FAQ’s
How do I make an appointment?
You can request an appointment online using this form.at any time. During working hours Simply call us at +447716716914 for making an appointment.
Do I need a referral to make an appointment?
Most spinal surgeons will accept only referred patients. This is to ensure that the doctor you are seeing is appropriate for you and your condition. Please check with your insurance company to see if a referral is necessary.
What to bring for your initial consultation?
For your first consultation, you will need to bring a referral letter from your GP if required.
List of documents for your first consultation:
- Referral Letter (if necessary)
- Insurance information
- Copies of images of X-rays, MRI’s, CT scans and the reports of medical imaging where possible
- List of medications (if relevant)
- We advise you to come to your consultations with a written list of questions to ensure you don’t forget to ask them when you visit the spinal surgeon.
Are my medical records kept private and confidential?
Your medical records are handled with the utmost respect to ensure your privacy. Our staff is regulated by information commissioner’s office regarding strict confidentiality requirements as a condition of employment regarding your medical file. We will not share the contents of your medical file without your consent.
How long do I need time off work after the surgery?
The recovery period varies for each patient based on the surgical procedure and general health of the individual. Generally, we recommended patients take two weeks off work to recover from any surgery and to resume light duty following resumption of work. Your spinal surgeon will give you specific instructions to follow for a successful recovery.
How long before I can resume driving?
Generally patients should wait at least one week before driving after surgery. The effects of general anesthetic and surgery can affect judgment and reflexes during the first week following your surgery. Your spinal surgeon will provide more specifics after considering your general health and type of the procedure undertaken.
When can I resume exercise?
Your doctor will instruct you about post-treatment exercises – the type and the duration to be followed. You may be referred to a physical therapist to help with strengthening and range of motion exercises following surgery.
How do I contact after hours?
There will be a point of contact 24 hours a day for any concerns you may have. You will be provided with contact details following your treatment.
How to cancel an Appointment?
Telephone the office during business hours and allow at least 24 hours’ notice so that we can offer your appointment time to patients on our waiting list.
We recognize that your time is valuable, and we make every effort to run on time. Occasionally, emergencies or patients require a little more time, and these cause
Frequently asked questions from GPs and Other Healthcare professionals
What would be a primary care first line treatment recommendation for back pain?
The first line of treatment for mechanical type of back pain in the community in terms of primary care would be: –
⦁ Firstly, reassure
⦁ Prescribe Simple analgesia
⦁ Activity modification and Core Strengthening Physiotherapy
If despite the above mentioned measures, the pain persists and is causing severe disability affecting activities of daily living it may require onward referral to a spinal surgeon.
Back pain is very common disorder. The overall lifetime prevalence of that pain is around 90%. i.e. 90% of people would be expected to have severe symptomatic back or leg pain during their lifetime. Back pain settles spontaneously within 3 months after its’ onset in vast majority of people.
Therefore, the first line of management of the back pain is reassurance. Although sinister pathologies can occur in adults but these are relatively rare with the overall incidence is around 2%. This means 2 out of 100 people to have a serious pathology within their back responsible for back pain.
Simple analgesics can help to manage the pain in the form of Paracetamol or non-steroidal anti-inflammatory drugs.
Physiotherapy can also help in managing the back pain through the use of conventional physiotherapy or chiropractor treatment or osteopathy. The overall effect of these therapeutic interventions is quite similar in that they allow muscle relaxation and settle down the inflammatory process that occurs in the acute episode of back pain.
As adjuncts to these people often find activities such as Yoga and Pilates help. For the most part these activities try address one of the key features of the pathology of back pain which is disuse atrophy. This is due to the fact that once one suffers back pain, one ceases to undergo the normal set of activities one would normally engage in. Therefore, the muscles in the back often wither down and this can make the pain worse in the long-term. Many of the interventions that we carry out as spinal specialists aim to reverse these processes.
What are the yellow flags related to back pain?
Yellow flags are psychosocial indicators of increased risk of causing long term disability caused by severe back pain. This can be associated with patients’ attitudes, beliefs, emotions, family and workplace environment. The behavior of a healthcare professional could also have a major influence on yellow flags.
Major factors linked to yellow flags in back pain might include the following: –
⦁ Belief that the pain is extremely severe and causing disability
⦁ Low mood
⦁ Social withdrawal
⦁ Fear avoidance behavior (avoiding physical activity because of the fear of pain)
⦁ Expectation that passive therapies rather than active participation in the treatments strategies will be beneficial
⦁ Work related problems and poor job satisfaction
⦁ Past history of back pain with significant time off work.
⦁ Issues with work compensation scheme
Back pain with all above mentioned factors can form part of a biopsychosocial model. Therefore, the issues which are outside of the particular focus of the pain can also influence ones’ symptoms. For example, spinal literature has proven that the individuals who lose their jobs and have become unemployed during the period of their painful episodes report worse pain scores but also poor responses to therapeutic interventions.
A multi-disciplinary approach should be adopted in these individuals for rehabilitating them to their optimal biological, physical and psychological wellbeing.
What are the red flags related back pain?
Red flags are potential indicators of serious pathology in a patient with back pain. Although there is no universally accepted list for red flags in back pain patients but the following are widely used in this category: –
⦁ Past history of cancer
⦁ Age more than 50 or less than 20
⦁ Unexplained weight loss or loss of appetite
⦁ Relentless night pain despite analgesics
⦁ Traumatic injury
⦁ Intravenous drug abuse
⦁ Recent infection or high grade temperature
⦁ Immunosuppression (HIV) infection
⦁ Corticosteroids therapy
⦁ Perianal Numbness
⦁ Bladder disorder such as urinary retention or incontinence
⦁ Bowel incontinence
⦁ Progressive neurological deficit in either or both the lower limbs
⦁ Persistently worsening back pain of over 6 weeks
It is important to understand that red flags are relatively uncommon but can be potentially devastating for the patients with potential permanent loss of bowel, bladder and sexual function. For example, the overall estimate is around 2% will suffer from serious pathologies when presenting with back pain. For example, a condition such as cauda equina syndrome can present insidiously with a fairly low-grade bowel or bladder dysfunction on the background of back pain.
One of the issues that primary care physicians might face in some situations they are concerned about for example cauda equina syndrome, they often refer on to a spinal service and are upset when the subsequent scans are normal. This is actually a relatively common finding in spinal practice. Recent studies have found that around 90% of scans done for cauda equina syndrome are negative for this condition. However, it is important to detect these rare but devastating condition that occur in the remaining 10% at an early stage so that they can be managed to prevent devastating effects to the individual such as permanent bowel or bladder dysfunction. Therefore, if one refers for an MRI scan for an individual where one suspects serious pathology is occurring and should not feel bad when the scan turns out to be normal as this is a good practice to prevent potentially serious harm to patients at the cost of an MRI scan.
What are the presenting symptoms of common spinal disorders?
Common spinal conditions referred from primary care:
⦁ Radiculopathy (arm or leg) with Neck or Back pain
⦁ Spinal stenosis (Causing Myelopathy or Neurogenic claudication)
Radiculopathy
Radiculopathy is the pain being referred down to the arm or leg by compression of the nerve or in the neck or back. In the vast majority of cases pain settles down within the first 6 to 12 weeks of onset of symptoms. Patient feels that pain radiates down from the neck or back into arm or leg in a dermatomal distribution supplied by a particular nerve. This can also be associated with a sensory change in the form of numbness or paraesthesia as well as motor weakness. Usually the symptoms are unilateral in a specific nerve root distribution. If the symptoms are bilateral sciatica or any bowel or bladder dysfunction, patients should be on emergency basis to the local hospital with MRI imaging available to exclude a spinal surgical emergency.
Spinal Stenosis
Spinal stenosis commonly affects the elderly population. Patients feel cramps in their legs when they walk a certain distance to an extent that they have to stop walking to relive pain and heaviness in their legs. The treatment for this is very simple and involves decompression spinal surgery. The decompression surgery releases the pressure on the nerves within the spinal canal and has good outcome with almost instantaneous pain relief if procedure goes smoothly in vast majority of patients. If there is any doubt about bowel or bladder or sexual dysfunction or perineal numbness, please refer the patient urgently for MRI to exclude spinal surgical emergency.