Spinal stenosis and herniated intervertebral discs are common degenerative conditions of the spine that can cause back pain, neck pain, and nerve-related symptoms such as numbness, tingling, or weakness in the limbs.
Spinal stenosis refers to the narrowing of the spinal canal, which leads to compression of the spinal cord or nerve roots. It most commonly occurs in the lumbar and cervical regions. The primary causes include age-related degenerative changes such as osteoarthritis, thickening of ligaments (ligamentum flavum hypertrophy), disc bulging, and the formation of bone spurs (osteophytes). In some cases, congenital narrowing of the spinal canal or previous spinal injuries may contribute.
A herniated disc occurs when the soft inner core of an intervertebral disc (nucleus pulposus) protrudes through its outer fibrous layer (annulus fibrosus), irritating or compressing nearby nerves. This can result from age-related disc degeneration, repetitive strain, heavy lifting, sudden twisting movements, or trauma.
Both conditions can present with localised spinal pain as well as radicular symptoms such as sciatica in lumbar disease or brachialgia in cervical disease. In more severe cases, neurological deficits may develop.
Treatment options are typically stepwise and depend on symptom severity. Initial management is usually conservative and includes analgesia (such as NSAIDs), activity modification, physiotherapy focusing on core strengthening and posture correction, and pain intervention procedures. Surgical intervention is reserved for patients with severe or progressive neurological deficits, significant functional impairment, or failure of conservative treatment.
I offer following interventions tailored to individual need and requirement that can be complimentary to other treatment modalities, aiming towards reducing pain and improvement in quality of life-
- Medial branch block/ Facet joint injection (NICE NG 59)
- Dorsal Root block
- Epidurals (Caudal, Transforaminal)
- Radio frequency Denervation/Pulse radiofrequency
- Neuromodulation (spinal cord and dorsal root ganglion stimulation) for refractory pain where all other treatment modalities have proven unsuccessful/limited.
You can request your GP to arrange a named consultant referral to the Barts neuromodulation service to access these advanced treatment options if they are not available in your area.