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What is Special About Multiple Sclerosis Sufferers?
Multiple Sclerosis is a condition where the insulating fat surrounding nerve fibres is depleted in various areas of the body resulting in impaired transmission of nerve impulses along these fibres. Consequently sensation, cognitive processes, eyesight, muscle control or strength may deteriorate. This often occurs in a haphazard fashion with transient recovery. Whilst there is a downhill trend the process may arrest for long periods.
Seldom does this process directly generate nerve pain such as sciatica. Back or Neck pain and pain referred in to the arm (Brachialgia) or leg (Sciatica) may arise in Multiple Sclerosis Sufferers as part of the Degenerative Disc Disease seen in the rest of the population and with the same pathologies; disc protrusions, nerve entrapment / scarring / tethering, Lateral Recess Stenosis, Axial Stenosis, Spondylolytic Spondylolisthesis, vertebral slippage, “Instability”, Failed Back Surgery or failed chronic pain management.
The problem for Multiple Sclerosis Sufferers is that General Anaesthesia may aggravate the impaired neurological function and especially cognitive processes. Therefore surgery with General Anaesthesia is avoided wherever possible. The advantage of Transforaminal Endoscopic Lumbar Decompression and Foraminoplasty is that it avoids General Anaesthesia yet allows all the above pathologies to be addressed.
What causes pain in cases of Multiple Sclerosis Sufferers?
Multiple Sclerosis Sufferers may present with various combinations of back, buttock and leg pain, numbness and muscle weakness, Symptoms are often aggravated by an abnormal asymmetrical gait arising from loss of spatial awareness, loss of limb control and numbness in the feet. The back pain may arise from irritation within the disc wall but more commonly arises from the pinching of the trapped nerve in the exit doorway (Foramen) from the spinal column. The foramen may be distorted and the nerve is tethered by years of scarring reaction to repetitive bruising, can not evade the pinching by the bulging distorted disc wall or overriding facet joints (or fracture margins in the case of Spondylolytic Spondylolisthesis). The disc may be degenerate and bulging and contribute to the irritation of the tethered nerve. When advanced the compression causes numbness and weakness to develop. The patchy weakness of the muscles controlling the spinal segments results in asymmetrical loss of control of the disc levels and aggravation of the effects of the local pathology at each level and aggravation of symptoms arising at these levels.
Why is diagnosis difficult?
Unfortunately Multiple Sclerosis Sufferers may present with rather confusing combinations of symptoms arising from the loss of nerve function as well as the symptoms arising from te Degenerative Disc Disease at more than one disc level.
In the light of the primary diagnosis of Multiple Sclerosis, physicians tend to associate symptoms with the Multiple Sclerosis rather than that of the underlying Degenerative Disc Disease. In addition the dangers of treating the Degenerative Disc Disease with open surgery for this particular group of patients makes physicians or surgeons reticent to offer the surgical solutions which would be offered to less challenged patents.
Until the advent of aware state surgical examination, the sources of Multiple Sclerosis Sufferers were hard to define and surgeons engaged in pre-operative ‘guesstimation’ based on the results of clinical examination, X-rays, MRI scans and CAT scans. The complexity of the spinal region means that a wide range of possible conditions exist to confound diagnosis. In the presence of back and leg pain and Degenerative Disc Disease the surgeon will tend to focus upon and treat the pathologu evident on the X-rays ans scans. In our published studies the pain was arising at an adjacent level in almost 20% of cases.
Can the sources of pain be pinpointed?
Aware state surgical examination enables the patient to give the surgeon feedback, guiding him or her to the point that is responsible for the pain. This ‘live’ approach allows the causal level in Multiple Sclerosis Sufferers to be accurately defined and then viewed using endoscopic instruments through a tiny incision. In this way, neural anomalies and strange nerve combinations can be detected and diagnostic errors regarding the disc level responsible for the pain, avoided. Thus, the surgeon is guided to the precise source of pain at that specified inter-vertebral point and the understanding of the actual mechanisms underlying the causation of Multiple Sclerosis Sufferers.
Is accurately targeted treatment possible?
Single targeted surgery enables Multiple Sclerosis Sufferers to be precisely treated with the minimum of damage to tissues, reduced patient risk and enhanced long-term outcome and more essentially without the use of General Anaesthesia. This treatment, which is called ‘Foraminoplasty’ because it is carried out in the gaps or ‘Foramen’ between the vertebrae, allows the nerve to thoroughly liberated and the overriding joints or pointed fracture margins to be removed. This is only possible by the use of Endoscopic Minimally Invasive Spine Surgery where the full length of the exiting nerve can be explored and the points of irritation clearly demonstrated. In the breadth of presentations arising from Degenerative Disc Disease and Failed Back Surgery or Failed Chronic Pain management, Endoscopic Lumbar Decompression & Foraminoplasty achieved a successful enduring positive outcome in 80% of cases.
What is wrong with conventional surgery?
The use of multi-level open surgery in Multiple Sclerosis Sufferers including microdiscectomy, decompression, solid or flexible fusion and is an ‘overkill’ with negative side-effects including blood loss, potential nerve and tissue damage, extended post-operative care and unnecessarily operating on pain-free levels is fraught with aggravation of the current symptom status. It is not as effective as Foraminoplasty in addressing and ameliorating the effects of Multiple Sclerosis Sufferers, rather it runs the risk of increased neurological complications as well as causing the complications of recurrent disc bulging, infection, nerve damage and scarring round the nerve, implant failure, major vessel damage or sexual dysfunction.