May 17, 2017 447
GetDoc: So, let us start off by asking you this question – what is the difference between a spine surgeon and a neurosurgeon for spine?
Dr Paul: Orthopaedic surgeon deals with bone while neurosurgeon deals with nerves (central or peripheral nervous system). Central refers to spinal cord and peripheral refers to nerve ends. Orthopaedics deal with the spine, the vertebra. So when we differentiate the job, it depends on the pathology, what the underlying problem is. If the problem is in the bone, it will be dealt with by the orthopaedic and if the problem is in the spinal cord, it will be dealt with by neurosurgeon. But, there are cases where there will be an overlap of specialities. In such cases, we (orthopaedic surgeon and neurosurgeon) both work on the problem.
GetDoc: Do you see a trend in Malaysia about delaying treatment for example, if they have a back pain they keep postponing their visit to a doctor? What do you think is the right step they must take, in case of a problem?
Dr Paul: This is very common in Malaysia, in fact, a large number of patients go for traditional treatments first and only if that fails they come to us. At times, it would be in a very severe condition. However, there are patients who come to us first rather than get the traditional treatment done. We need to educate our population to reduce the incidence of lack of awareness. It all depends on the acceptance of modern medicine by the general public. Sometimes the effect of a delay is very modest, while other types of care are very time sensitive and a treatment needs to be given at a precise time. These critical treatments can greatly affect patient outcomes, specifically some patients will live with permanent consequences. A delay in treatment can mean the difference between life and death. As doctor, we have to know what is critical in terms of timing and to ensure we are able to treat the patients within the prescribed window of time.
GetDoc: Have you come across patients who took traditional treatment first but it only aggravated the condition and by the time they came to you, the patient is in a very bad state?
Dr Paul: Yes, I have come across quite a few such cases. For example, in disc prolapse, there is an impingement on the nerve group. In this condition, you have to do an early or urgent decompression of the nerve. Due to the delay in coming to the doctor, the disc happens to be completely extruded and there is a compression on the nerve root. In this condition there is no other way out than doing a surgery. This condition i.e. disc prolapse, if you can take care of it from early on, you can actually prevent the extrusion.
GetDoc: Can you walk us through your approach to treatment when a patient walks in for surgery?
Dr Paul: We have to establish the diagnosis – through presentation, history, examination and investigation (MRI). Then you lay down all the options you have – sometimes it can be a simple problem solved with medication and physiotherapy. If surgery is the only way out, you need to see if the patient is fit for the surgery whether they have any other problems such as heart, kidney, and liver problems etc. Patient has to be stabilized before going to surgery.
GetDoc: What are the long-term consequences of spine surgery?
Dr Paul: Consequences depends on the surgery itself. For example, if it is a minimally invasive surgery where there is a minimal of no destabilisation of the spine, you will have minimal consequences and that’s why now the trend is moving from open surgery to minimally invasive surgery. The second issue is what kind of surgery – if it involves a big segment, a long segment when stability will be disrupted. Recovery also will take time. Outcome will be less predictable and long term risks/complications will be higher.
GetDoc: What if you encounter a different spine issue during the patient’s surgery? How would you handle that?
Dr Paul: That depends on the severity of the condition. If we are doing a spine surgery for deformity and we find a tumour inside the spinal canal, we usually balance between the severity of the condition and the consequences, if it is a life-threatening condition we usually would proceed and do the surgery without telling the patient but 2 surgeons have to give consent, it will be the surgeon himself and together with the anaesthetist. But if it is not a life-threatening condition, we will either talk to the patient’s relatives to get their consent and continue doing the surgery or postpone the second surgery for another time.
GetDoc: How should we take care of spine health in general?
Dr Paul: You can divide this into general well-being and spine specific well-being. For general well-being, you need to have proper weight control, and be physically active. For the spine, you need to take care of your posture, for example how you carry heavy objects, how you sit or stand. You have to maintain your upright position when you sit or walk, you have to bend your knees when you lift heavy objects.
GetDoc: Talking about exercise, it is a known fact that exercise can help with spine health but it can also harm the spine. How true is that statement?
Dr Paul: That depends on what type of exercise you are doing, how prepared you are to do the exercise. For example, a weightlifter needs to be physically fit in order to do weightlifting lift that weight. He/she can damage the spine and the muscle around the spine. In such cases you need to keep in mind these 2 things – warm up before doing the weight lifting and gradually increase the strength, you cannot start off right at the top. Start with lower weights; work on the muscles so you can gain the strength slowly.
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by Hridya Anand
A biochemist by education who could never put what she studied to good use, finally found GetDoc as a medium to do what she loved - bring information to people using a forum that is dedicated to all things medical. View all articles by Hridya Anand.