Mission Statement
Our Mission at the Spinal Foundation, is to avoid:
- The "Psychiatric" Refuge
- The "Failed Back" Syndrome
- The 10 minute Specialist consultation
- Non-weight bearing X-Ray studies
- Entering the spinal canal conventionally
- Operating on the patient asleep
- Operating on the wrong level
- Persistent malposture
- The ill informed patient
We consider that the "Failed Back" syndrome is not a syndrome but a failure to identify the underlying cause of persistent pain and to address it specifically. The "Psychiatric state" of the patient has been linked to the outcome of back surgery and too often deemed to be the reason for intervention failure. Such a philosophy of misappropriated blame inhibits the quest to improve our diagnostic and surgical techniques.
After all how often does the Psychiatric state of the patient alter the outcome of a hip replacement? How often is a patient with an arthritic knee sent on a "Coping Course".
Obviously the pain is more disabling if the patient has nothing to hope for except the prospect of further deterioration and has been told to "Live With It" with neither diagnosis nor treatment apart from a pain management programme or a coping course.
Therefore, at the foundation our patients undergo extremely thorough examinations and we are able, with the aid of weight-bearing X-rays, MRI scans and Spinal Probing and Discography to accurately diagnose the source of the pain. In most cases we provide successful resolution of symptoms using advanced physiotherapy techniques, and when appropriate, we operate using advanced keyhole laser procedures to great effect.
Over 30% of patients referred to The Spinal Foundation have had prior conventional surgery and concomitant perineural scarring. Another 30% have been told that there is no definitive diagnosis and have been told to live with their pain. Scarring occurs even with the most skilled surgeon and may in fact be a reflection of an individual's enhanced healing potential. Incarceration of the nerve causes severe pain when the nerve becomes inflamed. Reduce the inflammation and the nerve can coexist with some degree of scarring. Where conservative measures fail, conventional re-exploration is not appropriate as the risk of yet more scar tissue forming too often negates the benefits of attempting to remove the old scar even when the environment is stabilised by fusion. This arena of perineural scarring is where keyhole laser techniques come in to their own, entering the canal by unconventional means after establishing the correct level by Spinal Probing and Discography and ablating the scar mass and sealing the track to reduce recurrent scar.
Our consultation, in the round, takes 45 minutes and specialists should resist management pressure to short circuit patient evaluation. Our patients complete an in-depth questionnaire to describe the progress and extent of symptoms and to classify their functional status against internationally accepted criteria. They then undergo an extremely thorough examination aided by weight bearing dynamised X-rays and MRI scans. This examination is a team approach with specialist physiotherapists and spinal surgeons. Patients are referred for advanced spinal physiotherapy and reviewed. If incompletely benefited they undergo spinal probing and discography and endoscopy to reach an accurate diagnosis and identification of the source of their pain.
Advanced spinal muscle balance physiotherapy is a powerful tool. We seek to address the spine as a "Total Entity" treating all the elements of the cervical, thoracic and lumbar spine with postural rebalancing and restabilisation physiotherapy, using the muscle balance approach. This approach requires rebalancing the scapulae (shoulder blades), the sacroiliac joints, the anteversion and retroversion of the pelvis and malalignment of lower limbs. Relative flexibility is the concept that the spine will overstrain at the point of maximal weakness somewhat akin to a piece of metal. Metal once weakened will flex at the weakened point. So the spine will overstrain at a weak segment below a stiff section. Therefore the stiff section needs to be mobilised and the overstraining segment needs to be stabilised. Muscle balance physiotherapy is achieving exciting results by correcting specific elements of malposture.
If we are to succeed with keyhole laser surgery then the status of the patient needs to be keenly evaluated and all the above generative forces need to be corrected prior to intervention. Keyhole laser spinal surgery retains segmental function whilst it removes only the degenerate material within the disc, retaining and stimulating vital chondrocytes, and reducing inflammation in the disc adjacent structures. In more advanced degeneration, scarring, osteophytosis, sequestration, and extrusion, is removed under direct vision and allows the foramen to be enlarged and tethered neural structures to be mobilised and the outcome to be tested on the operating table with the aware patient.
To date we have performed over 2800 Endoscopic Laser Foraminoplasties and Endoscopic Laser Decompression & Foraminoplasty with encouraging results determined by our research studies.
We learn from the feedback occurring during aware state surgery of previously unrecognised sources of pain. This offers great opportunities for more advanced treatment of back pain and peripheral radiculopathy.
We seek to regard and educate the patient, involving the whole family, and wherever possible the employer. In fact we are trying to assist employers with an expanding programme of preventative measures. Further explanation of our approach to the treatment of degenerative disc disease is presented in the respective pages in this web site.