Spinal Treatment Options

I offer both non-surgical and surgical treatment options, with the aim of selecting the least disruptive effective treatment for the individual patient.

Non-Surgical Treatment

Conservative management and rehabilitation

Many spinal conditions improve without surgery.

Non-surgical treatment may include:

  • Physiotherapy
  • Targeted exercise programmes
  • Activity modification
  • Medication strategies
  • Injections in selected cases
  • Pain management referral where appropriate
  • Strength and conditioning
  • Time and gradual recovery

The aim is not simply to “push through”, but to reduce inflammation, restore movement, rebuild strength, and protect long-term spinal function.

Injections and radiofrequency treatment

Some patients may benefit from targeted injections or radiofrequency treatment, particularly when symptoms appear to arise from specific joints, irritated nerves, or other identifiable pain generators.

These options can sometimes reduce pain enough to allow better movement, rehabilitation, and return to normal activity. They may also help clarify which structure is actually responsible for symptoms.

These decisions are individualised and based on the symptom pattern, examination findings, imaging, and response to previous treatment.

Surgical Treatment

Surgery is considered when non-surgical treatment is not providing adequate relief, when symptoms are significantly affecting quality of life, or when neurological symptoms or structural problems require more direct treatment.

Endoscopic Spine Surgery

Endoscopic spine surgery is one of the least invasive approaches available for selected spinal problems, particularly disc herniations causing sciatica.

Using a small camera and specialised instruments, the area of nerve compression can be treated through a very small incision.

For suitable patients, this may allow:

  • Less tissue disruption
  • Less post-operative discomfort
  • Earlier mobilisation
  • Shorter hospital stay
  • Earlier return to normal activities

Endoscopic surgery is not appropriate for every spinal condition. The key is selecting the right patient and the right pathology.

Microscopic Discectomy

Microscopic discectomy is used to remove disc material compressing a nerve.

It uses a small incision and surgical microscope to allow careful decompression of the affected nerve. It remains a reliable and well-established option when endoscopic surgery is not suitable or when slightly wider access is required.

Lumbar Decompression

Lumbar decompression surgery is performed to relieve pressure on nerves in the lower back.

It may involve removing thickened ligament, small areas of bone, or other structures narrowing the spinal canal or nerve exits.

The main goal is usually improvement in leg pain, walking tolerance, or nerve symptoms rather than treating back pain alone.

Cervical Disc Replacement

Cervical disc replacement, sometimes called artificial disc replacement, is a motion-preserving alternative to fusion for selected neck conditions.

It is most commonly considered when a damaged cervical disc is compressing a nerve or the spinal cord and causing symptoms such as:

  • Arm pain
  • Numbness or pins and needles
  • Weakness
  • Neck pain associated with disc disease

During surgery, the damaged disc is removed and replaced with an artificial disc designed to maintain movement at that level of the spine.

The aim is to decompress the affected nerve or spinal cord while preserving motion rather than permanently fusing the segment.

Cervical disc replacement is not appropriate for every patient. Suitability depends on factors such as:

  • The pattern of degeneration
  • Spinal alignment
  • Instability
  • Facet joint arthritis
  • Bone quality
  • The number of levels involved

For appropriately selected patients, cervical disc replacement can be an excellent option and may help reduce stress on adjacent spinal levels over time compared with fusion.

Part of consultation involves determining whether disc replacement or fusion is likely to provide the safest and most durable long-term result.

Spinal Fusion

Spinal fusion is used when a spinal segment needs stabilisation.

This may be considered for instability, deformity, certain degenerative conditions, fractures, or when decompression alone would not provide a durable result.

Lumbar fusion options may include:

  • ALIF – anterior lumbar interbody fusion
  • OLIF – oblique lumbar interbody fusion
  • TLIF – transforaminal lumbar interbody fusion

The choice of approach depends on the levels involved, anatomy, previous surgery, bone quality, alignment, and the goals of treatment.

Cervical Discectomy and Fusion

Anterior cervical discectomy and fusion, often called ACDF, is performed from the front of the neck to remove a disc or bone spur compressing a nerve or the spinal cord.

The disc is removed, the nerve or spinal cord is decompressed, and the segment is stabilised with a cage or graft and often a plate.

This may be recommended for cervical radiculopathy, cervical myelopathy, or selected degenerative conditions.

Posterior Cervical Decompression and Fusion

Some cervical conditions are better treated from the back of the neck, particularly when there are multiple levels of compression, spinal cord involvement, deformity, or instability.

Posterior cervical decompression creates more space for the spinal cord and nerves. Fusion may be added when stability or alignment needs to be maintained.

Vertebroplasty

Vertebroplasty is a minimally invasive procedure used in selected painful osteoporotic compression fractures.

Medical-grade cement is injected into the fractured vertebra to stabilise it and reduce pain.

This is not the main treatment for osteoporosis itself. The underlying bone health problem still needs medical management to reduce the risk of further fractures.

Vertebroplasty is considered when pain remains severe despite appropriate non-surgical care and when the fracture is still at a stage where stabilisation is likely to help.

Patients who may benefit most are often those with severe pain from an acute compression fracture, particularly when pain is limiting mobilisation or confining them to bed despite appropriate pain medication.