Her MRI scan revealed this to be caused by a large left C5/6 disc prolapse compressing the C6 nerve root.

Non-operative measures including rest, analgesic medication, physiotherapy and a nerve root steroid injection were used but her symptoms failed to respon.

Spinal surgical intervention was performed involving a C5/6 cervical disc replacement.

This technique provided a resolution of her pre-operative symptoms and allowed preservation of her spinal motion.

An MRI scan demonstrated discogenic deterioration at L5/S1 with a central disc bulge and reduced space for nerves (as per image left).

Non-operative measures including rest, analgesic medication, physiotherapy, facet joint injections and an epidural injection were used to initially treat the pain but the symptoms failed to respond.

A L5/S1 discogram (injection into the disc) verified the disc as the source of pain generation.

Surgery was performed involving an anterior lumbar interbody fusion. This resolved the patient’s symptoms and allowed her to return to her pre-injury activities without restriction.

He was diagnosed with a severe idiopathic scoliosis more typically seen in adolescent females, as shown in the images left.The curve was too large to brace and if left untreated would continue to increase.

Spinal surgery was performed to dramatically improve the curve and spinal alignment with screws, rods and bone graft, as shown in the images bottom left.

The patient is well and returned to school very pleased with his improved posture and height.

He has no need for a brace.

The diagnosis was of a delayed presentation of a complex neck fracture (bilateral cervical fracture / dislocation with neurologic deterioration), as shown in the image, left.

This was treated surgically to restore spinal alignment and space for nerves.

The surgery involved separate posterior (back of neck) and anterior (front of neck) approaches to reduce the dislocation and fix the fracture with rods, screws, local pelvic bone graft and a plate, as shown in the second image, left below.

The patient has recovered fully from the surgery with resolution of neck pain and the arm symptoms.

He will be able to return to all activities he enjoys though I have recommended against a return to contact sports.

(A recently well documented similar injury was suffered by a NRL player.)

If you’re suffering severe pain from a large disc prolapse or severe nerve compression, then the surgery to stabilise the spine and remove the pressure on the nerves, the benefits of that surgery far outweigh the risks associated with damage to nerves or the spinal cord.

I perform in the vicinity of 100 to 150 operations on the cervical spine a year, which involves either decompressive surgery alone or more commonly decompressive and fusion surgery. This stabilises the cervical spine but also recreates the normal anatomy of the spine and the space available for nerves.

With patients I discuss what I think the goals of the surgery are. If someone has severe neck or back pain, the goal of the surgery is to reduce, if not eliminate those symptoms, and for the vast majority of occasions, that’s very much achievable with modern spine surgery.

What is a good outcome from surgery?

For me a good outcome is if I’ve been able to achieve what we set out to do in significantly alleviating your severe neck or back symptoms. If I’m able to make a patient’s life considerably better, if not achieve complete resolution of symptoms, that’s a successful outcome.

What are the most common back problems?

The most common complaints people have relating to their spinal conditions are referred arm pain or leg pain, often referred to as sciatica or a pinched nerve.

They also experience debilitating back pain or they may experience a combination of both severe back pain and radiating arm or leg pain.

What causes back pain?

Most patients think that any pain that runs down their leg is sciatic nerve pain, or sciatica, or they may refer to that as a pinched nerve. A lot of patients will think that the back pain they’re experiencing is from pinched nerves.

Back pain is usually from injuries to discs, facet joints, ligaments or muscles. Nerve compression pain normally presents as radiating pain down the legs which is commonly referred to as sciatica or a pinched nerve.

And the top two back problems are?

There are two primary back problems. One is axial pain, which is either neck or lower back pain. The other major problem is nerve compression pain presenting either as arm or leg pain.

What are my treatment options – both surgical and non-surgical?

A range of treatment options exist for these conditions. The majority of the time whether you have back or neck pain the treatment is non-operative, but if symptoms persist or if extremely severe, then surgical options are available.

The most common surgical options for nerve compression symptoms involve simple nerve decompression. On occasion the spine may need to be stabilised to provide an environment whereby the compression of the nerves doesn’t reoccur.

Which back problems can specifically be treated surgically?

Surgery is certainly not warranted for a vast majority of spinal conditions and a lot of spinal conditions will get better just with the benefit of time and active rehabilitation.

However there is a small subset of conditions where spine surgery is certainly warranted and patients will do very well from having these conditions operated on. Generally this will include nerve compression symptoms, but also conditions that affect spinal stability.

As a spine surgeon, the various problems that we can treat through surgery for back pain include:

•  discogenic back pain
•  facet joint related back pain
•  instability or
• nerve compression.

What is my next step?

Make an appointment to come and see me so that I can thoroughly evaluate the condition that’s affecting your spine and provide you with a comprehensive array of treatment options to provide you with the best chance of achieving a resolution of those symptoms.