Dr. Biodun Ogungbo
I was on a radio programme recently talking about spine problems. The phone lines were open and members of the public got to ask questions as well as seek for enlightenment. The program was very interactive and this synopsis captures the essence of the discussion.
Spine diseases
First, you must understand that the spine is like building blocks with a hole in the middle protecting our spinal cord and the nerves. Same as the skull is protecting the brain! There are discs or so called shock absorbers between the bones of the spine. Same as cement between building blocks!
Houses wear and need repairs and so does our spine. With age, we develop ‘wear and tear’ in the joints of the body and the spine leading to arthritis. Arthritis is therefore ‘wear and tear’ of the bones and joints due to many factors such as age, weight, job and sporting activity, infection, tumours and rarely genetics.
Let’s talk about the first one, age!
The type of arthritis that develops due to age is called degenerative arthritis. This spine disease is likely to come to us all as we age and starts commonly from about 50 years of age. In the back, it causes back pain, stiffness and can progress to leg pains, leg weakness and difficulty walking. At its worst, it can also cause difficulty passing urine, passing stool and problems with erection in men, numbness of the private parts in women.
Other causes of spine disease are as follows:
Spine disease can also be induced by trauma. This can follow injury from a fall or even a road traffic accident. It can also be caused by infection typically Tuberculosis in this environment or by a bacterial infection in patients with diabetes. Finally, spine problems can come from tumours and cancers such as from the breast in women and the prostate in men. Such cancers can go to the bone and be the major cause of disability and death in sufferers.
Management of spine diseases
Many patients live with a bad back or bad neck suffering in silence. Usually, many are advised not to worry that all old people suffer from arthritis. The doctors’ call it ‘wear and tear’ and a consequence of old age. ‘Nothing can be done about it’.
However, this is not true and a lot can be done for arthritis of the spine. The important thing is for a proper diagnosis, evaluation and treatment offered by trained specialists in managing spine problems. These specialists can be chiropractors, physiotherapists, orthopaedic surgeons or neurosurgeons. Of course, everyone should know their limitations and levels of experience. Ideally, there should be close collaboration between the different specialists in the best interest of the patient.
The diagnosis of spine diseases depends on a good history. What is the problem, who is the person and what is the situation currently? How old is the patient, and whether male or female, fat or thin, etc make a huge difference in the overall scheme of things. How bad are the pain, disability and progression in the condition of the patient? These are important determinations of the nature of the problem and interventions required. Examination of the patient will help to determine the effect of the condition on the general health and physical function of the person.
Usually, doctors will ask for blood tests, x-rays and nowadays an MRI scan. MRI scan is the gold standard in diagnosis of spine problems. It helps to show the nerves and spinal cord to see whether they were affected by the disease and to what degree.
Surgery for spine diseases
Mr Ajayi started losing function in his arms and legs early in the year. He was asked to do MRI scan but could not afford it. So he started physiotherapy but this did not stop the deterioration. Eventually, he had the MRI scan which showed pressure on the spinal cord in the neck requiring surgery. He was referred to see the neurosurgeon. The surgeon was very clear in his explanation of the problem, and proposed an operation to rectify the pressure on the spinal cord. He agreed to have the operation and was carried out. A noticeable improvement in the power in the arms and legs was seen within 2 weeks of the operation and at the time of his final visit (4 weeks), he could stand and walk with a walking frame.
For operations on the lumbar spine (the back), the operation could range from a simple discectomy, simple decompression, laminectomy to more major surgeries with instrumentation using pedicle screw fixation. Different people undergo different operations, so are unique in a sense. The problems are usually different and the solutions for each patient also varied depending on their particular condition.
These operations can be performed effectively and safely in Nigeria. We have formed the special purpose vehicle to promote such in Abuja: Spine Fixed In Abuja. We have also recently formed the West African Spine and Scoliosis Society to promote spine care in the West African region.
So, now you know!
