Spinal conditions: neck and back

What is it?

Spinal care is provided through a multidisciplinary team that includes orthopaedic spinal surgeons, physiotherapists and pain specialists. Most neck and back conditions are managed without surgery. This page covers:

Mechanical neck pain and mechanical back pain: pain from the muscles, ligaments, discs and joints of the spine, often related to posture, strain or age-related change. It is very common, and most episodes settle within weeks.

Cervical radiculopathy: irritation or compression of a nerve root in the neck, often by a disc bulge or bony narrowing, causing pain, tingling or weakness down the arm.

Lumbar radiculopathy (sciatica): irritation of a nerve root in the lower back, often by a disc prolapse, causing pain down the leg, sometimes with numbness or weakness.

Cervical myelopathy: compression of the spinal cord in the neck, usually from age-related narrowing of the canal.

Neurogenic claudication / lumbar spinal stenosis: narrowing of the spinal canal in the lower back, which compresses the nerves.

What symptoms can it cause?

• Mechanical neck or back pain: pain and stiffness, worse with certain movements or positions, without nerve symptoms.
• Radiculopathy: pain spreading into the arm or leg along a nerve, with tingling, numbness or weakness.
• Cervical myelopathy: clumsy hands, difficulty with fine tasks such as buttons, unsteadiness when walking, and sometimes changes in bladder control. It can develop gradually and painlessly.
• Neurogenic claudication: pain, heaviness or tingling in the buttocks and legs on standing or walking, eased by sitting or bending forward.

How is it assessed?

Assessment starts with your history and a careful examination. Many people with mechanical pain do not need a scan. An MRI scan is used when there are nerve or spinal cord symptoms, symptoms that do not settle, or warning signs. X-rays, CT scans or nerve conduction studies are sometimes helpful.

What are the treatment options?

• Mechanical pain: staying active, physiotherapy and exercise, and simple pain relief. Surgery is rarely needed.
• Radiculopathy and sciatica: most people improve over weeks to a few months with time, medication and physiotherapy; image-guided injections are sometimes used. Surgery (for example decompression or discectomy) is considered for persistent, severe symptoms or significant weakness.
• Cervical myelopathy: because it can progress, it is monitored closely, and surgery to relieve pressure on the spinal cord is often recommended when symptoms are present.
• Lumbar spinal stenosis: many people manage well with exercise, physiotherapy and medication. Decompression surgery may be considered when symptoms limit walking and daily life despite these measures.

When might surgery be considered?

Surgery is considered when there is pressure on the spinal cord (myelopathy), significant or progressive weakness, symptoms that persist and limit daily life despite non-surgical treatment, or emergency features such as cauda equina syndrome. The decision is made with you and the multidisciplinary team.

What to expect from recovery and follow-up

Recovery depends on the procedure. Many people go home within a few days, and physiotherapy supports return to activity. Return to work and driving are discussed individually.

When to seek urgent help

Go to the nearest emergency unit or call 10177 if you have new numbness around the buttocks or genitals, difficulty passing urine or loss of bladder or bowel control (possible cauda equina syndrome), rapidly worsening weakness in the arms or legs, or back pain with fever or after significant injury. If you are under our care, also call the hospital switchboard and ask for Dr Labuschagne (Netcare Unitas Hospital 012 677 8000; Nelson Mandela Children's Hospital 010 133 0600).

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