Spinal Surgery: a potential solution for nerve compression

On a sunny morning in July 2017, Gold Coast Titans second-row NRL player Chris McQueen nervously lay waiting on a hospital gurney.

McQueen was about to undergo a cervical spine total disc replacement and anterior cervical fusion to help repair damage sustained through eight years and 154 first class games of brutal tackling in the NRL. He had felt comfortable with his decision to proceed with the surgery but as he lay bathed in the slab of fluorescent lights a wave of what-ifs finally hit him. What if something went wrong? What if he could never play another game of rugby again?

Just then his spinal surgeon, Laurence McEntee, entered the anaesthetic bay wearing blue scrubs and a clean-shaven smile.  

“We’re ready to go,” McEntee told McQueen.

After McQueen was wheeled into the operating theatre, McEntee reviewed the rugby player’s films one last time. The images that showed the bulging discs and bony spurs that were causing pain and numbness down both his arms.

Although McQueen, at 29, was relatively young to be having this kind of surgery he was far from unique. In fact, McEntee himself had had a similar operation when he was only 28.

“People don’t realise that spinal deterioration begins from their late teenage years onwards,” McEntee told me. “Generally, it’s a non-painful process with everyone’s spine wearing out at different rates.”   

According to the Australian Institute of Health and Welfare, chronic back pain affects about 4 million people and is the third leading cause of disease burden in Australia.    

McEntee calls it a massive problem. “It’s probably the number one leading cause of musculoskeletal disability, certainly in working-age people,” he said.

The causes of back pain are myriad including muscle and ligament strain, inflammation, osteoarthritis, scoliosis and compression fractures secondary to osteoporosis. However, McQueen was suffering from another common cause: radiculopathy, also known as nerve compression.

This condition arises from the spine’s complex anatomy. The spinal column consists of 24 vertebrae or backbones, along with the sacrum and coccyx. There are two main parts of a vertebrae: the body; and the vertebral arch – which projects posteriorly to form a bony tunnel through which the spinal cord runs.  

The vertebrae are joined to each other by intervertebral discs, which are composed of an outer fibrous ring and an inner gel-like centre. As we age the discs become more fibrous and less elastic leading to disc shrinkage and bulging which can compress on nerves. With trauma the fibrous ring can rupture, leading to extrusion of the gel-like centre and further nerve impingement.    

With ageing and degeneration, osteophytes, or bony spurs, can grow out from the edges of vertebral bodies also causing nerve compression.

Management includes activity modification such as avoiding heavy lifting or prolonged sitting. Paracetamol and non-steroidal anti-inflammatory drugs can be used to help with pain. 

Most episodes of radiculopathy are self-limiting, however if severe symptoms persist, surgery may be required to help relieve pressure on the nerves.

There are multiple types of spinal surgery involving either removing part of a damaged disc (discectomy), removing an entire damaged disc (disc replacement) or joining vertebrae together to prevent movement and nerve impingement (spinal fusion).

“With the proper approach to the diagnosis and treatment of people and then the right operation on the right person for the right reason, the results can be spectacular and really change people’s lives,” says McEntee.

Thankfully, up to 90 per cent of patients who see an orthopaedic surgeon don’t require surgery. “The vast majority of people can generally manage with regular exercise, maintaining good weight and posture, core muscle and back muscle strengthening exercises, and from physiotherapy,” McEntee says.

Indra Richmond-Suherman is a NT-based physiotherapist who recommends applying localised heat for an acute disc bulge, taking anti-inflammatories, and walking for at least 30 minutes a day.

He gives patients targeted exercises and stretches designed to reduce irritation of the sciatic nerve and improve back movement. “Education is important regarding minimising aggravating movements,” he said.

Surfers Health Medical Centre chiropractor Kate Hayter says it’s important to persevere with rehabilitation. “People stop too early when they’re out of pain, but they don’t realise that they’re still vulnerable to re-injury.”

Hayter recommends staying positive. “There’s a big mental barrier when it comes to injured backs. But if you stay positive that can really help.”   

Two hours after McQueen was anaesthetised, he woke to find his surgery was complete. The first thing he did, when it came time to change his bandages, was check to make sure his neck tattoos were intact.   

Within a week he was moving his neck and getting back to his normal day-to-day life. Beginning with gentle exercises and rehabilitation weights, he began to slowly build up his strength. In January 2018, after having signed a three-year contract with the Wests Tigers, he was given the green light to begin full training again.  

“I was still under-done in terms of my conditioning and just being back to NRL standard of footy, so I started the season in reserve grade,” McQueen said. In round 11 he was called to the senior team for their clash against the Penrith Panthers, and subsequently played two more first-class games for the Tigers during the 2018 season.  

He is pleased to report that he has full range in his neck and no longer suffers from any radiculopathy.

For anyone struggling with nerve compression, McQueen recommends surgery. “If you’re going ahead with the surgery, absolutely just look forward to it,” he said. “Because it’s going to change your life for the better.”

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Suvi Mahonen is a Surfers Paradise-based journalist. Her work appears in The Australian, the Australian Quarterly, Mamamia and other health and lifestyle publications. Follow her on Facebook, YouTube and online art-selling platform Redbubble.

Feature photo credit: Alfred Derks