Dr Hammond

26/06/2019

How can a slipped disc be prevented?

A slipped disc occurs when the soft cushion of tissue between the bones in the spine pushes out. It can happen in a moment of bending, twisting and lifting – especially if you’re making these motions at the same time. In other cases, poor posture is a contributor as is heavy lifting and poor muscle control.
We’ve asked consultant rheumatologist Dr Anthony Hammond for his advice on how to prevent a slipped disc and what the treatment options are if it does unfortunately happen.

Is it possible to prevent a slipped disc?
Yes and no. From the fact that the disc can go just under body weight and with normal or trivial excess use, it is not possible to avoid these problems completely if you have been “blessed” with weak discs.

These problems run strongly in families and twin studies have shown a highly heritable component so there may be nothing you can do to completely avoid issues arising. That said, keeping fit, maintaining posture and abdominal muscle strength and then all help.

In short, you should do as gran said: “sit up straight, don’t slouch and walk upright….”

What’s the treatment options?
Disc problems and sciatica (a compressed nerve) are very treatable but frequently badly managed. Usually a brief spell of rest (two days) might be needed with pain killers to help relieve the worst of it. Then physiotherapy is accessed.

Many episodes will settle with this but if they do not or if the pain is severe or if there is weakness or numbness then specialist help should be sought early. An MRI scan will usually be taken.
In my practice, sciatica can readily be treated by targeted steroid injections to the affected nerve root called transforaminal epidural steroid injection. These are evidence-based and proven techniques for the rapid control of pain, while nature takes its course.

Many patients will need no more than one or two injections. If this does not settle things then I can perform an endoscopic discectomy. This is the equivalent of conventional open surgical “micro” discectomy but performed through a 1cm skin incision without opening the spinal canal using a medical scope. It can be performed as a day case and recovery from the operation takes only a few days.
What about a partially slipped disc – what are my treatment options?
Finally, the most difficult and most neglected issue is mixed back pain and sciatica due to a bulging but not fully slipped disc. There is no conventional surgery for this, MRI scans are frequently under-reported and patents may be left to suffer long-term.

I have a day case minor operative procedure to reduce the bulge by decompressing from the middle of the disc and heat sealing the back wall called DISC-FX. The procedure is routinely effective in reducing or abolishing disc-related back pain even after decades of trouble.

Do not hesitate to book an appointment with Dr Hammond if you need to have your back pain checked.

14/06/2019

Dr Hammond on scans...

There is more confusion about the role of MRI scanning in spinal pain than almost any other subject. The first statement is that: in regards to pain, scans are agnostic, they simply don’t know. More strictly, scans can be read intelligently in the context of the history and examination, to give strong clues as to the presence of pain generating pathology and can be quite accurate for positive prediction. However, scans cannot diagnose the absence of pain and I can even show cases of people with pristine scans who turned out to have painful discs and respond to treatment. A report from a radiologist which reads “no source of pain seen”, should be ignored. The scan gives a road map of what needs to be explored by interventional diagnostic tests, rarely a defined destination.

Case report (with patient consent).

Mrs X, 38. Back pain for 10 years since childbirth. Daily, all back no sciatica. Not too severe if all provocation avoided but builds readily and limits all activities. Struggles after school run (7 minutes walk) and with all activities of daily living.

MRI scan. Comment on mild bulge of 5/1 disc, focus on visible wear of the SIJ and reported positive for SIJ.
On history and examination: No suggestion of SIJ pain, all seems discal to me.
Diagnostic test: Pain provocation discography L4/5 and L5/S1. L4/5 injection wasn’t noticed, L5/S1 -immediate pain 7/10 consistent with usual pain. Positive result L5/S1
Treatment: L5/S1 percutaneous decompression by DISC-FX.
Result: Pain pre-procedure 60/100 average daily, Disability score 24% (mild) ,

8 weeks post procedure. Pain zero, global estimate of improvement 95%, Disability score 6% (normal), Categorical response “Much Better”, parting comment. “Thank you, I have my life back”.

04/06/2019

Munich put on her best summer dress with sunshine and a street fair for the SIS Annual European meeting held at the Kempinski Hotel with 150 delegates in attendance.

SIS (www.spineintervention.org) is the senior technical standard-setting and scientific organisation in interventional pain management and the presentations focus on the best evidence on the safety and efficacy of these treatments.

Dr Hammond is an SIS tutor in interventional techniques and was invited to give a presentation as an expert practitioner on “A difficult case”. He chose “Not Fibromyalgia Syndrome” and described (with patient consent) a local lady who was presented to him as Fibromyalgia and whose complex, severe pain was substantially improved by correct diagnosis and treatment of both a small lumbar disc protrusion (ignored on scans) and 3 cervical disc protrusions and associated facet pain allowing her to return to activities and normal daily life.

For more details about how Dr Hammond can help with your spinal pain please contact:

Michelle Burgess
KIMS Hospital
Newnham Court Way,
Bearsted
Kent,
ME14 5FT
01622 538093
michelle.burgess@kims.org.uk

or

Ingrid Butler
The London Spine Clinic
116 Harley St
London W1G 7JL
020 7616 7720

26/04/2019