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Chronic Back Pain and Neuropathic Pain

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By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Back pain is a very common problem in our society. Most of them are self-limited. Some become chronic back pain which is disturbing and difficult to treat. I am going to explain how neuropathy contributes to the development of chronic back pain.

Neuropathic pain is distinct from other types of pain. If a person breaks a bone or got a cut, pain signals are carried via nerves from the site of the trauma to the brain. That is how we can feel pain when we have an injury. With neuropathic pain, however, pain signals originate in the nerves themselves.

How Neuropathic Pain Develops

In many cases, the nerves become damaged or dysfunctional after responding to an injury or trauma, causing hypersensitivity to pain. The nerves then send faulty signals of pain even when the injury has healed. Neuropathic pain or neuropathy, is a chronic condition, meaning it does not go away. Instead, the pain becomes the disease process. An estimated 7 to 10% of people have neuropathic pain. Chronic back pain is a common example of neuropathic pain.

When Back Pain Causes Neuropathy

Neuropathy can result from any type of pain that compresses or impinges on a nerve. A slipped disc, for example, could press against a nearby nerve, causing pain. Neuropathic pain originating from the back or spine may include:

  • Chronic pain radiating down the leg (sciatica) or the arm (cervical radiculoapthy)
  • Chronic back pain

Why Early Treatment is Crucial

Early treatment is important, since more aggressive treatment may be needed if symptoms are not addressed soon. Over time, exposure to significant pain can cause changes to the central nervous system that make the body become more sensitive to even a slight touch. This phenomenon is known as central sensitization.

As with other types of chronic pain, delays in treatment may also make other health problems more likely. Depression, anxiety, difficulty sleeping, and an inability to work and take part in other activities are some health issues associated with untreated neuropathy.

Managing Chronic Pain

Chronic back pain does not go away completely even with the right treatment. The treatment aims to manage the pain so that the person can be functional. The first step is to get a thorough medical evaluation to determine the cause of the pain. It can be muscle strain, arthritis, slipped disc, or other things.

The medical treatment depends on the cause of the pain. Whatever the problem is, there are a number of effective strategies for coping with chronic back pain.

  1. Reduce the stresses in your life. It may be your job or problems in the family. You have to try your best to sort out this problem
  2. Have enough sleep. Our body carries out repair work when we are asleep.
  3. Avoid activities that worsen your pain. E.g. bending down, prolonged sitting, and carrying heavy things.

I hope this information is useful to all of you.

Chronic Back Pain and Neuropathic Pain

Dr Tony Setiobudi is an Orthopaedic & Spine Surgeon at Mount Elizabeth Hospital (Orchard), Singapore. He treats bone, joint, muscle and ligament problems in adults and children. He has a special interest in nerve compression and spine problems such as back & neck pain, scoliosis, kyphosis, spine tumor & infection, spinal cord injury, osteoporosis fracture, spinal stenosis and slipped disc.

Problem in Your Buttock Can Cause Low Back Pain

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By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Problem in Your Buttock Can Cause Low Back Pain

80% of the population suffer from low back pain at least once in their life time. Sometimes, low back pain is caused by injury to the muscles, joints or the discs in the lumbar region. Other time, it is related to subtle wear and tear changes that cause gradual wearing down of the cartilage or the disc. 

When there is significant pain in the buttock, it may be originating from the sacroiliac joint which is a joint that connects the spine and the hip bones. Sacroiliac joint is a common cause of low back pain. However, the diagnosis may not be obvious and often requires thorough physical examination.

There are two sacroiliac joints, one on each side of the spine. These joints transfer the weight of the upper body to the lower limbs. This joint operates under tremendous strain during activities like running, jumping and sitting. Unlike the knee joint which wide range of motions, sacroiliac joint has a very little movement.

Problem in Your Buttock Can Cause Low Back Pain

Anatomy of sacroiliac joint

Problems related to the sacroiliac joint is called Sacroiliac Joint Dysfunction (SIJ dysfunction). It affects both men and women but women tend to get it more. The ligaments stabilising the sacroiliac joint become lax during childbirth causing it to be prone to injury.

Apart from injury, weak muscles surrounding the joint are often the cause of SIJ dysfunction. If this is not addressed, the pain persists and becomes chronic. The nerves supplying the joint constantly send pain signal to the brain causing discomfort. Sometimes, the pain signal process continues independently of the original issue. This means after all identifiable problems are addressed, the pain can still persist.

People with SIJ dysfunction complain of low back pain very close to the buttock. It can affect one side or both sides of sacroiliac joints. The pain may radiate to the hips, thighs and calves especially when the nerves crossing in front of the sacroiliac joint are irritated. Initially, the pain comes on after prolonged sitting. When it gets worse, other activities like walking, climbing and running can trigger the pain.    

SIJ dysfunction can be treated with medications and physical therapy. Strengthening the surrounding muscles and the core muscles helps to stabilise the sacroiliac joint. More severe form of SIJ dysfunction may require more invasive procedures like steroid injections or radiofrequency ablation.  Radiofrequency ablation is done by passing heat in the form of electric current to desensitise the nerves supplying the sacroiliac joint. It can provide an excellent pain-relief. Operation to fuse the sacroiliac joint is rarely required. It is reserved for severe debilitating problems in the sacroiliac joint that do not respond well to less invasive forms of treatment. 

Problem in Your Buttock Can Cause Low Back Pain

Dr Tony Setiobudi is an Orthopaedic & Spine Surgeon at Mount Elizabeth Hospital (Orchard), Singapore. He treats bone, joint, muscle and ligament problems in adults and children. He has a special interest in nerve compression and spine problems such as back & neck pain, scoliosis, kyphosis, spine tumor & infection, spinal cord injury, osteoporosis fracture, spinal stenosis and slipped disc.

Tumor Tulang Belakang – Salah Satu Penyebab Sakit Pinggang

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By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Tumor Tulang Belakang - Salah Satu Penyebab Sakit Pinggang

Pernahkan anda mengalami sakit pinggang?

Kebanyakan kita menyepelekan sakit pinggang yang sebagian besar akan sembuh sendiri jika beristirahat. Padahal, bisa jadi itu bukan sakit pinggang biasa. Untuk sakit pinggang yang berhubungan dengan masalah otot dan degenerative memang tidak serius. Tapi, sakit pinggang ini bisa menjadi masalah serius jika disebabkan oleh tumor.

 

Berikut ini adalah contoh kasus tumor tulang belakang. 

Ibu Maria (bukan nama sebenarnya), 42 tahun, mengeluh sakit pinggang selama 3 bulan. Berat badan turun 5 kg. Dua hari sebelum ke dokter, secara tiba-tiba beliau tidak bisa jalan karena kaki merasa sangat lemah. Hasil pemeriksaan lengkap menunjukkan ibu Maria menderita tumor tulang belakang yang menjepit saraf. Tumor ini menyebar dari usus besar (tumor primari). Saraf yang terjepit menyebabkan kelemahan di otot kaki  sampai pasien tidak kuat berjalan. Beliau menjalani operasi untuk mengambil tumor, membebaskan saraf dan menstabilkan tulang belakang. Setelah operasi ibu Maria bisa berjalan kembali dengan normal. Pasien menjalani chemotherapy dan radiotherapy untuk membasmi tumor lebih lanjut.

Tumor di tulang belakang adalah penyebab sakit pinggang yang berbahaya yang memerlukan penanganan segera. Tumor ini dapat membesar secara cepat dan tiba-tiba. Jika menjepit saraf, pasien bisa mengalami kelumpuhan secara tiba-tiba. Sering kali tumor di tulang belakang terjadi karena penyebaran sel tumor dari tempat lain seperti di usus, prostat, payudara dan lain-lain. Banyak sekali pasien yang mengeluh sakit pinggang tanpa keluhan lain seperti kasus Ibu Maria. Dengan pemeriksaan lengkap, tumor di tulang belakang  dan asal tumor (tumor primari) bisa ditemukan dan ditangani secara keseluruhan. Jika pasien mengabaikan keluhan sakit pinggang, tumor ini tidak akan terdeteksi atau mungkin akan terdeteksi dalam kondisi yang lebih parah.

 

Jenis sakit pinggang seperti apa yang tidak boleh diabaikan?

Sebagian besar sakit pinggang tidak berbahaya. Jika sakit pinggang disertai berat badan menurun secara drastis, sakit pinggang lebih parah saat beristirahat, atau sakit pinggang yang terus menerus dan tidak pulih lebih dari satu bulan, pasien perlu segera periksa ke dokter untuk menegakkan diagnosa apakah hal ini berhubungan dengan tumor.

 

Mengapa tumor tulang belakang mengakibatkan sakit pinggang?

Tumor tulang belakang dapat menyebabkan sakit pinggang karena beberapa hal.

  • Tumor membuat tulang belakang menjadi tidak stabil.
  • Tumor membuat tulang belakang rapuh dan gampang patah. Sakit pinggang meningkat secara tiba-tiba jika ada patah tulang di punggung.
  • Tumor bisa menjepit saraf. Hal ini menyebabkan sakit pinggang terkadang menjalar ke kaki atau ke perut dan dada.

 

Apakah pentingnya untuk mendeteksi tumor tulang belakang secara dini?

Dengan berjalan waktu tumor bisa makin membesar, jika masih berukuran kecil tentu saja lebih gampang dioperasi dari pada sudah berukuran besar. Lebih baik lagi dioperasi sebelum tumor menjepit saraf dan mengakibatkan kelumpuhan.

 

Jadi jangan menyepelekan sakit pinggang yang tidak kunjung membaik apalagi jika berat badan menurun dan sakit pinggang memburuk saat istirahat. Segera periksalah ke dokter untuk mencari penyebabnya. 

 

Tumor Tulang Belakang - Salah Satu Penyebab Sakit Pinggang

Dr Tony Setiobudi adalah spesialis bedah tulang dan super-spesialis bedah tulang belakang di Mount Elizabeth Hospital (Orchard), Singapore. Dr Tony menangani masalah tulang, sendi, saraf, otot dan ligamen pada orang dewasa dan anak. Dr Tony mempunyai keahlian khusus dalam penanganan saraf terjepit (HNP & spinal stenosis) & masalah tulang belakang seperti nyeri punggung & leher, scoliosis, postur bungkuk (kyphosis), tumor & infeksi tulang belakang, cedera saraf besar (spinal cord) & patah tulang osteoporosis.

 

 

Operasi Postur Bungkuk Dapat Menambah Tinggi Badan

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By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Operasi Postur Bungkuk Dapat Menambah Tinggi Badan

Postur bungkuk adalah masalah medis dan masalah estetika. Orang dengan postur bungkuk sering jatuh karena pandangan ke depan terganggu.

Postur bungkuk bisa disebabkan oleh bermacam-macam masalah medis:

  • Ankylosing spondylitis
  • Scheuermann’s disease
  • Proses penuaan (ageing)
  • Patah tulang belakang
  • TBC tulang belakang.

Postur bungkuk yang disebabakan oleh ankylosing spondylitis, Scheuermann’s disease dan TBC tulang belakang sering kali parah. Karena terlalu parah, sering kali pasien tidak dapat beraktifitas dengan baik. Operasi untuk menegakkan postur bungkuk ini perlu dilakukan. Dengan teknologi modern, operasi tulang belakang untuk menegakkan postur bungkuk menjadi jauh lebih aman.

Postur bungkuk ini memerlukan pemeriksaan yang menyeluruh. Ada beberapa kriteria untuk operasi terutama untuk postur bungkuk yang parah. Operasi dilakukan dengan bius total. Tulang belakang ditegakkan dengan menggunakan rods dan screws. Selain pandangan ke depan lebih normal, setelah postur lebih tegak pasien juga akan lebih tinggi. Secara estetika, pasien juga terlihat lebih tegap dan percaya diri.

Operasi menegakkan postur bungkuk ini lebih baik dilakukan secara dini semasa pasien masih muda dan sehat. Terkadang untuk pasien manula, operasi ini tidak mungkin untuk dilakukan terutama jika pasien menderita banyak penyakit kronis lain seperti diabetes, tekanan darah tinggi, sakit jantung dan lain-lain yang membuat resiko operasi lebih tinggi.

Pasien perlu tinggal di rumah sakit selama 5-7 hari. Setelah operasi pasien dirawat di ICU atau high dependency unit selama 1 malam. 2 hari setelah operasi pasien melakukan fisioterapi untuk berjalan. Setelah operasi, rasa nyeri dihilangkan dengan obat analgesik sehingga pasien tetap merasa nyaman.

 

Operasi Postur Bungkuk Dapat Menambah Tinggi Badan

Dr Tony Setiobudi adalah spesialis bedah tulang dan super-spesialis bedah tulang belakang di Mount Elizabeth Hospital (Orchard), Singapore. Dr Tony menangani masalah tulang, sendi, saraf, otot dan ligamen pada orang dewasa dan anak. Dr Tony mempunyai keahlian khusus dalam penanganan saraf terjepit (HNP & spinal stenosis) & masalah tulang belakang seperti nyeri punggung & leher, scoliosis, postur bungkuk (kyphosis), tumor & infeksi tulang belakang, cedera saraf besar (spinal cord) & patah tulang osteoporosis.

Osteoporotic Spine Fracture

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By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

When the bone is soft or osteoporotic, it can fracture with trivial injury or even without injury. Spine bone is one of the most commonly affected bones in osteoporotic fracture. It can be debilitating. But it doesn’t need to affect you. You can prevent osteoporosis by having regular screening and early treatment.

Mild fracture can heal by itself. The pain may not be too bad.

In severe fracture,  the back pain can be very excruciating to the extent that the patient is unable to sit, stand and walk for a period of time. If the pain prevents the patient from  getting out of bed, surgical treatment is required. The surgery depends on the stability of the spinal column. If the spine is stable, the patient needs cement injection (vertebroplasty) to strengthen the bone. If the spine is not stable, bigger surgery is required with the use of spinal implants. Surgical treatment for severe fracture has a high success rate. Immediate stability of the spinal column after surgery will result in significant reduction of pain.

Osteoporotic treatment to strengthen the bone is important regardless whether surgery is required. This is to reduce the risk of having another osteoporotic fracture.

Osteoporotic Spine Fracture

Dr Tony Setiobudi is an Orthopaedic & Spine Surgeon at Mount Elizabeth Hospital (Orchard), Singapore. He treats bone, joint, muscle and ligament problems in adults and children. He has a special interest in nerve compression and spine problems such as back & neck pain, scoliosis, kyphosis, spine tumor & infection, spinal cord injury, osteoporosis fracture, spinal stenosis and slipped disc.

 

The Danger of Excessive Mobile Use

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By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

The Danger of Excessive Mobile Use

People of all ages are glued to their mobile phones. Other than the social impact, this phenomenon causes serious health issue to the neck.

Neck posture is bending forward for many hours a day, everyday, for many months and years. Can you imagine our teenage children are having this habit from such a young age? The damage to the neck is accumulative and irreversible to some extent.

Excessive mobile use causes upper cross syndrome

The more forward is the neck posture, the harder the neck muscles need to work to maintain the head up.  This cause muscle imbalance and neck pain. This condition is called “Upper Cross Syndrome”. The neck pain does not get better unless the cause is identified and avoided.

Overtime, this causes chronic pain which is even more difficult to treat.

 

Excessive mobile use causes premature degeneration on the discs in the neck 

Forward neck posture exerts excessive amount of pressure to the discs in the neck. This causes premature degeneration on the discs. The discs become thin and bulging. Sometimes, it causes narrowing of the spinal canal and nerve compression.

 

The symptoms do not appear immediately. It may take years to manifest. But sure it will. Thus, it is important to limit mobile use.

There are some tips that you can do to reduce the damage to the neck when you need to use your mobile excessively

  1. Read your mobile at the eye level so that you neck posture is still upright.
  2. Do regular exercises
  3. Do strengthening of the inner neck muscles to balance up

The Danger of Excessive Mobile Use

Dr Tony Setiobudi is an Orthopaedic & Spine Surgeon at Mount Elizabeth Hospital (Orchard), Singapore. He treats bone, joint, muscle and ligament problems in adults and children. He has a special interest in nerve compression and spine problems such as back & neck pain, scoliosis, kyphosis, spine tumor & infection, spinal cord injury, osteoporosis fracture, spinal stenosis and slipped disc.

The Danger of Spinal Cord Compression

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By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

The Danger of Spinal Cord Compression

 

Spinal cord is a big nerve that connection the brain with the arms and legs. External compression to the spinal cord can interfere with the normal function of the nerves. People with spinal cord compression do not necessarily complain of neck pain or back pain. Spinal cord compression can occur in a few situations:

  1. Slowly because of wear and tear or degenerative process.
  2. Rapidly because of tumor or infection.
  3. Suddenly due to fracture

Whatever the cause is, the treatment of spinal cord compression is surgery to free up the spinal cord. Spinal cord compression from slow process results in difficulty walking and difficulty using the hands. Patients with this condition rarely becomes paralysed. The surgery does not need to be done urgently. However, when the spinal cord compression occurs rapidly or suddenly, the patient may become paralysed. This requires urgent surgery to free up the spinal cord.

Spinal cord compression should not be left untreated.

The Danger of Spinal Cord Compression

Dr Tony Setiobudi is an Orthopaedic & Spine Surgeon at Mount Elizabeth Hospital (Orchard), Singapore. He treats bone, joint, muscle and ligament problems in adults and children. He has a special interest in nerve compression and spine problems such as back & neck pain, scoliosis, kyphosis, spine tumor & infection, spinal cord injury, osteoporosis fracture, spinal stenosis and slipped disc.

Why Fuse the Spine?

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By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Why Fuse the Spine? Spine stabilization

Spinal fusion surgery is indicated when the spine is expected to be unstable after the index operation. In general if there is a sign of instability before surgery, spinal fusion is indicated.

Spinal fusion for nerve compression

Spinal fusion surgery is often performed when the spine shows abnormal movement. Freeing up the nerve from compression (spinal stenosis) often requires removal of bones, ligaments and disc materials. This created further instability in the spine. If the spine is unstable prior to surgery, the spine will become more unstable after the surgery. Thus, spinal fusion is required

 

Spinal fusion for deformity (abnormal posture) correction

Scoliosis or kyphosis (hunched back) often requires surgery to correct the deformity. This requires spinal fusion surgery to maintain the correction and to provide immediate stability after major postural correction.

 

Spinal fusion for spinal tumor surgery  

In spinal tumor, the normal bone is replaced by tumor tissue which causes weakness in the spine. Removal of spinal tumor creates void in the spinal segment which makes the spine very unstable. This void is often replaced by metal implant. Spinal fusion surgery is required to hold the metal implant in place and to provide immediate stability.

 

It is important to know the reason why spinal fusion surgery is required. If you have any questions about why you need spinal fusion surgery, you can approach your doctor for further clarification.

Why Fuse the Spine?

Dr Tony Setiobudi is an Orthopaedic & Spine Surgeon at Mount Elizabeth Hospital (Orchard), Singapore. He treats bone, joint, muscle and ligament problems in adults and children. He has a special interest in nerve compression and spine problems such as back & neck pain, scoliosis, kyphosis, spine tumor & infection, spinal cord injury, osteoporosis fracture, spinal stenosis and slipped disc.

 

Microdiscectomy | Operation for Slipped Disc

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Microdiscectomy | Operation for Slipped Disc

Explanation about slipped disc and the cause of the pain. Spinal cord is compressed and slipped disc surgery Singapore helps remove the compression and stops the pain.

Slipped disc can be very painful. The typical symptom is pain radiating to the leg with sudden onset. The diagnosis is confirmed with physical examination and MRI scan. Slipped disc surgery (microdiscectomy) can help overcome the pain.

Microdiscectomy is an operation to remove the slipped disc and to free up the nerve. This operation is done with a small incision. The vision during the operation is enhanced using the help of microscope. This operation has a high success rate. The leg pain can disappear or become significantly better immediately after the surgery.

If you have any questions about slipped disc or microdiscectomy, please do not hesitate to contact us.

Author: Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho), Orthopaedic & Spine Surgeon, Mount Elizabeth Hospital (Orchard), Singapore

 

What Makes Spine Surgery Safe?

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What Makes Spine Surgery Safe?

Many more minimally invasive spine surgeries are performed nowadays compared to a few years ago. The rate of complications has reduced significantly with advanced and modern technology.

The experience of the spine surgeons themselves play a significant role in reducing the complication of spine surgery. It has been showed that surgeons who perform more than 50 spine surgeries in a year has significantly lower rate of complication compared with surgeons who perform less than 50 cases per year. If you need spine surgery, make sure that you choose the surgeon with adequate experience in spine surgery.

Other than the operators, there are modern technology that plays an important role to make spine surgery safe. 

  • Neuromonitoring is used to monitor the nerve function at all time during spine surgery. If there is any problem with the nerve, the neuromonitoring machine can alert the surgeon. This allows the problem to be rectify during the surgery.
  • Microscope helps to provide clearer surgical fields especially when the surgical incision is small. Microscopic magnification allows the surgeons to identify the important structure very clearly.
  • Image Guidance using Xray or CT scan provide radiographic feedback to help us to localise the intended area of surgery. It also allows the surgeon to confirm the accuracy of implant placement.
  • Computer Navigation is navigation system similar to GPS. This is used in spine surgery especially in difficult area such the upper cervical spine. This technology provides specific information to the surgeon on the exact area where they are operating when the anatomical landmarks are minimal.

Thus, experienced surgeon together with appropriate modern technology makes the minimally invasive spine surgery safer than before.

Author: Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho), Orthopaedic & Spine Surgeon, Mount Elizabeth Hospital (Orchard), Singapore

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