Spine Conditions (Adults):

Common conditions:

1. Chiari malformation

This is a complex group of disorders, caused by a malformation of the brain, at the cranio-cervical junction, resulting in the downward displacement (herniation) of the cerebellar tonsils through the foramen magnum.

There can be obstruction to the flow of cerebrospinal fluid (CSF), resulting in hydrocephalus.

Sometimes, the fluid may be forced through the central canal of the spinal cord, causing a syrinx. This condition is called Syringomyelia.



MRI showing the low position of the cerebellar tonsils, causing a tight space at the cranio-cervical junction.



MRI showing the syrinx formation in the spinal cord, as a result of the Chiari malformation at the cranio-cervical junction.

Symptoms and signs
  • Headaches aggravated by straining, eg. coughing
  • Ringing in the ears
  • Dizziness
  • Difficulty swallowing
  • Muscle weakness
  • Numbness and tingling in the legs
  • Altered sensation in the legs
  • Poor coordination
Treatment Surgery is usually required:

A. Treatment of hydrocephalus
- Ventriculo-peritoneal shunt

B. Treatment of Chiari malformation
- Suboccipital decompression craniectomy and duraplasty

C. Treatment of Syringomyelia
- Syringo-subarachnoid shunt

2. Intervertebral spinal disc herniation

This is a spine condition, in which a tear occurs in the intervertebral disc and allows the soft central portion to bulge out. Inflammatory chemicals are released which cause pain, and the disc material may compress the adjacent nerve root, causing neuropathic symptoms. The majority of disc herniations occur in the lumbar spine (L4-5 or L5-S1). The second most common site is the cervical spine (C5-6, or C6-7).

Symptoms and Signs

Neck pain

Low back pain

Nerve root compression symptoms (radicular symptoms and signs), affecting the leg (lumbar spine) or arm (cervical spine)
  • Sensory changes -Numbness, tingling,
  • Motor changes – muscle weakness, absent tendon reflexes
  • Sciatica, radiculopathy
  • Bowel, bladder, and sexual dysfunction (cauda equine syndrome)


MRI cervical spine showing a disc herniation at C5-6 level.

Treatment

1. Surgery

Anterior discectomy and disc replacement or fusion.



Picture of operation wound for anterior cervical discectomy and artificial disc replacement



Post-operation XRay showing the new artificial disc.

2. Nucleoplasty

This is a minimally-invasive procedure to treat contained disc herniations. Using a special introducer needle and XRay or CT-guidance, the instrument, (spine wand) is inserted by percutaneous technique into the affected disc. It is used to remove a small amount of disc tissue via controlled thermal energy (coblation therapy). This causes the pressure within the disc to decrease, reducing the disc bulge and compression of the nerve.

It can be used to treat cervical disc herniations (CT-guided) or lumbar disc herniation (XRay-guided)

Hospital stay is minimal; usually only one day, and recovery is much faster than open surgery.



Axial MRI scan showing a C5-6 left lateral disc herniation.

Nucleoplasty procedure performed with CT-guidance.



CT scan showing the Spine wand within the left lateral aspect of the disc.



Picture showing a very small puncture wound after nucleoplasty, left side of the neck.



MRI showing a lumbar disc herniation (L4-5 level)



XRay showing the spine wand within the L4-5 disc space.

Results

70-80% of patients usually show improvement of symptoms within one week of the procedure, and continue to improve up to 2 months later.

Stroke Hydrocephalus Brain Tumour Arachnoid Cyst Spine Conditions (Adults) Spine Conditions (Children) Brain and Spinal Cord Tumors in Children




Contact Us: Feel free to call +65 6235 0945 / visit us @ Mount Elizabeth Hospital, #09-10, 3 Mount Elizabeth, Singapore (228510).

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