decrease the need for oral pain medications, which can have systemic side effects.

3. Risks: Despite their benefits, LESIs carry some risks, including:

• Infection or bleeding at the injection site

• Temporary increase in pain

• Dural puncture, leading to headaches

• Allergic reactions to medications

• Nerve damage (rare)

Again; These types of injection provide only a varying degree and time period of improvement and if the pain is not related to structures or inflammation within the epidural space or the inflammation or mechanical nerve compression too severe then there my be no real beneift.

Conclusion: Lumbar epidural steroid injections are a valuable treatment option for back pain and sciatica, offering pain relief and improved function through various approaches. While generally safe, patients should consider potential risks and discuss them with a healthcare professional before undergoing the procedure.

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Sacroiliac Joint Injections

CT-Guided Sacroiliac Joint Injections: Benefits and Risks

CT-guided sacroiliac joint injections are a minimally invasive procedure used to diagnose and treat pain originating from the sacroiliac joint, typically caused by inflammation or injury.

1. Diagnosis and Pain Relief: These injections involve injecting a local anesthetic and corticosteroid into the sacroiliac joint. Pain relief confirms the joint as the pain source, while steroids reduce inflammation and provide lasting relief.

2. Benefits:

Precision: CT guidance ensures accurate needle placement for optimal results.
Minimally invasive: The procedure avoids surgical risks and requires less recovery time.
Improved function: Pain relief enables patients to participate in physical therapy and resume daily activities.

3. Risks: Although generally safe, sacroiliac joint injections have potential risks, including: