Mr Chris Brown
Consultant Orthopaedic Spinal Surgeon
Practices at: Circle Reading Hospital
Consultant Orthopaedic Spinal Surgeon who places the focus on patients as individuals and sets realistic expectations at the first meeting to deliver the very best care.
- Spinal surgery
- Managing back and leg pain
- Patient-reported outcomes measures
- Fellowship of the Royal College of Surgeons
- General Medical Council
I see a lot of older patients with back complaints, who experience a combination of pain in the lower back and legs, weakness, and difficulty walking, and a common cause of this can be a spinal stenosis. This is a condition where the nerves running down the inside of your spine start to narrow, leading to aches and pains in your back and legs. These symptoms tend to get worse over time, with the potential for nerve damage if left untreated.
A stenosis can occur through the natural aging process, as the discs in your back start to erode through general wear and tear, causing the spinal canal to narrow and the surrounding nerves to get bundled up or pressed together. Patients tend to be over 60, although occasionally I will see younger patients who may have developed a stenosis as a result of a trauma or perhaps through an inherited condition. An MRI will help me determine which of these factors is causing the problem, and I can then tailor my approach accordingly.
As with many of these conditions, I prefer to lead with a non-invasive treatment plan, as this can often provide relief without the need for surgery. If, however, physiotherapy has not helped your symptoms improve, spinal decompression may be the best option in finding a more definitive solution.
The aim of the surgery is to create space around the nerves leaving the spine, relieving any pressure that may have built up due to the narrowing of the spinal canal. It can help reduce your symptoms, often eliminating the symptoms felt in your legs, easing back pain and allowing a more active lifestyle again. As with a microdiscectomy, it is performed via a small cut in the centre of your back (the length of which depending on how many discs or vertebrae are affected), and tissue and/or bone is removed around the disc until the affected nerves are freed.
You will need to undergo a general anaesthetic for the procedure, which carries its own risks such as blood clots, strokes, and heart attacks, but there are other serious risks related specifically to this kind of surgery. Although very rare, spinal decompression can result in the leakage of spinal fluid, infection, nerve damage, and paralysis. If nerve damage has occurred prior to the surgery, this means some of your symptoms may remain. I always intend to set any patient expectations from the first consultation, talking you through all of these potential risks in greater detail so you can make an informed decision about your treatment plan.
One key piece of advice I give my patients whenever they are facing surgery is to be in the best shape you can be. Try to maintain a certain level of activity rather than complete bedrest, as otherwise your back is in danger of ‘seizing up.’ It’s a good idea to set small targets for yourself, attempting to push through your symptoms ever so slightly each time. If you are not sure what is safe to try, consult our physiotherapy team, who will be more than happy to advise you on safe practice.
I also advise my patients to give walking poles a try. Rather than a walking stick, which encourages you to place pressure on one side of your body, walking poles ensure that there is no uneven load towards one side, evening out your gait. If you regularly use walking poles, it can really help in terms of relieving some pressure from your lower back.
Your level of fitness prior to surgery will greatly affect your recovery time, although typically my patients will be able to leave hospital one-to-two days after the operation. You’ll need to take it easy at first, and if possible, it would be wise to have some help at home from family or friends, at least during the first week. Usually, you’ll be up on your feet the next day, but it will likely be around six weeks before you can undertake any highly physical activity again. As with your pre-surgery preparations, set those small targets for yourself again and gradually try to increase your level of activity, starting by walking short distances and slowly building up. I will see you for a follow-up consultation to check your progress; in the meantime, our physiotherapy team will work with you to offer exercises to aid in your recovery.
With a multi-disciplinary team at Circle Reading for all your treatment needs, I would certainly encourage you to book a consultation with me if you are experiencing any of the symptoms mentioned here. Without any waiting lists, I can get you diagnosed quickly, and can advise you if spinal decompression may benefit you.
As a Consultant Orthopaedic Spinal Surgeon, it may come as a shock to you that I try to avoid surgery for my patients if at all possible. My patient’s wellbeing is always my first and foremost concern, and I will do whatever I can to help alleviate your symptoms and get you back to normal function. If this can be done with a more conservative approach, avoiding the need for surgery and the heavy toll it can take on your body, I will actively look to pursue this course of treatment.
Sometimes, however, a form of surgery is necessary in order to get the best results. A microdiscectomy is one such surgical procedure which is particularly successful in cases where a patient reports sciatic pain, with the pain radiating down the legs.
At your first consultation with me, I will likely assess your condition with a physical examination and request an MRI to give a clearer indication of any underlying issues. The MRI will show a detailed picture of your lumbar spine, including the space between each vertebrae where the nerves pass through. As such, I’ll be able to see anything from herniated discs to stenosis to pinched nerves and nerve damage, and can take a closer look at the sciatic nerve.
What is sciatica and how is it treated?
Sciatica is a very common condition involving pain and stiffness in your lower back. The pain can often radiate down one side of the buttocks and into your leg (sometimes both legs, depending on the specific nerve affected). If this mirrors your experience, I would include a Straight Leg Raise (SLR) test as part of your physical examination, checking your range of spinal movement (which may trigger some of your symptoms) along with testing your reflexes, leg strength and sensitivity.
More often than not, non-invasive measures will be enough to help your condition improve; this makes our multi-disciplinary approach at Circle incredibly beneficial, as our physiotherapy team will be on hand from your first appointment and can develop a program designed specifically for your needs. They can suggest certain exercises and stretches to help regain strength and relieve pressure on the sciatic nerve.
If physiotherapy has shown no significant improvement, and you’ve still been in pain for six-to-eight weeks, a microdiscectomy would be a possible next step, especially if you’ve been experiencing pain, weakness and/or numbness radiating down into your legs.
Performed under a microscope for precision and accuracy, a microdiscectomy is where I would make a 1.5-2.5cm cut in the centre of your back to remove a small part of the disc around the affected nerve, relieving any pressure. The surgery is performed under general anaesthetic, and usually takes between 45 minutes to an hour. Due to the need for a general anaesthetic, the operation will normally require a one-night stay in our hospital.
Risks and Complications
It is important for my patients to be aware of the potential risks, as with any surgery. The risks of any general anaesthetic include blood clots, heart attacks, and strokes; with regard to this specific surgery, there is the possibility of nerve damage in rare cases, and paralysis under very rare circumstances. Whilst these risks should be noted, I commonly perform microdiscectomies and such risks are very rare indeed. Patients also report that the procedure has been very effective for them in reducing their level of pain, helping them to increase their mobility and get back to an active lifestyle.
During your recovery from the surgery, our physiotherapy experts will again work closely with you to keep you as mobile as possible during this time, as this can help reduce recovery time. This is especially effective in the six-to-eight week period after surgery. Although it is wise to limit any unnecessary bending or twisting movements, there is no evidence to suggest that this kind of limitation will prevent any further relapses. Many of my patients feel comfortable enough to return to work within a few weeks, with light exercise being encouraged. It is important not to push yourself too hard, especially in the early days after surgery – pain is a good sign that you should probably stop. Before undertaking any kind of new exercise regime post-operation, it is wise to consult the physiotherapy team, as they can advise on best practice moving forward.
If you’ve been experiencing sciatic pain, you’ll know how debilitating it can be, especially if that pain is radiating into your legs. Why put up with it any longer than you have to? With no waiting lists and a multi-disciplinary team at Circle ready to offer you the best treatment plan, why not book your first consultation with me today? I can offer you all the necessary scans to get you diagnosed quickly, answering any queries you may have along the way, before helping you decide on a plan of action.
There are a number of avenues to explore when it comes to back and neck pain, so it is my priority to make a correct diagnosis early on and start treatment as soon as possible.I have a conservative approach to any kind of surgery or operation, and will actively try to avoid it if there are other non-invasive options available. These options will be presented to you as part of our multi-disciplinary approach, with our expert physiotherapy team on hand from your first consultation with me. Many patients are able to effectively manage their level of pain with the help of a dedicated physiotherapist, who will work with you and your specific needs in your rehabilitation.
The extensive facilities on offer at Circle Reading help to give me a wide array of diagnostic information. I’d usually request an MRI or CT scan at an early stage in order to get an accurate diagnosis promptly. MRIs are particularly good at highlighting any inflammation, giving me a clear idea whether or not an injection or epidural will be of use. One of my primary aims is to help you feel at ease, answering any questions you may have, highlighting all treatment options available to you, and offering advice on the best course of action, if you so wish. Ultimately, any decision made is yours, and I will always aim to clearly set out expectations about the success rate of any treatment and expected recovery time.
If you have already undertaken a course of physiotherapy and it hasn’t been successful in reducing your pain, I may advise you to undergo a spinal epidural or nerve root injection (depending on your specific needs).
Nerve root injections and spinal epidurals are predominantly designed to give a local anaesthetic and steroid shot as an anti-inflammatory, helping to reduce your pain. It has often proved very successful, enabling many of my patients to regain normal function and return to an active lifestyle, which may have proved difficult prior to the treatment.
A spinal epidural or nerve root injection is a simple day case with low risk. It can take between 15 and 45 minutes, with very little recovery time, although I always advise my patients to arrange for assistance in terms of transport home while any temporary numbness wears off. Numbness usually subsides within a few hours.
With the facilities provided at Circle Reading, I perform the injection under X-ray guidance, which is running throughout the operation, ensuring a high level of accuracy with the best possible outcomes.
You will be asked to lie face down, and I will clean the intended injection site with an antiseptic, as well as administering some light sedation for an epidural. If you’re suffering from a herniated disc or spinal stenosis, a spinal epidural may be the best option, where the steroid and anti-inflammatory is injected into the area around the spinal column known as the epidural space. If you have radiating pain in the arms or legs (such as with sciatica), I will likely opt for a nerve root injection to target that specific bundle of nerves, injecting into the cluster of nerves as they branch out from the spinal column.
As with any procedure, there are some small risks, such as possible infection or nerve damage, but the majority of my patients report significant improvement long term. Occasionally, patients can report increased pain around the site of the injection, but this typically goes away within 24-48 hours.
At a follow-up appointment to check on your progress, I will again work closely with our physiotherapy team, who may be able to advise on a further course if you now find that you are more mobile, as well as recommending ideas for best practice when playing sports or taking part in physical activity. This may help prevent any relapses in spinal pain.
From your first appointment with me, I always want to be clear in terms of setting any expectations, and the results of this procedure can vary. Some patients experience full pain relief without it ever returning; others may be relieved of symptoms for a few weeks or months, only for the pain to return, albeit not as severe. Under these circumstances we can look into the possibility of further injections. Sometimes, the pain relief may only be temporary and can return as bad as it was. In such cases where the nerve root injection has provided ineffective pain relief, I would potentially look towards a nerve stimulation approach, but would ask for further diagnostic information first to rule out any other issues. As always, surgical options are a last resort if necessary.
If you have been experiencing consistent back pain that hasn’t responded to over-the-counter painkillers, why not book an appointment with me? With no waiting lists at Circle, I can diagnose you promptly, offering you the best options so you can make an informed decision and start treatment at your convenience.
Patients often tell me how debilitating their back pain can be, preventing them from doing many of the activities they love, severely affecting their quality of life. Fortunately, there are a number of options available to you, and if one method doesn’t seem to help, I can easily point you in the direction of an appropriate alternative.
Sometimes, lower lumbar/spine pain can be managed effectively through physiotherapy, pain medication and/or corticosteroid injections. However, if you have already tried these options and your pain has persisted with little to no improvement, spinal fusion surgery may present the best chance at improving your quality of life.
There are many reasons why you might require a spinal fusion; age-related structural changes to your spine, joint instability due to a previous surgery, a progressively deteriorating stenosis (narrowing of the spinal column), or even fractures in your vertebrae as a result of a trauma or accident.
Spinal fusion is a much bigger operation than other spinal surgeries, and the traditional approach involved a large cut down the length of the spine so as to allow full access to the spinal column. With my minimally invasive methods, my aim is to get into the spine, causing as little damage as possible to the surrounding muscles and tissue. I do this with multiple smaller cuts, avoiding the need to cut through the muscle. I also carry out the procedure alongside radiology specialists, using X-ray guidance to ensure the utmost accuracy and give greater visibility.
The method may be different, but the aim of the spinal fusion surgery remains the same, using a bone graft to ‘fuse’ two vertebrae together for stability, sometimes secured with metal rods and screws.
For you, the patient, the smaller cuts mean less blood loss during the operation itself, and results in a rapid recovery (as the smaller incisions heal quicker) with less pain, far better than the uphill battle faced when recovering from a more invasive open surgery.
With this minimally invasive approach, patients are often able to return home a few days after surgery. Of course, I always want to set expectations beforehand that despite the faster recovery times, it is still major surgery, and it can be tough afterwards. You will need to take it easy, especially in the first few days, avoiding any bending, lifting, or twisting. With this in mind, it would be wise to ensure before surgery that a family member or trusted friend will be able to stay at home with you and help out during the early part of your recovery.
I cannot stress enough how important rehab is in the weeks and months after the operation. Fortunately, through our multi-disciplinary approach at Circle, we have an expert physiotherapy team who will work closely with you during your rehabilitation period, and this is absolutely key in making the best possible recovery. After a couple of weeks, it is a good idea to get moving as soon as possible, as this will further aid in your recovery. My pain management specialists will also be able to offer advice on reducing any pain and stiffness, working in tandem with the physiotherapy team, and I will see you for a follow-up appointment to assess your progress. At this stage, we should be able to tell if the fusion has been successful, and I will happily address any concerns or issues you might have.
General complications of any spinal surgery can include blood clots and stroke, nerve damage, and infection (although this risk is reduced due to the ultra-clean air in our operating theatres). You may experience some pain around the site of the bone graft, and in some circumstances this can persist. There is also the small possibility of an unsuccessful fusion, failing to reduce your level of pain or improve your mobility, but this is rare, and many of my patients report that their symptoms have significantly improved having undergone the surgery. I commonly perform minimally invasive spinal fusions and it is generally a very safe procedure, with just a small percentage of patients who encounter difficulties.
If you are concerned about the ramifications of a traditional spinal fusion and open surgery, why not book a consultation to talk it over with me? I can determine whether or not a minimally invasive approach would be appropriate for you, advising you on the best possible treatment path. If you have any sort of recurring back or neck pain, it is important to get it seen to as quickly as possible so as to prevent any further damage and find appropriate pain relief for you. With no waiting lists, I can see you for a consultation at your earliest convenience and get you started on an effective treatment plan.
A physical injury or trauma to the neck, as well as general wear and tear through ageing, can cause one or more of the discs in your neck to start pushing on the surrounding nerves. Not only can this cause severe pain in your neck, it can trigger pain in your shoulder and/or arm, as well as a numbness or tingling sensation in these areas. Sometimes you may even experience some muscle weakness in those upper limbs. Clearly, medical intervention is needed to help you maintain normal movement.
For an initial consultation, diagnostic scans may not be required, as I will usually be able to diagnose the issue through a physical examination, but if surgery is considered at a later date, I may request an MRI at a follow-up appointment to get a closer look at the cervical nerve root in your neck. During the physical exam itself, I will check your range of movement, extending the neck to see if it triggers any symptoms in your arms and shoulders, as well as checking your reflexes.
If your symptoms have persisted beyond four-to-six weeks, and a combination of rest and physiotherapy has proved ineffective, I would likely look at a surgical approach, assuming you are otherwise in good health. As an alternative to a spinal decompression procedure, I can perform a neck disc replacement, inserting an artificial disc implant into your neck that mimics the function of the affected disc.
Previously, neck fusion used to be the only option, which whilst being effective in dealing with the damaged disc and resulting pain, meant that neck movement was often rather restricted due to the fusing of the remaining discs. Not only does fusion surgery take a lot longer to heal from, a disc replacement often allows the full range of movement you had prior to your symptoms occurring, as well as avoiding other complications such as the bone graft not properly fusing. By taking out the degenerated disc, you also reduce the chance of the other surrounding discs developing degenerative disease.
Early on, I like to set expectations, particularly regarding expected outcomes. It is important for me to find out what a patient’s main concerns might be, so I will spend some time with you to ensure you feel at ease about the operation and understand the various risks that go hand in hand with such a procedure. Aside from the usual risks of general anaesthetic (which include a blood clot, stroke, and heart attack), there is the risk of infection (although this is minimal due to the ultra-clean operating theatres provided by Circle), as well as potential nerve damage. There is also the possibility that despite the operation, your pain and weakness may continue with little improvement. This may sound disconcerting, but the reality is that these issues are very rarely encountered, and if you are otherwise fit and healthy prior to surgery, there is a great chance of success.
The disc replacement is performed under general anaesthetic and usually requires a one-night stay in our hospital. I make a small cut in the front of your neck, removing the deteriorated disc causing the nerve compression, cleaning up any bone spurs along the way. With the disc removed, this creates a gap to allow me to place the artificial disc at its normal height, relieving the affected nerves, before securing the disc to the adjacent bones.
Due to the need for only a small incision, patients often have a very rapid recovery. As the incision is made at the front of your neck, some patients will have a sore throat at first and may experience some difficulty speaking and swallowing, but this should pass relatively quickly. During your rehabilitation period, you will work closely with our dedicated physiotherapy team, and they will guide you in finding the right balance between physical activity and rest.
I will see you for a follow-up consultation roughly two weeks after your surgery to assess your progress and your condition, such as checking that the incision site is healing well. A full recovery depends on various factors, but many of my patients begin to engage with a physiotherapy programme after four weeks, and those with more physical jobs are usually able to return after six weeks. Your expected recovery times will be discussed at each stage so you are kept well-informed.
With a high success rate of restoring normal movement and range of motion for my patients, a neck disc replacement could be the best solution for you. If you are uncertain about the procedure or have any queries at all, please don’t hesitate to book a consultation with me; through a simple examination I can determine whether or not it would be beneficial for you, and advise if there are other treatments available. Together with our multi-disciplinary team at Circle, we can set out a realistic path towards your recovery.
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