Problems with the spine can be both painful and difficult to resolve. At the Sunday, May 19 meeting of the Pattaya City Expats Club, Dr. Montien Sirisuntornlak, an orthopaedic surgeon with Phyathai Sriracha Hospital, described two interventions to treat pain problems related to the spine. Also, the hospital provided a nurse to give free blood pressure checks for those that wanted them.
The two interventions Dr. Montien mentioned were: (1) spinal injections and (2) vertebroplasty or kyphoplasty. Both interventions are considered “surgery,” he explained and serious side effects can occur with either, but he noted they are rare.
Back by popular demand after a short stint of R & R, ‘Hawaii Bob’ Sutterfield starts the meeting by conducting the Frugal Freddy drawing of specials at Pattaya’s many value & quality restaurants.
Spinal injections are used for both pain relief and for diagnostic purposes. This technique is performed using a live X-ray (called a fluoroscopy). Dr. Montien explained that spinal injections are usually performed only after more conservative treatments (such as medicines) have not provided adequate pain relief. One type of spinal injection consists of an injection of a long-lasting steroid combined with a local anaesthetic; another is injection of a “root block.”
Dr. Montien said that spinal injections are used to treat what is called “radicular” pain – that is, pain radiating down an arm or leg. This type of pain can be caused by a compressed or irritated spinal nerve root. It can also be caused by a herniated disc. However, he said that spinal injections are not used for musculo-skeletal pain. He proceeded to describe the two types of spinal injections: (1) epidural steroid, and (2) selective nerve root block (SNRB).
He explained that epidural steroid injections are given into the epidural space between the outermost membrane covering the spinal cord and the wall of the spinal canal. The epidural steroid injections provide temporary relief from pain; the relief can last from a couple of weeks to a few months, but in some cases may not always be effective. Most doctors will not prescribe epidural steroid injections more often than three times a year because of Corticosteroid side effects.
Vertebroplasty and kyphoplasty, Dr Montien explained, are used to treat VCF (vertical compression fracture). Further, these compression fractures may involve the collapse of one or more vertebrae in the spine, and are a common result of osteoporosis.
Dr. Montien added that most radicular pain gets better on its own (or aided by rehabilitative exercises). He mentioned that SNRB injections are given near the affected nerve as it exits the spinal column. These injections are used to treat radicular pain caused by irritation of a specific nerve root. Sciatica – low back pain and leg pain caused by a herniated disk in the lumbar spine – is a common condition treated by a selective nerve root block.
Vertebroplasty and kyphoplasty, he explained, are used to treat VCF (vertical compression fracture). Further, these compression fractures may involve the collapse of one or more vertebrae in the spine and are a common result of osteoporosis. Osteoporosis is a disease that results in a loss of normal bone density, mass and strength, making the bone increasingly porous and vulnerable to breaking. Vertebroplasty uses image guidance to inject a cement mixture into the fractured bone through a hollow needle. With kyphoplasty, a balloon is first inserted into the fractured bone through the hollow needle to create a cavity or space. The cement is injected into the cavity once the balloon is removed. Dr. Montien said that these procedures are usually recommended after less invasive treatments – such as bed rest, a back brace or pain medication – have been ineffective, or once medications begin to cause undesired side effects.
Dr. Montien is a specialist in spinal surgery and joint replacement. He has spoken to the Club on two previous occasions about spinal problems and their treatment. He provided a handout with more information – you can visit the website: http://www.bupa.co.uk/individuals/health-information/directory/i/spinal-injections to read this information.
After the presentation, Master of Ceremonies Richard Silverberg updated everyone on upcoming events and called on Roy Albiston to conduct the Open Forum, where questions are asked and answered about Expat living in Thailand.
For more information about the many activities of the Pattaya City Expats Club, visit their website at www.pattayacityexpatsclub.com.
Board member Lawrie McLoughlin introduces Dr Montien Sirisuntornlak, an orthopaedic surgeon with Phyathai Sriracha Hospital, providing a glowing testimonial of Dr Montien’s work: “Dr Montien saved my life with vertebroplasty and kyphoplasty,” Lawrie said.
Following Dr Montien’s talk, Gavin Waddell, Manager of the International Department of Phyathai Sriracha Hospital and Dr Montien answer questions about back surgery and treatment at Phyathai.