At Home Christian Jessen 2014 - 133

| promotion|
An MRI scan
will show
the location
of the disc
disease

meet the
expert

Mr Christopher
John Dare BSc
(Hons) BM (Hons)
FRCS (Tr&Orth) is a
consultant adult and
paediatric spinal surgeon
Mr Dare (pictured, above) is based at
the University Hospital in Southampton
with a private practice at the Nuffield
Health Wessex Hospital.
Appointed in 2009, Mr Dare trained
in general orthopaedics in Wessex
before subspecialising in spinal surgery
following a spinal fellowship in East
Anglia. His practice covers all aspects
of appropriate spinal intervention in
adults from the neck to the lower back.

conservative treatment and are thus left with
the binary options to either live with the pain
or consider surgery,' says mr Dare.
'the way I view back pain is in terms of
quality of life. During a consultation, I want to
get to the bottom of what effect the back pain is
having on the patient's quality of life. If the
patient is suffering with a relapsing and
remitting type of pain, which is intense and
long-lasting when present, and life revolves
around the back pain, then I would consider
a discussion about surgical options.
'to be suitable for artificial disc replacement,
there needs to be reasonable preservation of disc
height and good preservation of the small facet
joints at the back of the spine. It is also essential
that the bone is strong enough to support an
artificial disc and it may therefore be necessary

to formally measure the bone density with a
DexA scan before deciding on suitability.'

Treating the pain

'I would obtain an mrI scan of the lumbar
spine to look for disc disease,' says mr
Dare. 'For consideration of lumbar disc
replacement, ideally there will be isolated
disc disease, preferably one level, but I have,
in rare circumstances, operated on three level
degeneration. It is important to note that simply
because a disc looks degenerate on a magnetic
resonance imaging (mrI) scan, this does not
necessarily mean it is painful, as similar findings
can be seen in patients who experience no pain.
'I would then try and ascertain where the
pain was coming from (identifying the pain
generator), initially by performing selective

blocks to the joints at the back of the spine
(facet joints) to try and ascertain if these joints
were contributing to the pain. I would then
proceed with a procedure called a provocative
discography. this procedure involves direct
stimulation of the disc via a needle to try and
reproduce the typical back pain suffered.
'Once I am as certain as I can be that the
pain generator is the disc and the bone quality
is good enough, I would proceed to carry out
artificial disc replacement.
'Unlike most spinal surgery, in order to
replace the disc, the surgical approach is from
the front through the abdomen. the scar on the
skin is approximately 10cm side to side for
a single level and about a 20cm up and
down scar for two levels. the advantages of
approaching the spine this way are that no
muscles are cut and recovery is very quick.
In my hands, most patients are discharged fully
independent after 48 hours.'
As with all surgery there are risks, and with
abdominal approaches, the risks are different
to posterior spinal surgery but remain low.
mr Dare adds: 'I perform this procedure
on patients who wish to consider surgery as
an option for their back pain and fulfil the
criteria outlined. to date, the results have been
very good, with 95% of patients delighted with
the outcome of their surgery, there have been
no mechanical failures of the disc and no
significant complications of surgery.'

FOR MORE INFORMATION
If you have been suffering with back pain,
call 02380 987191 for advice on
procedures or alternative treatments.


http://www.nuffieldhealth.com/

Table of Contents for the Digital Edition of At Home Christian Jessen 2014

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