Mr Jonathan Bull

Mr Jonathan Bull
Neurosurgery
Central London


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Mr Jonathan Bull

Neurosurgeon in
London

MA MB BChir MD(Res) FRCSGlasg FRCSEng (Neuro.Surg)

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Mr Jonathan Bull areas of expertise:

Professional statement

Mr Jonathan Bull is a consultant neurosurgeon and spinal surgeon. He treats a full range of brain and spinal disorders which cause pain and dysfunction in the spine and the limbs with both simple and complex procedures.

He studied neurophysiology and medicine at Cambridge University before qualifying in 2000.

Mr Bull completed initial surgical training at St Mary’s campus, Imperial College, followed by higher surgical training in neurosurgery under the tutelage of Henry Marsh in the south Thames Programme. Alongside this, he achieved a Doctor of Medicine (MD Res) at University College London (UCL) specialising in MRI imaging of paediatric brain tumours.

He then undertook two specialist fellowships in complex spine surgery, initially as the Sir Victor Horsley Complex Spine fellow between the Royal National Orthopaedic Hospital, Stanmore and the National Hospital for Neurology and Neurosurgery (Queen Square). He was subsequently awarded a European Association of Neurosurgical Societies (EANS) fellowship at University Hospital Klinikum rechts der Isar. He became a Fellow of the Royal College of Surgeons in 2011.

Mr Bull joined the Barts Health Trust as a Consultant in 2012; his NHS practice is based in the Trust’s Royal London Hospital.

 Credentials

GMC: ‍4767846

 Professional experience

• Consultant Neurosurgeon and Spinal Surgeon, Jonathan Bull Spinal Surgery - HCA The Shard / London Bridge Hospital / Wellington Hospital, Cromwell Hospital and London Independent Hospital (Oct 2014 – present)
• Consultant Neurosurgeon and Spine Surgeon, Barts Health NHS Trust (2012 – present)

 Sub-specialties

• Minimally invasive approaches to neck and back pain
• Minimally invasive approaches to degenerative spinal disorders
• Neck pain
• Back pain
• Spinal Stenosis
• Sciatia
• Complex spine procedures emcompassing spinal tumours;
• Malignant spinal cord compression;
• Tuberculosis of the spine
• Spinal trauma including vertebroplasty

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 Education

• MA MB BChir Neurophysiology and Medicine, University of Cambridge (1995 – 2000)
• Basic Sugical training, Imperial College / St Marys Hospital (2002 – 2004)
• MD (Res) - Diffusion MRI imaging of Paediatric Brain Tumours, UCL (2006 – 2008)
• Higher Specialist Training - Neurosurgery, South Thames Neurosurgical Rotation (2005 – 2012)
• Sir Victor Horsley Complex Spine Fellowship, Royal National Orthopeadic Hx Stanmore / Queen Square, National Hx for Neurology & Neurosurgery (2011 – 2012)
• European Association of Neurosurgical Societies (EANS) Fellowship Field Of StudyComplex Spine Surgery, University Hospital Klinikum rechts der Isar, Munich, Germany (2013 – 2013)

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 Professional membership

• Fellow of the Royal College of Surgeons (FRCS) (2011)
• British Association of Spinal Surgeons
• Medical Defence Union
• British Medical Association
• British Society of Neuro Surgeons
• North American Spine Society
• Society of British Neurological Surgeons

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Languages spoken

  • English

Patient reviews for Dr. Jonathan Bull

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Patient reviews

Verified Patient
05/09/2018

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Patients comments

What i appreciated most during my consultation with mr j. bull was that he offered me a number of options to treat my spinal stenosis and nerve compression.

Verified Patient
09/07/2018

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Diseases, Medical Tests and Treatments

Arm pain

What causes arm pain? Arm pain has a number of causes, including: Muscle injury – also known as a strain, generally caused by overexertion ...

Back pain

Pain in the lower back is a pathology caused by various factors, such as excessive stress or poor posture. Less common is the lower back pain caused b ...

Minimally invasive spinal surgery

What is minimally-invasive spinal surgery? Minimally invasive spine surgery, sometimes known as laparoscopic spine surgery, is an alternative to op ...

Neck pain

Cervical pain (neck pain) occurs in the upper part of the spine, in the cervical area. It is a pain usually caused by trauma, illness, progressive det ...

Sciatica

What is sciatica? Sciatica is a very painful condition that can last for several days. It occurs due to the irritation of the sciatic nerve, which can happen through inflammation or injury. Sciatica is not a disease itself, but is a symptom of another health problem. It usually causes a radiating pain that extends from the back to the leg, even reaching the feet. The muscles around the area tend to contract before the pain, worsening the situation. On other occasions, one of the spinal discs moves backwards, putting pressure on the nerve. What are the symptoms? The symptoms that sciatica produces can hinder quality of life. Some of the most common indicators include: Pain: the degree of pain can vary from a mild pain that hardly causes discomfort to a dull or very intense pain that hinders the ability to move. Tingling: occuring in the legs, calves and feet. Numbness: areas where pain and tingling occur may be numb. Weakness: it is very common to feel weakness in some parts of the body. Causes of sciatica why it occurs Sciatica pain is caused by inflammation or injury of the sciatic nerve, sometimes caused by compression in muscle contractures, a disc displacement in the spine, or a narrowing of the nerve channel. The most common causes of sciatica are: Herniated disc Spinal stenosis Piriformis syndrome Lesion or fracture of the pelvis Tumours Can it be prevented? Sciatica cannot be prevented since it is not a disease, but a symptom. However, experts recommend regular exercise and practising good posture. What is the treatment? Because sciatica is a symptom of another condition, the cause must be identified and treated. In some cases, no treatment is necessary and the sciatica gets better on its own. In other cases, medication, surgery, or physiotherapy may be indicated in order to alleviate the pain or to correct the problem. ...

Spinal stenosis

Spinal stenosis is a narrowing of the spinal canal that puts pressure on the spinal cord and roots. When located in the lower part of the spinal column it is known as lumbar canal stenosis, while when the narrowing occurs in the top of the spine, it is called cervical canal stenosis. The lumbar and cervical areas are usually the most affected, although the narrowing of the canal does not cause pain if it does not compress any nerves. Spinal stenosis often occurs gradually due to the ageing process and the deformation of bones and tissues around the spinal canal. It usually affects people who are over 50, although it can also affect young people who suffer some type of spinal trauma. The treatment includes taking medications (anti-inflammatories or steroids) to reduce the pain and the inflammation, as well as resting, or doing some physical therapy. Surgery is recommended when there is nerve compression that progressively worsens. ...

Arthroplasty

What is arthroplasty? The term “arthroplasty” refers to any surgical procedure to restore the function of a damaged joint, often by replacing them with artificial joints made of chromium, cobalt and titanium, along with high density plastics. The ultimate aim of arthroplasty is to correct deformities, reduce or eliminate pain in the affected areas, and restore mobility. Arthroplasty is commonly performed on the hip, knee, elbow, shoulder, and ankle, among others. Different types of arthroplasty include: Joint replacement – the damaged joint is removed and replaced with a prosthesis. Hip replacements and knee replacements are the most common. Interpositional arthroplasty – tissue, such as skin or muscle is interposed to keep inflammatory surfaces from rubbing together. Excisional arthroplasty – bone is removed from the surface of the joint to stop the bones making contact. Scar tissue is left to fill the gap. Resurfacing arthroplasty – the surfaces of the bones at the joint are replaced with a smooth, protective metal coating.   Why is arthroplasty done? Arthroplasty is carried out to replace the damaged joint with a healthy one, allowing the patient to live a full and active life with adequate mobility. Arthoplasty may become necessary due to: Rheumatoid arthritis Osteoarthritis Osteoporosis Osteonecrosis Misaligned joints (often due to traumatic injury)   What does arthroplasty consist of? Arthroplasty procedures are carried out under general anaesthetic. The patient’s heart rate, blood pressure, breathing, and blood oxygen are monitored, while the surgeon makes an incision and removes and/or repairs the damaged parts of the joint, before closing the incision with stitches. The process of placement of the prosthesis will be different depending on the type of joint replacement.   Preparation for arthroplasty No special preparation is required for arthroplasty, other than notifying the specialist of the possibility of being pregnant and the medication the patient is taking, which may be strong in cases of rheumatic diseases and may need to be stopped or changed prior to the operation.   Care after the intervention After the intervention, the patient may feel pain, which is normal in any intervention. In case of pain, the specialist will recommend the best treatment. During the hospitalisation, specialists will soon begin to move the joint, so that recovery is as effective as possible and the patient regains mobility as soon as possible. After being discharged from the hospital, the patient must go for rehabilitation for a few months to fully recover the mobility of the joint and also to check that make sure that the prosthesis is functioning properly. ...

Brain metastasis

What is a brain metastasis? A brain metastasis is a type of cancer that begins in any part of the body and spreads to the brain. The types of cancers that occur most frequently and that develop metastases at the brain level are lung, breast, and genitourinary tract cancers. However, there are other types of cancer that rarely spread to the brain, such as colon or prostate cancer. In other rare cases, a tumour can spread to the brain from an unknown location, in what is known as cancer of unknown primary origin. What are the symptoms? When metastasis occurs, the tumour appears in the brain and as it grows it causes inflammation and intracranial pressure. The main symptoms of brain metastasis are reduced co-ordination or difficulty with special awareness, headache and fever, memory loss, weakness on one side of the body, and seizures. Can it be prevented? There are no known measures to prevent a brain tumour, but it is recommended to avoid unnecessary radiation, contact with chemical substances and carcinogens. What is the treatment? The treatment of brain metastasis depends on the type of tumour and its size, where it originated, and the patient's overall health. The main objectives of treatment are to relieve symptoms, and improve quality of life and well-being. The prognosis for brain metastasis is poor, but modern treatments are prolonging life expectancy, allowing patients to live for months or years, in some cases, after diagnosis. Radiation is often used in the brain, especially if there is more than one tumour. Surgery can also be used when there is only one tumour and the cancer has not spread to other parts of the body or brain. While there are tumours that can be completely removed, others can only be reduced in size, which is known as cytoreduction. Chemotherapy is rarely used in the treatment of brain metastatis, as is not as effective as surgery and radiation therapy (although some tumours do respond to it). Surgical resection followed by stereotactic radiosurgery, which is a form of radiation therapy that focuses high-powered X-rays in one area of the brain, is also an option. Medications are also taken to relieve symptoms. ...

Chiari malformation

The Chiari malformation is a congenital defect characterised by when the cerebellum (the part of the brain that controls balance) projects and comes to occupy part of the space for the spinal cord. In many cases, it occurs because of not having enough space. Although sometimes it might not have any symptoms and goes unnoticed throughout life, Chiari malformation can obstruct proper circulation of the cerebrospinal fluid, which is intrinsic in the communication between the brain and the rest of the body. Consequently, Chiari disease causes significant motor difficulties. Currently, the only treatment to correct their effects and stop its evolution is cranial surgery. ...

Craniocervical junction abnormalities

They are alterations of the occipital bone, the foramen magnum or the first two cervical vertebrae. These anomalies diminish the space occupied by the brain stem and spinal cord and give rise to cerebral symptoms. Anomalies of the cervical skull junction include pathologies such as odontoid bone, high hypoplasia, and Chiari malformation. ...

CT scan (CAT)

What is a CT scan? A computerised tomography (CT) scan, also known as a CAT scan, works by combining numerous X-ray images that are taken from different angles and processing them through a computer to produce a cross-sectional image of different parts of the body. CT scans can be used to take images of bones, blood vessels and soft tissues and provide much more detail than regular X-ray images. What does a CT scan involve? CT scans are carried out in just a few minutes, and can take up to 30 minutes to complete. During a CT scan, you lie down on a table that slides in and out of the CT machine. You rest your head on a pillow and you may be strapped to the table to help you stay in position. If your head is being scanned, a special head cradle might be used. Whilst you are being scanned, the CT scan technician stays in an adjacent room and will communicate with you via intercom. In some instances, you might be given a contrast dye which highlights certain tissues for the technician.  What is a CT scan for? A CT scan is often used for diagnostic reasons, for example, they are used a lot when dealing with patients who have been injured and might have internal damage. A CT scan is also used for the following: To locate a tumour or blood clot To guide procedures, such as surgery, biopsies or radiation treatment To diagnose bone and muscle disorders To determine if there is any internal bleeding present  To check how effectively a treatment is working To examine conditions affecting the heart and its blood vessels (coronary CT scan) How can you prepare for a CT scan? It may be necessary to remove certain clothes and accessories before a CT scan, depending on which part of the body is being scanned. Usually you will have to avoid food and drink a few hours before having a CT scan.  What does it feel like during a CT scan? A CT scan is painless; however, it usually requires you to remain very still, which can sometimes be challenging, particularly if the patient is a child or in pain. Movement can blur the images, so it is important to stay still during the scan. Sometimes the patient can be given a mild sedative to help them relax.  What happens with the results? Once your scans are complete and the images are ready, the radiologist will write a report which is then shared with your doctor, who will discuss the results with you. Results can be processed either within a few days or a few weeks.  ...

Degenerative disc disease

What is degenerative disc disease? We all have discs between the vertebrae, which, in young, healthy people, act as shock absorbers, helping the back to stay flexible and absorb the impact between the bones caused by movement. However, the natural ageing process leads to wear and tear, and the once rubbery discs shrink and lose integrity. This is known as degenerative disc disease (DDD). Despite its name, degenerative disc disease is not a true disease, nor is it progressively degenerative. However, it can lead to low back pain (with or without sciatica), particularly if the discs collapse completely, leading to osteoarthritis.   What are the symptoms of degenerative disc disease? Degenerative disc disease presents a series of localised symptoms, usually in the lower back or in the neck, depending on the location of the affected discs. Symptoms include: Pain that can range from mild and nagging to persistent and disabling Pain in the lower part of the back, which radiates towards the buttocks and thighs Pain in the neck that radiates to the arms and hands Pain that gets worse when sitting Pain when bending, getting up or twisting the body Pain that is relieved when walking and moving Pain that decreases if you change position often Severe intermittent pain, lasting from a few days to months Tingling and numbness in extremities Muscle weakness in the legs and feet   Causes of degenerative disc disease There are several factors that cause degenerative disc disease, mostly associated with natural wear and tear over time: Ageing Dry discs – as we age the spinal discs dry out, meaning they are less capable of absorbing shock. Activity, exercise and sports – over time, activity can lead to tears in the outer core of the discs. Injuries   What is the treatment for degenerative disc disease? The main objective of treatment is to manage the pain. To this end, it is necessary to exercise to increase the strength and flexibility of the muscles that surround the spine. Exercise increases blood circulation to the back, providing the joints and muscles with oxygen and nutrients, and carrying inflammatory waste products away. In addition, there are treatments that promote the strengthening of the back: Physical therapy Medications, including non-steroidal anti-inflammatories (NSAIDs) and pain relievers (consult your doctor about what medications you should take, if any). Surgery – this may involve replacement of the discs with artificial implants or spinal fusion Spinal mobilisation Applying heat and cold to the painful area   ...

Discectomy

What is a discectomy? Discectomy is a surgical procedure to partially or completely remove a spinal disc. The spinal disc is the cushion that separates the vertebrae, the bones that make up your spine. Why is a discectomy performed? A discectomy is usually performed to treat a herniated spinal disc. A spinal disc hernia means that some of the fluid has leaked out and has begun to press on the surrounding nerved. This can produce pain in the back that spreads to the legs and causes intense weakness in the muscles. A discectomy is carried out when more conservative measures, such as physiotherapy and steroids, have failed to alleviate the pain and weakness from the hernia. Where a discectomy is performed to correct problems caused during a previous discectomy, it is known as a revision discectomy. What happens during a discectomy? A discectomy is generally carried out under general anaesthesia and may require an overnight hospital stay. To access the herniated disc, surgeons may either perform open surgery or make use of keyhole techniques (also known as a microdiscectomy). In some cases it may be necessary to remove part of the vertebra to get access to the herniated disc. The aim is to remove only the part that is herniated, but in some cases the surgeon may need to remove the whole disc. If the whole disc is taken out the surgeon will need to fill the space with bone, which could come from a donor or could be made from synthetic material. Preparing for discectomy No special preparation for discectomy is required. You will, however, need to inform the doctor of any medications you are taking including herbal supplements. You will also need to see the anaesthetist prior to the operation to assess your suitability for general anaesthetic. Aftercare Recovery after discectomy is usually rapid. You will usually be asked to get up and walk as soon as the anesthesia wears off and often you can return home the same day of the surgery. At first you may feel pain, weakness or numbness, which should disappear during the next few weeks. For an optimal recovery, it is recommended to walk as often as possible, and your rehabilitation program should include physiotherapy and exercises to carry out at home. As for returning to work, if it is in an office, you can return after two or four weeks; on the other hand, if it is a job that requires manual labour, it can usually be resumed after four to eight weeks. ...

Hydrocephalus

What is hydrocephalus? Hydrocephalus is the name given to the build-up of excess cerebrospinal fluid in the brain (hydrocephalus means ‘water on the brain’). The function of this substance is to protect the brain, but too much of it puts harmful pressure on the brain. Cerebrospinal fluid also surrounds the spinal cord. This condition can be congenital, which means that you are born with hydrocephalus or it can be acquired, which means that you develop it after birth as a result of other factors including tumours, infections such as meningitis and bleeding on the brain. This is a common condition in babies with myelomeningocele. Prognosis of the disease Hydrocephalus can cause permanent brain damage and problems with physical and mental development. If treated, sufferers can lead a normal life (although with certain limitations) but if left untreated it can be fatal. The best prognosis for hydrocephalus is for hydrocephalus that is not caused by infection. Symptoms of hydrocephalus Symptoms in children can include: Irritability and poor head control Vomiting Drowsiness Eyes that seem to turn downward The child’s head may enlarge more than the face And in older children and adults: Headaches Balance problems Blurred vision Nausea Problems with thinking and memory In addition, this pathology in babies causes the soft spot of their head to bulge. Medical tests for hydrocephalus A CT scan of the head is performed to diagnose hydrocephalus. This may be accompanied by an MRI scan of the brain and spinal cord, skull ultrasound, lumbar puncture, and x-rays. What causes hydrocephalus? Hydrocephalus may be caused by genetic problems or problems in the foetus during pregnancy. Signs of its presence include: Blockage of cerebrospinal fluid flow Cerebrospinal fluid cannot be absorbed into the blood · The brain produces too much CSF. When this happens, the CSF puts pressure on the brain, pushing it upward and damaging the brain tissue. Can it be prevented? In babies, the head can be protected from injury and infections and other disorders associated with hydrocephalus can be avoided. Treatment for hydrocephalus Treatment for hydrocephalus depends on the cause. It the cause is a brain tumour blocking the flow of cerebrospinal fluid, then removing the tumour may be the best treatment. However, most patients with the condition will require a procedure to divert the cerebrospinal fluid away from the brain. They may undergo surgery to implant a shunt, a flexible but robust tube that diverts fluid flow to another area of the body where it can be absorbed. In some cases, fluid may be rerouted within the brain with an endoscopic third ventriculostomy. The surgeon makes a hole in the floor of the brain to allow the trapped fluid to move away from the surface of the brain where it can be absorbed. Other complementary measures may include medicines, removal of the parts of the brain that produce CSF, and rehabilitation. Which specialist treats it? The specialist responsible for treating it is the neurosurgeon. ...

Kyphoplasty

What is kyphoplasty? Kyphoplasty is a type of surgery performed on the spine to reduce pain caused by a spinal fracture or condition such as osteoporosis. A number of spinal conditions can cause the spine to fracture and compress, causing severe pain and making it more difficult to move. By stabilising the fractures with cement, kyphoplasty aims to alleviate pain, strengthen the spine, and improve mobility. Kyphoplasty is very similar to vertebroplasty, another procedure for stabilising the spine. The difference is that while a vertebroplasty procedure involves injecting cement directly into the spine, kyphoplasty involves inflating special balloons to make space in the fractured bone first, before injecting the cement mixture. What does it involve? Kyphoplasty is generally performed by an interventional radiologist, and is usually a day case procedure, so you won’t have to stay in hospital overnight. You will usually be sedated for the procedure using an IV line, and you may be given medication to help with nausea nd pain. The procedure involves making a small incision in the back and guiding a small tube to the target area, with the help of an X-ray. A balloon is passed through the tube then inflated to create the space for the cement mixture. Finally, the mixture is injected through the tube. The doctor will then bandage the area where the incision was made and remove the IV line. The whole procedure should take about an hour, but it can take longer if the doctor needs to treat more than one vertebra. How do you prepare for kyphoplasty? Prior to the operation your doctor might order an X-ray or MRI scan to produce a clear picture of the area that needs repair. On the day of the operation you should be able to take your usual medication, with the exception of anti-inflammatory tablets, but you may be asked not to eat or drink anything for several hours before the procedure. Aftercare After the procedure it’s likely you’ll need to stay in a recovery room for a couple of hours. If there were complications, or if more than one vertebrae was treated, you might need to stay in hospital overnight. The interventional radiologist might also recommend a follow-up appointment to scan the area of the operation and discuss your symptoms. Your doctor will advise you on what physical activity you can do after the procedure. Generally, you’ll be advised to increase your activities gradually and resume all medication. You should feel pain relief immediately or within a couple of days of the procedure. You might, however, feel some pain from the incision that was made. Many patients who have undergone kyphoplasty are able to reduce their pain medication within a couple of weeks of the procedure, and are much more active after the procedure. Alternatives to this treatment Kyphoplasty isn’t suitable for everyone. It is more effective the sooner it is performed after a fracture, so if your fracture has already healed, kyphoplasty may not be recommended. Kyphoplasty may not be suitable for someone with a lung disease or emphysema because the procedure involves lying down for at least an hour. In some cases special accommodations can be made. Finally, kyphoplasty might not be recommended if you have a problem with abnormal blood clotting, because this can make the surgery itself unsafe. ...

Laminectomy

What is a laminectomy? A laminectomy, also known as an open decompression, is an operation performed to remove the lamina, part of the bone of a spinal vertebra. The spine is a structure that protects the spinal cord and is composed of 33 vertebrae divided into the cervical, thoracic, lumbar, sacral and coccygeal regions. The vertebrae are separated by intervertebral discs. Why is it performed? A laminectomy is usually performed to treat spinal injuries that compress the structures of the nervous system (spinal cord or spinal nerves), such as herniated discs, certain tumours, osteoarthritis, and, most commonly, spinal stenosis (a condition that mainly affects older people). The main symptoms of this pathology are: numbness, spasms, or pain in the back weakness in the arms or legs difficulty or poor balance when walking bowel control problems Surgery usually results in total or partial relief of symptoms. What does it involve? A laminectomy involves making a small incision in the skin, along the lumbar vertebrae, to separate the muscles and expose the bone. To relieve pressure on the pinched nerve and spinal cord a part of the vertebral lamina is removed. The nerve is then carefully moved to one side and the herniated part of the disc is removed. The muscles are then repositioned and the incision sutured. In the case of cervical spine injuries, the approach is made from the front, while in the case of lumbar injuries, it is made from the back. Preparing for a laminectomy Before having a laminectomy, a spinal x-ray must be performed. An MRI or CT scan may also be necessary to confirm spinal stenosis. To prepare for the procedure you may need to stop smoking, stop taking certain medications, and refrain from drinking alcohol. You must also tell the doctor about any other pre-existing conditions you have. Finally, you may be asked not eat or drink 6 to 12 hours before the surgery. Post-operative care In principle, after the operation you can get up and walk when the anaesthetic wears off. However, you will usually be discharged from hospital between one and three days after the intervention. Once at home, you will need to rest in order to heal the wound according to the doctor's instructions. Excessive bending, lifting, or twisting is not recommended until about six weeks after surgery. Alternatives to this treatment A laminectomy may be complemented by arthrodesis (spinal fusion) to help stabilise sections of the spine. This technique may also be part of a more major procedure such as a discectomy (surgery to remove all or some of the cushion that helps support part of the spine). ...

Lumbar fusion

Lumbar fusion is recommended for the treatment of fractures, instability due to degenerative disease, tumours and other ailments that affect the stability of the spine. This is the latest promising measure when other treatments (such as girdles, massages, measures of postural improvement, anti-inflammatories and acquisition of an adequate weight) have not been successful. It is a delicate surgery that usually lasts from four to six hours and is performed under general anaesthetic. It also requires complementary postoperative rehabilitation.  ...

Lumbar herniated disc

What is lumbar spine disc herniation?  A spinal disc herniation, herniated disc or a slipped disc, refers to a condition affecting one of the discs in the spine. Between each vertebrae in the spine, there is a cushion, known as an intervertebral disc. A tear in the out, fibrous ring of one these discs can allow the central, jelly-like section of the disc to budge out. This is called a spinal disc herniation, more commonly referred to as a slipped disc. Although it can happen anywhere along the spine, it most commonly occurs in the lower back (lumbar). What are the symptoms? The most common symptom of a lumbar spine herniated disc is back pain. If the disc presses on surrounding nerves, individuals may experience arm or leg pain, numbness or tingling, and weakness. Intense pain in the buttocks, thighs and even feet is also common.  In some case, people experience no symptoms at all. What causes it? The most common cause is gradual wear and tear through ageing. As a person ages, the water content of the intervertebral discs reduces, making them less flexible and more likely to rupture. Additionally, bending, twisting, lifting heavy objects awkwardly, obesity or an injury or trauma can all put increased strain on the back. How can it be prevented? The risk of a slipped disc can be reduced by maintaining a healthy lifestyle and a healthy weight, and regular exercise is important. When lifting heavy objects it is also helpful to observe a safe technique to avoid unnecessary strain. Smoking also causes discs to lose flexibility and giving up may help to reduce the chances of suffering a herniated disc. What is the treatment? Most herniated discs will gradually improve and treatment may just consist of avoiding painful positions, taking gentle exercise and medication for the pain. Physiotherapy is also commonly used to treat a slipped disc, using exercise plans, positions and massages to treat the injury. Medications are used to ease the pain and the type used will depend on its severity. Over the counter pain killers are used for mild cases whilst stronger painkillers are prescribed for worse cases. Additionally, anti-inflammatory injections directly into the spine are used to relieve severe pain in the short term in some cases and muscle relaxants are also deployed in some cases. If the symptoms do not improve or are very severe, surgery might be an option. An operation known as a discectomy can be used to cut away part of the disc to release the pressure on the surrounding nerves.  ...

Nervous system

What is it?     The nervous system is a complex collection of nerves and cells that transmit signals from the brain and spinal cord to different parts of the body. The nervous system has two main parts, the central nervous system (CNS) and the peripheral nervous system (PNS). The central nervous system is made up of the brain and spinal cord, and the peripheral nervous system is made up of the somatic and autonomic nervous systems, which are made up of nerve fibres from the spinal cord that cover the whole body, including muscles and internal organs.  The central nervous system is made up of the brain and spinal cord. The brain has two hemispheres which are divided into lobes, they include; the encephalon, the brain, the cerebellum, the medulla oblongata, and the diencephalon. In the brain, the neurons – which are made up of a nucleus, axons, and dendrites – play an important role, communicating through axons and dendrites, sending electrical signals that release neurotransmitters.   Nervous system function      The main function of the nervous system is to process signals while coordinating the body. The nervous system is responsible for managing, supervising, and controlling bodily functions, including muscles, joints, and internal organs.      The nervous system uses receptors to gather information, these are placed all over the body such as in the eyes, ears, and the skin, among others. The receptors gather data and send it to the nerves via the nervous system.     The nervous system ensures the internal functioning of the body and controls breathing and heartbeat among many others things. Other functions that it controls include:   Brain growth and development Thoughts and emotions Learning and memory Sleep Movement, coordination, and balance Stress Ageing Body temperature Appetite and thirst. Nervous system diseases There are many diseases and disorders that can affect the nervous system, the most common ones are:   Multiple sclerosis: the neuronal axons progressively lose myelin, which is vital for sending electrical impulses. The body is eventually unable to send these electrical impulses. The disease causes weakness, muscle spasms, coordination problems, and balance issues, among many other symptoms. Tumours: there are many tumours that can affect the nervous system, including; astrocytomas, glioblastomas, meningiomas, and gliomas.   Epilepsy: is a disorder where some neurons are hyper sensitive and activate at the slightest change, causing symptoms such as loss of consciousness, a lack of coordination, weakness, and in more severe cases, seizures. Amyotrophic lateral sclerosis: is a progressive deterioration of the nervous system motor cells. Muscles eventually stop receiving messages from the brain and this causes atrophy, preventing movement, disabling the patient. As the disease progresses, it may affect heart and respiratory muscles. Infections: there are some that do not alter the marrow, such as HIV and syphilis. Meningitis is the inflammation of the meninges, which surrounds the brain and spinal cord, and it is caused by bacteria and viruses.    Dementia: these diseases affect the brain and cause a progressive deterioration and loss of neurons, leading to cognitive and motor loss. Conditions include Alzheimer’s and Parkinson’s.   Guillain-Barré syndrome and other autoimmune conditions.     Other diseases include neuropathies and metabolic disorders, injuries, sectioning, mononeuropathies, or neuralgias.  Treatments for nervous system diseases  Multiple sclerosis: there presently is no treatment that cures it. Treatment seeks to prevent disease progression and lessen relapse frequency. Tumours: there are five types of treatments commonly used, including active monitoring, surgery, chemotherapy, radiotherapy, and targeted therapy.   Epilepsy: the specialist will recommend epilepsy medications, however, if this does not help the seizures, surgery may be considered. There are also therapies such as vagus nerve stimulation, brain stimulation, or the ketogenic diet amongst others.  Amyotrophic lateral sclerosis (ALS) Meningitis: bacterial meningitis is treated with intravenous medication and corticosteroids. Viral meningitis normally gets better on its own, providing the patient is getting enough rest and fluid intake.   Alzheimer’s: there is presently no known cure, but there are medications that can control or delay the onset of symptoms in the early stages of the disease.  Parkinson’s: there are many treatments including pharmaceuticals, surgery, and non-pharmaceutical therapies. What specialist do I need to see for a nervous system disease? The specialists who diagnose and treat nervous system diseases are neurologists and neurosurgeons. However, as the disease progresses, the patient may see many specialists including; psychologists, oncologists, resident doctors, and many more. ...

Nervous system malformations

What are malformations of the nervous system? The nervous system is a complex network of nerves and cells that covers the entire body. It is responsible for transmitting information between the brain and spinal cord and the various parts of the body through the nerves, allowing the person to feel and react to stimuli. The nervous system is composed of: The central nervous system – the brain and spinal cord The peripheral system – the somatic system, which controls voluntary actions and the autonomic system, which controls involuntary actions. Most are neural tube defects, i.e. birth defects in the brain, spinal cord and spine. These occur in the first month of pregnancy, before a woman knows her condition. The most serious abnormalities are: Spina bifida Anencephaly: a large part of the brain and skull do not develop. Babies with this condition are usually stillborn or die soon after birth. Encephalocele: the tube does not close near the brain, with an opening in the skull forming a bulge. Iniencephaly: there is an extreme deformity of the spine, the baby has no neck, and the face is attached to the chest. Chiari malformations: part of the brain tissue passes into the spinal cord.   Prognosis of nervous system malformations Malformations of the nervous system are serious conditions, since they can cause paralysis and disability. There are some nervous system malformations, such as inicincephaly or anencephaly in which the baby is stillborn or dies shortly after birth.   Symptoms of nervous system malformations Some nervous system malformations have hardly any symptoms; others cause symptoms that severely impact the patient’s life, such as paralysis, physical deformities, and problems with some of the body’s systems (e.g. urinary and digestive). Spina bifida is the most common type of nervous system malformation. It occurs when the neural tube is not completely closed. This condition causes paralysis of the legs, which can affect their motor functions for life or even cause intestinal and urinary dysfunctions. Children with spina bifida may also have intellectual disabilities. In some forms of spina bifida, there may be a lump on the back formed by a cyst coming out of the spine.   Medical tests for nervous system malformations Imaging tests such as magnetic resonance imaging (MRI) and nuclear magnetic resonance imaging (NMR) allow doctors to examine the nervous system structures.   What causes malformations of the nervous system? Although much research has been done on the origin of nervous system abnormalities, the exact causes of why the foetal nervous system does not develop fully are unknown. It is thought that a combination of genetic, nutritional and environmental factors may cause these conditions. It is thought that the following are potential risk factors: The mother is obese The mother has diabetes and for some reason the disease is not being well controlled The mother is taking certain medication to prevent seizures Exposure to radiation during pregnancy   Can malformations of the nervous system be prevented? In women of childbearing age, folic acid is very important. Folic acid is a B vitamin that mainly helps the body in the creation of new cells. In fact, getting enough folic acid before and during pregnancy can help to prevent major birth defects in both the baby's brain and spine. Folic acid can be found in the following foods: Green leafy vegetables Fruit Peas, nuts and peas Fortified breads and cereals If the necessary amount of folic acid cannot be ingested through food, it can be taken as a dietary supplement.   Treatments for malformations of the nervous system Encephaloceles can sometimes be treated with surgery by inserting the bulging tissue back into the skull, while correcting malformations of both the face and skull. Treatment for spine bifida varies depending on the disease and its complications. Open spina bifida – with the spinal cord exposed, the opening may close before birth or within a few days of birth Hydrocephalus – if a baby with spine bifida has hydrocephalus, the fluid can be drained through a valve. treating hydrocephalus can prevent vision problems and blindness. Tied spinal cord – the cord can be separated from the surrounding tissues Urinary and bowel incontinence and infections – affected by myelomeningocele, the patient has nerve damage that prevents complete emptying of the bladder. It can be resolved by inserting a catheter into the bladder.   Which specialist treats malformations of the nervous system? There are several specialists who can diagnose and treat malformations of the nervous system. Most are dealt with by neurosurgeons, but certain conditions may warrant the involvement of a medical oncologist or neuroradiologist. ...

Second medical opinion

What is a second medical opinion? A second medical opinion is when you consult with a doctor that is not your regular doctor about a potential diagnosis and/or treatment plan. There is no legal right to a second opinion, however, it is rare for a doctor to refuse. Why would you get a second medical opinion? Patients may consider a second medical opinion if they are facing a new diagnosis or recommended treatment because sometimes this can feel confusing and a second opinion can put their mind at ease. In addition, there are certain situations where a second medical opinion is sought after: Potential treatment is risky and could be life-changing or the diagnosis is possibly life-threatening The diagnosis is not clear-cut If you are considering a new treatment approach that is experimental The aims of obtaining a second medical opinion are: To confirm whether a diagnosis is correct and/or appropriate. To confirm whether a suggested treatment is correct and/or appropriate. To compare information received from each doctor so that you can make an informed decision – sometimes a second medical opinion can rule out the need for a potentially unnecessary invasive procedure. Possible disadvantages of seeking a second medical opinion include: The process can delay the start of treatment. Logistically, seeing another specialist might be difficult and possibly time-consuming. It might be stressful to hear the same diagnosis again. How would you seek a second medical opinion? You can request a second medical opinion from your GP or consultant, but before doing so it is recommended that you ask for as much clarification and explanation about the initial diagnosis and treatment, before seeking a second opinion. Obtaining a second medical opinion does not mean that the second doctor will then take over – if that is what the patient decides, then this needs to be agreed formally between doctors and hospitals.  ...

Skull fracture

What is a skull fracture? A skull fracture consists mainly of the breaking of one or more bones of the head. In fact, a skull fracture not only causes a fracture in the bone, but also causes injuries to veins and arteries, which can bleed near brain tissue. Nerve damage can also occur. Skull fractures may or may not involve brain injury, although the fracture usually does not involve brain injury. Fractures, especially those at the back and base of the skull, can tear the meninges, the tissues that protect the brain. There are different types of skull fractures: Linear: occurs on defined lines. It is usually a closed fracture that has no depressions or sprays and does not cut the skin. Composite: includes shards in the bone and goes through the skin. In this case, a fracture occurs in the skull, normally associated with brain damage. With sinking: in this case the skull sinks, pressing on the brain. Basal: the fracture is at the base of the skull and is normally located around the eyes, nose, or skull base near the spine. Prognosis The prognosis for the injury is generally positive as long as there is no brain damage. Fractures in the skull are usually slight, with minimal treatment being necessary, consisting simply of solving wound problems and assessing the patient's neurological status. However, in the case of brain damage, the consequences can be severe, such as permanent disability. Symptoms of a skull fracture Symptoms of a skull fracture may include the following: Bleeding, which may be from the wound or from the nose, ears, or around the eyes Bruising under the eyes or ears Change in pupil size Confusion Seizures Balance problems Drowsiness Migraine and headache Loss of consciousness Exceptionally stiff neck Problems on speaking and pronouncing Nausea and vomiting Motor difficulties Visual disturbances Medical tests for skull fracture Skull fractures are usually diagnosed by computed tomography (CT) scans. In this case, this test is better than magnetic resonance imaging (MRI). What causes a skull fracture? The causes of head injuries and, therefore, injuries involving a fractured skull are usually the result from impacts, blows or shocks to the head. These occur in traffic accidents, playing sports, etc. In children, the skull fracture is caused in most cases by a fall, for example during playing, cycling, rollerblading, and so on. It is estimated that more than half of fractures in children are caused by falls. In the case of adults, falls are also a frequent cause, although incomparable to the case of those over 65 years of age, in which more than 80% of skull fracture cases are caused by a fall. The second cause of these injuries is an accident in which a heavy or forceful element ends up impacting the patient's head, such as a golf ball, a falling debris... In this case, the trauma or accident is severe, so it overcomes the elasticity of the skull bones, breaking them and causing the fracture. A car accident is the third leading cause of this condition, although brain damage from a car accident is usually very severe. Can it be prevented? A skull fracture cannot be prevented because it is caused by an accident or trauma. However, there are useful measures that can help to keep the individual protected. Some of them are: Using seat belts and special child seats in cars Wear a helmet when doing sports such as climbing or contact sports. Helmet should be worn when riding a bicycle or motorcycle Wear special protective equipment for each sport Treatments for skull fractures Patients with a skull fracture but no brain injury are admitted to the hospital to monitor their condition and progress. It should be noted that most skull fractures do not require specific treatment, except for depression fracture, base skull fracture and compound fracture. In the case of a fracture involving a sinking fracture, the bone or skull fragments press on the inner part of the brain, and it can be injured. In turn, a part of the brain is exposed to the outside, allowing abscesses and infection to form in the area. Foreign materials and dead tissue should be removed and the wound treated as much as possible. Subsequently, the sunken skull will be lifted and placed in place, suturing the wound and beginning to observe the patient's progress. In skull base fractures, the patient should be placed at rest with the head raised, waiting for the leakage of cerebrospinal fluid to stop. If the meninges are torn, they usually close by themselves within two days to a week after the trauma. If the flow of cerebrospinal fluid does not stop, the specialist may try to remove it by inserting a small needle into the lower back. If it cannot be removed with the needle, the specialist may choose to begin removal surgery. ...

Spina bifida

What is spina bifida?   Spina bifida is a brain birth defect of the spine or spinal cord caused by a defect of the neural tube (the embryonic structure that becomes the foetal brain and spinal cord as well as in the tissues that contain them).   It tends to start in the first month of pregnancy in cases where the spinal cord doesn’t close properly (the neural tube tends to be formed during the first stages of pregnancy and closes 28 days after conception).            There are two different types of spina bifida:      Spina bifida occulta, where there is a small defect or opening in one or more vertebrae. It normally comes with neurological symptoms (lower limb weakness, atrophy, low sensitivity, or an alteration in reflexes), genitourinary symptoms (incontinence or urinary retention), and orthopaedic symptoms (foot deformities or changes in foot size). Open or cystic spina bifida: this is the most serious type of spina bifida. It normally appears as a cyst on the back. Within this type of spina bifida, there are two subtypes; meningocele and myelomeningocele. Condition prognosis The condition can be serious, depending on size, location, and any complications involved.  The higher the affected vertebrae are, the more likely the prognosis will be more serious and have more consequences. They include:    Neurological disorders such as hydrocephalus Syringomyelia Locomotor system alterations Genitourinary disorders. What are the symptoms? Spina bifida symptoms are not the same in all patients. Some may need orthotics, crutches, or wheelchairs. Others may have urinary and intestinal problems, or even hydrocephalus. There are different types of spina bifida, including:       Spina bifida occulta: doesn’t tend to have any obvious symptoms, although signs can be seen on the baby’s skin.   Meningocele: the membranes surrounding the marrow push out and form a sac of fluid.      Myelomeningocele: the vertebral canal remains open allowing the membranes around it to push out and form a sac. The nerves and tissues are normally exposed.    Tests for spina bifida     There are three tests that can be carried out during pregnancy to detect spina bifida:     An AFP test (AFP is a protein made by the baby and the placenta during pregnancy which goes into the bloodstream) is done during the second trimester and it checks blood protein levels in the mother’s blood. This test is not conclusive. This may be done alongside human chorionic gonadotropin (hGC), estriol, and inhibin A tests.   Ultrasounds, which can also be inconclusive.      Amniocentesis; the withdrawal of amniotic fluid from the foetal sac for analysis.     To confirm spina bifida occulta after birth, certain tests will be done which may include an ultrasound, an MRI, or a CT scan.    What causes it? The causes for neural tube defects remain unknown, however some risk factors have been identified. Risk factors include; being overweight, poorly managed diabetes, and certain seizure medications.   How can it be prevented? Taking folic acid (which is found in most multivitamin supplements) can reduce the risk of having a baby with spina bifida.    What is the treatment? Treatment for spina bifida depends on the seriousness of the case.  In some cases treatment is not necessary.         The main type of treatment is surgery, this can be done before birth (foetal surgery), and it should be done before the 26th week of pregnancy. If left untreated, the baby’s nervous function may deteriorate after birth. Surgery can also be performed after the baby is born. With meningocele, surgery after birth involves placing the meninges in their place and closing the vertebrae openings. With Myelomeningocele, surgery is done to minimise the risk of having an infection which could leave the nerves exposed. What specialist should I see? The specialist who treats spina bifida is a neurosurgeon.     ...

Spinal cancer

What are spinal tumours? Spinal tumours are the abnormal growth of cells on the vertebrae. Cancerous tumours of the spine are not very common, however, the spine does have other more frequent types of cancer that affect it. One in four cancer patients develop a tumour that metastises in the spine which causes pain and possible functional injuries. Not all spinal tumours are cancerous. There are three types of tumour, which are: Spinal, primary, and metastatic tumours Intramedullary tumours: that develop in spinal cord cells Extramedullary tumours: that develop in the network of cells surrounding the spinal cord. Prognosis: Spinal tumours may compress the medulla or the nerves. This results in a loss of movement and limb sensitivity. The tumour can sometimes be fatal, depending on where it is located, which is why early detection is so important. What are the symptoms? Spinal tumours can cause a variety of symptoms, especially if they grow. They can affect the spine, nerve roots, blood vessels, and the bones surrounding the spine. Some common symptoms include: Pain near the tumour Back pain that usually gets worse at night Loss of muscle sensitivity, particularly around the joints Difficulty walking Affected sensitivity Paralysis in parts of the body Medical tests: An MRI scan is quite often used to check the progression of the tumour. This test is useful for diagnosing the tumour early on, which means that chances of not interrupting spinal functions are higher. X-rays are useful to rule out other degenerative conditions or fractures caused by the tumoural invasion, but they do not play a key role in diagnosing these types of tumour. A CT scan or a biopsy can be carried out to rule out a spinal tumour or help determine its location. What causes them? Spinal tumours are not very common, and the reason for them is unknown. Some specialists believe that genetics may play a role in developing tumours, although it is not clear if these faulty genes are inherited or if they develop over time. How can they be prevented? These types of tumour tend to be treated quickly to avoid central nervous system damage. Early detection is the best prevention. What is the treatment? The main aim of the treatment is to get rid of the tumour. Depending on the method used, it can be a challenging surgery. The main option is normally to remove the tumour by surgery. If this isn’t enough or the tumour cannot be completely removed, then other treatments will be considered. These include radiotherapy and chemotherapy. What specialist should I see? A neurosurgeon is the specialist who tries to prevent, who diagnoses, assesses, and treats issues of the central and peripheral nervous system. These conditions may sometimes require surgery. ...

Spinal disc replacement

Spinal disc replacement uses an artificial disc designed to mimic the natural lumbar vertebrae. It is a flexible structure that acts as a distributing point of charge and allows the harmonic movement of the spine. When spinal mobility is impaired, discs are implanted in prosthesis surgery. There are two types of prostheses: the total, made of steel (sometimes with a plastic part), which replaces all the components of the disc; and the partial, which replaces only the disk core and is made up of different plastic materials. The lumbar disc prosthesis is being used more and more to treat patients with severe low back pain (degenerative disc disease). ...

Spinal fusion

What is spinal fusion? Spinal fusion, also known as vertebral arthrodesis, is a surgical intervention that aims to fuse two vertebrae in the spine permanently, so that there is no movement between them. Why is spinal fusion performed? Spinal fusion is carried out to treat degenerative diseases of the spine, such as: spinal stenosis fracture in the vertebrae infections or tumours spondylolitesis (condition that causes a vertebra to slide forward) curves in the spine, such as scoliosis or kyphosis In some cases, spinal fusion carried out as part of a wider surgical procedure to repair the spinal cord, such as when treating a slipped disc. What happens during spinal fusion? Spinal fusion consists of fixing two bone pieces together with the use of screws, plates and titanium bars. The goal is to stabilise the spine to relieve local pain as well as peripheral nerve pain, or ensure that the spine grows in the right way. The spine can be approached from the front, back or side, depending on where the fusion needs to be made. Some surgeons are able to perform spinal fusion using minimally-invasive techniques, which can result in fewer complications and a faster recovery. To successfully fuse the two vertebrae together, a bone graft is generally required that will be placed in between. This could be harvested from a donor, made from your own pelvic bone, or made from synthetic material. The overall length of the surgery depends on how easily the surgeon can access the spine, and if any other procedures are being performed. Preparing for discectomy No special preparation for discectomy is required. You will, however, need to inform the doctor of any medications you are taking including herbal supplements. You will also need to see the anaesthetist prior to the operation to assess your suitability for general anaesthetic. Aftercare After surgery, you may need to stay in hospital for a few days. You’ll be gradually introduced back into physical activity to ensure your recovery is a smooth as possible, with a program of physiotherapy that generally starts six weeks after your operation. You will also be given painkillers to manage the symptoms immediately after surgery. Finally, when returning home, you’ll be given advice on complications to watch out for, including blood clots and infection. ...

Spinal surgery

What is spinal surgery? Spinal surgery consists of performing surgery to correct possible structural abnormalities. Back injuries, and more specifically those of the spine, have become a problem that is affecting more and more people around the world. The passing of the years, accidents, overexertion and bad posture in everyday life are the causes of the problem. Spine surgery allows surgeons to decompress, move and fix vertebral structures, and replace them if necessary. Back surgery is an option to consider when conservative treatments have not worked and the pain remains persistent and prevents the development of a normal life. There are several types of back surgery: Discectomy: This involves removing the herniated part of the disc to access the swollen nerve and relieve its irritation. Laminectomy: The bone covering the vertebrae is removed and enlarged to relieve pressure from a stenosis. Fusion: Spinal fusion consists mainly of joining two or more bones of the spine together. This can relieve pain by giving stability to a fracture or simply to eliminate the pain that begins with the movement of the vertebrae, which can degenerate or injure some of the vertebral discs. Disc implant: As an alternative to fusion, there is the implant of a disc, although it cannot be used by everyone. Why is spinal surgery performed? Spinal surgery is performed to correct spinal pathologies that cause pain. Back surgery is used to relieve the pain and/or numbness associated with this pain, which often radiates to other areas of the back, arms and legs.  Normally, back and spinal pain is caused by the compression of a nerve within it. Nerves can be compressed for several reasons. An example would be disc problems, such as a herniated disk, which can end up pressing too hard on a vertebra against the nerve. Occasionally, osteoarthritis causes excess bone in the spine. What is spinal surgery? There are different options for intervening on the spine. They are as follows: Fusion Fusion or vertebral arthrodesis is usually used in the following cases: There is instability, which can be caused by various causes, such as scoliosis or spondylolisthesis. In these cases, there is an excess of mobility in the spine. Arthrosis pain from hypertrophic arthrosis joints Deformities-when there is a deformity, such as from scoliosis Spinal stenosis Anterior cervical fusion: used to treat degenerative disc disease. Bone grafts are used to fuse the treated segment. Posterior cervical fusion: Posterior lumbar fusion Surgical techniques Percutaneous techniques: these are injections or techniques such as radiofrequency denervation to relieve lumbar and cervical pain. Electro dermal therapy Vertebroplasty: This consists mainly of increasing the intraosseous space of a vertebra by injecting bone cement to add vertebral stability. Decompression techniques Microdisectomy: used to remove herniated fragments from the intervertebral disc. One of the most commonly used procedures in spinal surgery is microdiscectomy with lumbar microdecompression. Microdecompression: used to treat canal stenosis Preparing for spine surgery The patient is usually admitted to the clinic where the operation will be performed one day before undergoing it. The anaesthesia tests, as well as the physical and preoperative exams, will already be done at the time of the patient's admission. They should not eat or drink anything for at least 12 hours before surgery begins. Apart from the basic aspects, spinal surgery does not require any special preparation, although you should be prepared to face the weeks of recovery, when you may need the help of a family member or companion to get used to activities little by little. Care after spinal surgery Normally, the patient will be admitted under observation for several days, and once he or she returns home he or she will have to face recovery. It is important to keep the wound clean and follow the instructions or recommendations provided by the specialist. If the patient has undergone a discectomy, it is common for the patient to feel pain or weakness, although recovery is quick and symptoms should improve markedly within one to two weeks after surgery. In cases of fusion surgery, recovery is more complicated because you will need to rest and not return to your daily activities for at least three to four months, and bone healing may take more than a year to complete. If the patient has undergone vertebral arthrodesis, he or she should rest and not perform daily activities for about two months. Alternatives to spinal surgery Today, there are several options for spinal surgery. In the surgical case, the main alternative to conventional surgery is by using minimally invasive techniques. These minimally invasive surgical techniques allow access to the spine through tiny incisions with which the tissue to be treated and the surrounding tissue is barely damaged. Minimally invasive spine techniques achieve great results minimising the level of surgical aggression and offering the patient a shorter and less painful post-operative period. In turn, there are other, more conservative methods for treating problems in the spine. Some are based on a combination of pain-reducing medications that are accompanied by occupational therapies and physical therapy exercises to strengthen the area. Other treatments such as transcutaneous stimulation, radio frequency denervation or spinal cord neurostimulation may relieve chronic spinal problems and pain. ...

Subdural haematoma

It is an accumulation of blood in the brain surface. Usually the result of a serious head injury. This often results in brain injury and can cause death. ...

Tethered spinal cord

What is tethered spinal cord syndrome? Tethered spinal cord syndrome is a congenital malformation characterised by scar tissue that fixes the spinal cord to the dura (the soft tissue membrane surrounding it), preventing the normal flow of spinal fluid around the cord and the normal movement of the fluid within the membrane. This tethering (fixation) causes cysts to appear. Tethered spinal cord syndrome is usually diagnosed in childhood although some people show symptoms in adulthood. Prognosis of the disease If the tethered spinal cord is treated surgically, the prognosis is good, although the outcome will be less favourable the later the surgery is performed. Symptoms of tethered spinal cord Some of the symptoms of tethered spinal cord are: Back and leg pain Difficulty standing  Deformity, weakness, or numbness in the feet Faecal and/or urinary incontinence Changes in spinal or foot growth Worsening of scoliosis These symptoms often occur gradually during growth spurts or during growth hormone treatment for short stature. Medical tests for tethered spinal cord The following tests may be performed to confirm the diagnosis of a tethered spinal cord: CT scan MRI scan X-ray Ultrasound of the spinal cord Muscle examination Kidney and bladder tests What are the causes of tethered spinal cord? Tethered spinal cord is a pathology that is present from birth and is caused by the abnormal development of the spine during pregnancy. It is sometimes related to other pathologies such as spina bifida and Chiari malformations. Can it be prevented? Tethered spinal cord cannot be prevented as such, but it can be treated to prevent it from recurring. Treatment for tethered spinal cord Tethered spinal cord is treated with surgery, which removes the scar tissue from around the spinal cord in order to restore fluid flow and movement to the spinal cord. A graft is also placed to strengthen the dural space and reduce the risk of scar tissue forming again. If cysts have formed, a tube or shunt is inserted to drain the fluid from the cysts. While most children will need only one untethering procedure, some may require a further procedure. The neurosurgeon will decide when and how to perform the surgery. After the surgery After surgery, the patient will have to sleep for about 5 days flat on their back, face down or on their side. After this time, they will be able to sit up and get out of bed. If all goes well, they will then be discharged and will have a follow-up visit within 7-10 days. Which specialist treats it? Treatment is carried out by the neurosurgeon.  ...

Vascular malformations

This is a congenital malformation of the blood vessel and can appear in the veins, capillaries, arteries and lymph vessels. There are different types of vascular malformations that differ in accordance with which blood vessel is affected. They are present from birth and increase in size with age. ...

Vertebroplasty

What is vertebroplasty? Vertebroplasty is a minimally-invasive intervention to treat acute spinal fractures. In a vertebroplasty, a cement mixture is injected into the fractured bone via a hollow needle. Vertebroplasty is performed in a hospital or outpatient clinic. The procedure may be performed under local anaesthesia, in which case you will probably also receive medication to help you relax and feel sleepy. In some cases it may be performed under general anaesthesia. Why is it done? Usually, vertebroplasty is recommended when other, less-invasive treatments have not been successful, e.g. bed rest, use of a back brace, administration of painkillers, or when medications have started causing side-effects such as ulcers or stomach problems. What does a vertebroplasty involve? The technique involves the injection of a specific type of surgical cement through a precision puncture under X-ray guidance. After administration of a local anaesthetic, a needle is introduced to the fracture, and then the cement is injected in a controlled manner. Once the cement has hardened, within a few minutes, the vertebra is strengthened. Preparation for vertebroplasty: In the week before your procedure: Have a written record of the correct date, time and location of the procedure. Make arrangements for the return journey home after the procedure. You must not drive after the procedure. Ask a relative or friend to take you home. For the appointment, bring a list of your medications. Tell the doctor if you are allergic to any medications as well. Tell the doctor if you are using herbal products, nutritional supplements or over-the-counter medications. Consult your doctor if you have to stop using aspirin or any other medication (whether prescribed or over-the-counter) before the procedure. It may be necessary to undergo a spinal X-ray, a CAT scan , an MRI scan or a bone scan. You may also have to undergo blood tests before your procedure. Consult your doctor for more information about these and other examinations that you may require. The night before the procedure: Ask your doctors for specific instructions concerning food and drink. Care following a vertebroplasty: Most people can walk after the procedure. However, you may have to remain in bed for 24 hours after the procedure; after this period, you can gradually resume everyday activities. Many patients experience pain shortly after their vertebroplasty. The majority report that their pain has improves significantly within 48 hours. ...

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