Sciatica is nerve pain in the legs caused by a problem in
the lumbar spine.  In its commonest presentation it can be
felt anywhere from the buttock through the outside or back
of the thigh, into the calf, and then into the sole or outside
of the foot.  It does not have to be felt in a continuous line
all the way down; it can be felt in patches anywhere along
that course. 

Some patients have sciatica arising from a different level
in the spine, in which case the distribution of pain may be
different, most likely towards the groin or down the front
of the thigh or shin.

It typically feels like a shooting, burning, or electric shock
sensation. It is unremitting and over the counter painkillers
generally do not help at all.  Even stronger ones prescribed
by your GP may not help very well.

Sciatica is best investigated and managed early as it is
quite disabling and in many cases it can respond quickly to
simple treatments such as image guided spinal procedures.

We have a particular interest in sciatica and

sciatica treatment

. For more information or to book an appointment
please call 0207 186 1007.

Spinal stenosis is narrowing of the central channel in
the spine that contains the spinal cord and nerve roots.
It tends to occur in people after the age of 55, and
presents as pain in the back, buttocks, or legs usually
when standing or walking.  A characteristic presentation
is severe burning pain in the legs on walking short
distances which stops quickly on resting, and starts
again on resuming walking.

Spinal stenosis should be investigated and managed
early.  It can be disabling and permanent problems can
result if it is left too long.

In many cases it can be managed very well by image
guided spinal procedures, but in some cases surgery
may be necessary.

We have a particular interest in spinal stenosis. 
For more information or to book an appointment
please call 0207 186 1007.

Age related changes in the spine tend to happen in
a fairly characteristic way and to follow a typical pattern. 
What we see most frequently is some loss of height due
to increasing spinal curvatures, disc degeneration, and
vertebral body collapse, with symptoms of neck or back
pain, brachalgia, or sciatica.

Most patients have a combination of several of the
structural problems mentioned above but it is important
to fully assess the patient clinically and to do appropriate
imaging and other diagnostic tests if necessary. 

Problems in the ageing spine are managed by a
combination of physical therapy, drugs, image guided
spinal procedures, but some cases may require spinal
surgery.

We have a particular interest in the ageing spine.  For
more information or to book an appointment please call
0207 186 1007.

There are several terms commonly used to describe a herniated intervertebral disc, such as herniated disc,
ruptured disc, slipped disc, bulging disc, but they all
mean the same thing.

Intervertebral discs don’t actually move; they are firmly
attached to the vertebral bodies above and below. 
They have a thick ring of fibrous tissue called the annulus
fibrosus around the outside that holds in place some elastic
jelly called the nucleus pulposus.  The disc keeps the
vertebrae apart and acts as a shock absorber.  As we get
older the disc degenerates in a fairly characteristic pattern;
the nucleus becomes dehydrated and loses its elasticity,
and the annulus weakens. The disc also loses height.

A disc herniation occurs when the annulus weakens
allowing the nucleus to bulge into the weakened area. 
Sometimes the annulus splits allowing some nucleus
material to leave the disc and enter the spinal canal.
Herniated discs can cause both axial pain (back and
neck pain) and radicular pain (sciatica or brachalgia).

We have a particular interest in disc herniations. 
For more information or to book an appointment
please call 0207 186 1007.

Facet joints, or zygoapohyseal joints, are synovial joints
between the vertebral arches of adjacent vertebrae. They
are found at all levels in the cervical, thoracic, and lumbar
spine.  Without them our spines would be rigid structures
with no flexibility.  They give us the wide range of spinal
movement we enjoy. However, just like all joints they
suffer from wear and tear, and they can cause pain. The
most likely levels to be affected by facet joint pain are the
lower lumbar levels – L4/5 and L5/S1, and any level in the
cervical spine.

Facet joint pain can be treated in a number of ways from
simple physical therapy, through drugs, to image guided
spinal procedures.

We have a particular interest in facet joint pain. 
For more information or to book an appointment
please call 0207 186 1007.

Brachalgia is nerve pain in the shoulder, arm, or hand
caused by a problem with the spinal cord or nerve roots in
the neck.  It is the arm equivalent of sciatica. The location
and distribution of the pain gives a good indication of the
level(s) in the spine causing the problem.

Just like sciatica it tends to respond poorly to painkillers,
even strong ones prescribed by your GP.  Patients
suffering from brachalgia are often very tired and can
feel desperate as they can find it very hard to find a
comfortable position they can sleep in.

It should be investigated and managed early as it can be
disabling.  In many cases it can respond quickly to simple
treatments such as image guided spinal procedures.

We have a particular interest in brachalgia.  For more
information or to book an appointment please call
0207 186 1007.

Neck and back pain are extremely common.  Most people
suffer from either or both at various stages in their life.
They can be difficult to investigate and manage but it is
important to do so as some people can be quite disabled
by them.

Neck and back pain do not normally need special
investigations or imaging unless the pain is disabling or
causing sickness absence from work.  The investigations
used depend on the particular problem or symptoms
but include X-Ray, CT, MRI, and neurophysiology studies.
The management of neck and back pain follows the
general principles of physical therapy, drugs, image
guided spinal procedures. Only a very small proportion
require spinal surgery.

We have a particular interest in back and neck pain.  For
more information or to book an appointment please call
0207 186 1007.

Osteoporosis is a bone disorder characterized by a
reduction in bone density, accompanied by an increase
in fragility and risk of fracture.

There are two main classes of osteoporosis – primary and
secondary.  Primary osteoporosis occurs most commonly
in post-menopausal women due to the loss of reproductive
hormones that maintain bone strength in earlier life. 
Secondary osteoporosis occurs as the result of other
factors, such as certain drugs.  The commonest cause of
secondary osteoporosis is long term regular steroid use.
The patients most at risk of secondary osteoporosis from
long term steroid use are asthmatics, patients with
severely impaired renal function, transplant recipients,
and some patients receiving steroids as part of their
treatment for cancer.

People with osteoporosis are at risk of suffering fractures
- typically hip, wrist, or vertebral body fractures.

If you think you might have osteoporosis or may be at risk
of it you should be investigated.  There are many now
treatment options available for osteoporosis.

We have a particular interest in osteoporosis. 
For more information or to book an appointment
please call 0207 186 1007.

Vertebral body fractures occur most commonly as a
consequence of osteoporosis.  They occur in patients
with both primary and secondary osteoporosis.  Some
occur painlessly and patients may not even be aware that
they have suffered one.  Most however cause severe pain
in the back, which can often be disabling and unresponsive
to strong painkillers.

The pain from vertebral body fractures can usually be
treated very quickly and effectively with procedures such
as vertebroplasty or balloon kyphoplasty.

We have a particular interest in vertebral body fractures. 
For more information or to book an appointment please
call 0207 186 1007.

Metastatic tumours in the spine are usually treated by
radiotherapy or chemotherapy.  Surgery is normally
avoided as it can be difficult and results can be poor. 
Many cases of spinal metastases or multiple myeloma
can be treated by vertebroplasty or balloon kyphoplasty. 
Some spinal metastatic tumours can be successfully
managed by image guided tumour ablation using
cryotherapy or radiofrequency.

We have a particular interest in spinal tumours. 
For more information or to book an appointment
please call 0207 186 1007.

Some patients have persistent pain following spinal
surgery.  In most cases their pain will be much better after
surgery but they may have a small amount of troublesome
residual pain, In a smaller number of cases the pain they
have after surgery may be different or worse than the
pain they had before the surgery.

These patients require careful specialist management.
The management of pain after spinal surgery generally
involves drugs, and image guided spinal procedures, or
neuromodulation, but severe cases may need spinal cord
stimulation.

We have a particular interest in pain after spinal surgery. 
For more information or to book an appointment please call
0207 186 1007.

Neuropathic pain is pain caused by damaged nerves.  This
damage can occur in any part of the nervous system from
the brain, through the spinal cord and large nerves, down
to smallest nerve fibres in the hands or feet.

Common causes of neuropathic pain include diabetes,
chemotherapy, and anti-retrovirals. It is also commonly
seen in patients with spinal problems.

Neuropathic pain can be difficult to treat.  It tends to be
unresponsive to typical painkillers even in large doses
and generally has to be treated by special drugs and
techniques.

We have a particular interest in neuropathic pain. 
For more information or to book an appointment
please call 0207 186 1007.

Complex Regional Pain Syndrome or CRPS is an uncommon
condition most commonly seen in the arms and hands,
and to a lesser extent the legs and feet, after an injury,
or rarely, an operation.

It has certain characteristic features.  A limb affected
by acute CRPS will be red, shiny, and swollen.  It will be
extremely painful, and even touching the skin lightly may
cause severe burning pain.  It will also be extremely
painful to move the limb.

The causes of CRPS are still unclear, and it needs very
careful management.  It can take several months of
intensive treatment to treat CRPS.  Sometimes advanced
techniques such as spinal cord stimulation may be needed.

We have a particular interest in CRPS. For more information
or to book an appointment please call 0207 186 1007.

Multiple myeloma is a malignant disease affecting bone
marrow.  It is a common cause of severe and sometimes
incapacitating spinal pain.  This can be difficult to manage
with painkillers, chemotherapy, or radiotherapy but it tends
to respond well and quickly to vertebroplasty and balloon
kyphoplasty, which can also strengthen the vertebrae
affected by the condition.

We have a particular interest in multiple myeloma. For
more information or to book an appointment please call
0207 186 1007.