The Priory Hospital
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'4 steps to a healthy Easter'
Woman's Own Magazine
1st April 2013
'Slipped disc? The jab even surgeons say is better than an operation'
11th March 2013
'Fighter puts back into qualifying bid'
10th January 2013
'How to look after your back'
Womans Own Magazine
'Feel great in 2013'
Womans Own Magazine
31st December 2012
'The health MOT test you can do in your living room'
The Daily Mail
10th October 2012
'How pilates can make your bad back worse'
The Daily Mail
19th June 2012
Please note that this explanation, as with all the explanations on my website, is my interpretation of this condition. It is not intended to provide an exhaustive explanation of degenerative scoliosis but rather a simplistic overview.
Degenerative scoliosis is a condition in which the spine becomes unbalanced in three planes (front to back, side to side and rotationally) due to uneven wear and tear of the discs in the lumbar and sometimes lower thoracic spine. In my opinion it is a different condition to an adult who has grown up with adolescent idiopathic scoliosis.
Additionally in my mind, childhood scoliosis is a separate spinal subspecialty and something, which should be dealt with by spinal surgeons with a specific interest in this. I do not specialise in this, however if you are a have a child with scoliosis I can recommend spinal surgeons who do.
Degenerative scoliosis can present with either back pain alone, back pain and leg pain or symptoms of spinal stenosis.
If you are diagnosed with degenerative scoliosis then the options for management are pain management, which can include spinal injections or surgery. The main reason for performing surgery is if you have spinal stenosis as well as a degenerative scoliosis. In these cases the surgery is mainly for the leg symptoms and the worry is that when decompressing the spine the spine is made unstable owing to the degenerative scoliosis. In this situation the spine needs to be stabilized and the scoliosis may need to be corrected.
In some cases the spine may feel unstable and this may present with back pain secondary to the muscles fatiguing as they try and keep the back upright and stable. In these situations it is less clear whether surgery will help but it is an option.
Being a surgeon, like all surgeons, I enjoy operating, however it is much more important skill to know when not to operate.
It is the “decision rather than the incision” that is most important.
Obviously there are times when an operation cannot be avoided and this is referred to in medical terms as an absolute indication. The only real absolute indication for surgery in spinal stenosis is when a patient has “cauda equina syndrome”.
There is however a graduation of symptoms which make the need for surgery more pressing. We refer to these as relative indications. These include loss of neurological function or progressing loss of neurological function. By this I mean worsening motor function or weakness with associated pain. If the stenosis compresses the lower lumbar nerves enough to give a patient weakness then surgery may well be necessary.
I will however be able to guide you towards a decision about surgery but I feel very strongly that surgery should be the last resort unless absolutely necessary.
I also believe that in the majority of cases the final decision about surgery has to be made by yourself with the best possible information to hand to help you make the right decision.
Obviously there is a lot more written on the internet about this condition but if you are diagnosed with it if you come and see me, I will go through your management options with you very carefully and together we will decide what is best for you and your family.
Mr Ishaque is highly experienced and widely recognised as a leading Consultant Spinal Surgeon. He is one of the few surgeons to have been awarded both the British Orthopaedic Association's Robert Jones Gold Medal and a Hunterian Professorship from The Royal College of Surgeons of England. He is one of the youngest surgeons to have achieved this, having been awarded both honours, before the age of 40.