Other regions: Neck / thoracic / pelvis

Pain can arise in other areas of the spine, chest, abdomen or pelvis.

NECK PAIN

Neck pain due to spinal degeneration is common in middle age but unless there is associated severe arm pain seldom is there a surgical solution (unless there has been severe trauma resulting in instability because of fracture or dislocation). Dr Howie does not see patients with neck pain but Mrs Howie can help.

THORACIC PAIN

Thoracic pain is less common than neck and back pain and only very rarely does it have a surgical solution, e.g., thoracic disc prolapse. This is almost always associated with signs of spinal cord or nerve compression (pain extending beyond the spine). Incidental thoracic disc prolapses not causing symptoms are frequently identified on MRI scan and are virtually never progressive and don’t require surgery. Arthritic conditions such as ankylosing spondylitis or DISH commonly affect the thoracic spine. Metastatic cancer (secondary spread) can occur here especially with breast and lung cancer.

PELVIS

Gynaecological conditions are commonly associated with pain in the lower back, e.g., endometriosis. Back pain is often worse just before or during menstruation and can occur at time of ovulation. Severe back pain can follow being placed in stirrups (the lithotomy position) for childbirth or surgery. Back pain can persist following epidural anaesthesia. Spinal surgery is not indicated for bothersome pain felt in the vagina or perineum.

Alteration in bladder function can have a spinal cause. Sudden onset of urinary incontinence with numbness in the perineum (around the anus or genitals) with associated sciatica especially if in both legs may be due to a massive disc prolapse causing compression of the cauda equina. This requires urgent medical assessment and possible surgery to prevent long-term consequences ( especially bladder and sexual dysfunction).

Erectile dysfunction (impotence – loss of erections) is not usually due to spinal disease.