Between the vertebrae in your spine are flat, round discs that act as shock absorbers for the spinal bones. Sometimes some of the gel-like substance in the center of the disc (nucleus) bulges out through the tough outer ring (annulus) and into the spinal canal. This is known as a herniated or ruptured disc and the pressure it puts on the spinal nerves often causes symptoms such as pain, numbness and tingling. Initial treatment for a herniated disc may involve low level activity, nonsteroidal anti-inflammatory medication and physiotherapy. If these approaches fail to reduce or remove the pain, surgical treatment may be considered. Discectomy This surgery is performed to remove part or all of a herniated intervertebral disc. Open discectomy – involves making an incision (cut) over the vertebra and stripping back the muscles to expose the herniated disc. The entire disc, or parts of it are removed, thus relieving pressure on the spinal nerves. Microdiscectomy – this is a ‘minimally invasive’ surgical technique, meaning it requires smaller incisions and no muscle stripping is required. Tiny, specialised instruments are used to remove the disc or disc fragments. Laminectomy or Laminotomy These procedures involve making an incision down the centre of the back and removing some or all of the bony arch (lamina) of a vertebra. In a laminectomy, all or most of the lamina is surgically removed while a laminotomy involves partial removal of the lamina. By making more room in the spinal canal, these procedures reduce pressure on the spinal nerves. They also give the surgeon better access to the disc and other parts of the spine if further procedures e.g. discectomy, spinal fusion, are required. Spinal Fusion In this procedure, individual vertebrae are fused together so that no movement can occur between the vertebrae and hence pain is reduced. Spinal fusion may be required for disc herniation in the cervical region of the spine as well as for some cases of vertebral fracture and to prevent pain-inducing movements.

Joint replacement surgery is commonly used to treat end stage damaged joints. The joint damage can be the result of wearing out such as osteoarthritis or other forms of joint disease including rheumatoid arthritis or after trauma. In these procedures, the damaged joint is replaced by an artificial joint usually composed of metal, plastics or ceramics. These operations are major procedures which require the patient to be in hospital for several days and followed by a significant period of rehabilitation. The procedure for joint replacement and the specifics for the procedure will be covered at the time of assessment and booking of surgery. Occasionally blood transfusions are required; if you have some concerns raise this with your surgeon during consultation.

Narrowing of the spinal canal or spinal stenosis can lead to compression of the spinal cord or spinal nerves, depending on the location of the stenosis. It can result in pain or loss of function of arms or legs or both. Surgery can be used to relieve the stenosis in certain cases.

In special cases, a spinal fusion maybe required. In general terms, it is not a recommended treatment option for isolated neck or low back pain due to its unpredictability and changes in the spinal biomechanics.