Conditions

I can help diagnose and treat a variety of spine-related conditions including:

• Useful information for patients
• Acute Back Pain
• Nerve Root Pain and Some of the Treatment Options
• Cauda Equina Syndrome
• Coccydynia and operations for coccygeal pain
• Lumbar Discectomy and Decompression
• Spinal Stenosis
• Scoliosis information for patients
• The Spine and MRI Scanning
• Lumbar Spondylolysis and Spondylitic Spondylolisthesis

Your Spine

The spine is composed of bone, joints, discs, ligaments, muscles and nerves which all work together to support the body and enable movement.

Composition of the Spine

The Spinal column is the structure that supports your body from your head to your pelvis. It consists of a series of blocks of bone, separated from each other by a “disc” (sometimes referred to as a shock absorber). The interaction between the blocks of bone and disc allow a specific amount of movement between every vertebra.

There are seven vertebrae that make up the cervical spine, twelve in the thoracic spine and five in the lumbar region. The remainder form the sacrum and coccyx.

The vertebra form a bony tunnel called the spinal canal in which the spinal cord runs. The cord is a collection of nerves which links the brain and the body. It runs from the brain to the first or second lumbar vertebrae. Below this the nerves are in strands called cauda equina. The complex interaction between the spinal column, and the spinal cord is the key to understanding your symptoms.

Spinal pathology refers to the abnormality causing spine problems. Any problem that causes pressure on the spinal cord or nerves may result in symptoms, namely:

• Pain
• Numbness
• Tingling
• Weakness, or
• Abnormalities in your ability to use your hands, legs, bladder or bowels.

Discs

The vertebrae are linked by an intervertebral disc at the front and by two facet joints at the back. The intervertebral discs formed of a tough outer part, and a softer inner part.

The disc can efficiently absorb compressive and jarring forces but is more susceptible to twisting forces which can result in the outer layers weakening and occasionally tearing or stretching.

As we get older the consistency of the disc changes. It can deteriorate and dehydrate -this is part of normal wear and tear and is also known as disc degeneration.

The wear to the spinal discs in the vast majority of the population does not reach a level that produces pain and disability that requires treatment.

Facet Joints

The facet joint is the joint between the vertebrae towards the back of the spine. The surfaces of the facet joints are cartilage lined and they are lubricated with synovial fluid.

Like other joints in the body they can wear (degenerate). This wear is part of the normal ageing process.

These changes are often widespread and cannot be reversed. Wear on a joint can be called arthritis.

Wear or degeneration may be the source of back or neck pain.

Spinal Nerves

The spinal nerve roots exit the spinal canal through foramina (holes) between the vertebra and facet joints. They are often compressed or irritated by surrounding tissues which can result in leg pain, back pain or arm pain. This is known as sciatica when it affects the legs and radiculopathy in the arms.

Ligaments

The ligaments hold the spine together and will wear or degenerate with age.

Normal ageing ligaments can become stiff and thickened which can affect their function, resulting in reduced spinal movement and pain.

Muscles

The spine is supported by muscles and these are essential to posture and movement. Short lived episodes of acute back pain can be due to muscle pain.

Good muscle tone aids correct alignment of the vertebrae. Sudden onset of back pain is often due to muscle pain or spasm and in many cases improves spontaneously but can be helped by manual therapy (physio, chiropractor, osteopath).

Back pain

Back pain is common. 60-80% of the population will be troubled by it at some point and often will experience an episode of pain of sufficient severity to prevent them from performing their normal work or social activities.

Symptoms of back and neck pain will usually settle, or at least improve significantly, within seven to ten days. In over 80% of cases pain will resolve within four to six weeks.

About half of those who suffer back pain may experience another episode within two years.

Approximately 10% of people will seek medical attention for their pain.

People are encouraged to stay active and get on with their lives despite their discomfort. This will often require you to modify the way certain activities are performed.

The majority of patients with acute spinal pain can be managed by their G.P or physiotherapist. However a small number of patients have significant pathology, such as tumours, fractures, infections and cauda equina lesions that require prompt diagnosis and specialist management.

The Red Flag system is widely used to identify these patients.

This requires people with severe ongoing back pain, greater than 8-12 weeks or developing weakness of arms, legs or problems passing urine or opening bowels to be referred urgently by their healthcare provider so that investigation with x-rays, MRI scans or blood tests can be performed.

Following appropriate triage and assessment the majority of patients can be managed with advice and analgesia, formal physiotherapy treatment may be beneficial if symptoms persist.

SEE YOUR GENERAL PRACTITIONER OR ACCIDENT AND EMERGENCY IF YOU EXPERIENCE THE FOLLOWING WARNING SYMPTOM OR ‘RED FLAGS’:

Numbness or pins and needles affecting the genitals or the back passage. Episodes of urinary or faecal incontinence. (You should seek urgent/immediate medical advice and contact your G.P or attend A&E).

Patients over 50 years of age with back pain for the first time.

Symptoms with night sweats or fevers.

Pain that wakes you from sleep.

Sudden or severe deterioration in leg pain (sciatica).

Severe neck or back pain following a fall or accident should always be assessed by GP or Accident and Emergency.

Mark Blackman’s aim will be to make an accurate diagnosis of the source of your pain.

This will typically be achieved by the use of radiological imaging and at times specialised scans and blood tests may be required.

This will enable you to discuss the treatment options and long term outlook for your condition.