Spine & Orthopedic Insights
Articles and clinical perspectives from the practice — written to help patients and their families understand spine conditions, surgical options, and what recovery actually involves. These articles are informational. They are not a substitute for a clinical consultation.
Book ConsultationWhat Your MRI Report Is Actually Telling You
Most patients who come to a spine consultation have already had an MRI. Many have read the report. Few have found it reassuring.
MRI reports are written by radiologists for clinicians — not for the person whose spine is being described. The language is precise and clinical, and it tends to enumerate findings without contextualising them. A report that lists ‘multilevel disc desiccation, posterior disc protrusion at L4–5 with mild thecal sac indentation and bilateral neural foraminal narrowing’ may be accurate, but it tells the patient almost nothing about what they should do, how worried they should be, or whether any of it is relevant to the pain they are actually experiencing.
Here is the first thing worth understanding: MRI findings and symptoms do not always correspond. Studies of asymptomatic adults — people with no back pain at all — consistently show a high prevalence of disc bulges, disc degeneration, and facet joint changes on MRI. These are often findings of age and load history, not findings of injury or disease. An MRI that shows a disc bulge is not the same as a report that explains why your back hurts.
The second thing worth understanding is that not every finding on your MRI requires treatment. The clinical question is not ‘what does the MRI show?’ but ‘which of these findings, if any, is responsible for your symptoms?’ That question is answered by correlating the imaging with your clinical history and physical examination — not by reading the report in isolation.
When you come to your consultation with an MRI report, bring it — along with the images themselves if you have them. What the report describes will be explained in the context of your specific symptoms, your examination findings, and your functional concerns. A report that appears alarming on paper often looks very different when it is read alongside the person it describes.
Preparing for Spinal Surgery: What to Do in the Two Weeks Before Your Procedure
The two weeks before spinal surgery are among the most useful weeks in the entire process — and for most patients, the most underused. What you do in the lead-up to your procedure has a measurable effect on your recovery, your post-operative pain levels, and your ability to engage with physiotherapy when it begins.
The most important thing you can do is prepare your home before you leave for hospital. You will return from surgery with restrictions on bending, lifting, and in some cases, stair climbing. A firm chair at a comfortable seated height makes the first days at home significantly more manageable than a low sofa. If your bedroom involves stairs and you have had lumbar surgery, consider sleeping on the ground floor for the first week. A raised toilet seat is worth purchasing if lumbar procedures have been performed — sitting down and rising from a low toilet seat in the first post-operative days is more uncomfortable than most patients anticipate.
Arrange for support. You will need someone to drive you home from hospital and to be present for at least the first 48 hours. Beyond that, having a support person available for the first week to help with meals, household tasks, and collecting medication is not a luxury — it is a practical requirement. Trying to manage alone in the first week after spinal surgery is the most common reason for post-operative discomfort extending beyond its normal duration.
Stop smoking if you smoke. Smoking directly impairs bone healing — and if your procedure involves fusion, bone healing is the whole point of the operation. The effect of smoking on fusion rates is well-documented and significant. Stopping even two to four weeks before surgery reduces this risk. It also improves anaesthetic safety.
Review your medications with your GP or the pre-admission clinic. Blood thinners — including aspirin, warfarin, and newer anticoagulants — require specific management before surgery and the instructions vary by medication and procedure. Do not assume you know the protocol. Confirm it explicitly.
Do not fast for more than the instructed period before surgery. Dehydration is common in patients who start restricting fluids too early. The standard instruction is nothing to eat or drink after midnight, but for afternoon procedures, your team may permit clear fluids until several hours before. Follow the specific instructions you are given rather than the general rule.
These preparations take a few hours of effort before surgery. They return weeks of smoother recovery after it.
Managing a Spine Condition at Work: What Actually Helps
The majority of patients I see in clinic are working professionals. Most of them have the same concern: how do I manage this condition without it ending my career, or restructuring my entire working life around it?
The answer, in most cases, is more achievable than they expect — but it requires understanding what is actually loading the spine during their working day, and what can be changed without overhauling everything.
Prolonged static sitting is the most consistent aggravating factor for lumbar disc conditions in desk-based workers. Not sitting itself — prolonged, uninterrupted sitting without position change. The discs of the lumbar spine receive their nutrition through movement and load variation; sustained static compression impairs that exchange. The practical implication is that breaks matter more than the chair. A high-specification ergonomic chair used without movement for four hours produces worse disc loading than a mediocre chair with a movement break every 45 minutes.
The specific break does not need to be long or formal. Standing up, walking to a colleague’s desk rather than emailing, or spending two minutes in gentle lumbar extension are all sufficient to interrupt the static loading pattern. The discipline required is not physical — it is the habit of interrupting a working state that most professionals find hard to leave.
Screen height and keyboard position are the two most commonly overlooked contributors to cervical spine symptoms in desk workers. A screen positioned below eye level — a laptop on a desk without a stand — forces a sustained flexion posture in the neck. Over hours and years, this loading pattern contributes to cervical disc degeneration and foraminal narrowing. The fix costs almost nothing: a laptop stand, an external keyboard and mouse, and a screen positioned so the top of the display is at or slightly below eye level.
For patients with diagnosed disc conditions, the movement that most reliably aggravates symptoms is combined forward bending and rotation — the movement pattern involved in picking something up from the floor while turning. Teaching patients to avoid this combination and replace it with a neutral-spine hip hinge is the single most effective postural intervention I recommend. It takes ten minutes to learn and significantly reduces the frequency of acute exacerbations.
Exercise matters — but type and timing matter more than quantity. High-impact loading of a symptomatic spine before adequate muscular support is established is counterproductive. The sequence is: stability before strength, strength before load, load before sport. Physiotherapy-guided progression through that sequence is the appropriate pathway, not a return to the gym or running track before the spine is ready for it.
Living with a spine condition at work is manageable for the vast majority of patients. The management is mostly a series of habits rather than restrictions — and habits, once established, carry minimal cost.
Navigation-Assisted Surgery: What It Means for Your Procedure
When people hear that a spinal procedure will use ‘navigation’, they sometimes imagine something out of science fiction. The reality is more straightforward — and the clinical benefit is significant.
Spinal navigation works on the same basic principle as GPS. Before or during surgery, imaging of the patient’s spine is acquired — in our practice, using the Medtronic O-arm, which provides a three-dimensional intraoperative scan. This imaging data is fed into the StealthStation navigation system, which then tracks the position of surgical instruments in real time relative to the patient’s anatomy.
In practical terms, this means the surgeon can see, on a screen, exactly where an instrument is positioned within the patient’s spine — down to the millimetre — without relying solely on anatomical landmarks or standard fluoroscopy. In procedures that involve placing screws into the pedicles of the vertebrae — narrow bony corridors that sit close to nerves and major vessels — this level of precision matters considerably.
The spine is not a standardised structure. Anatomy varies between patients, and in patients with deformity, prior surgery, or significant degeneration, those variations can be substantial. Navigation reduces the reliance on assumptions about where structures should be, and instead works with what is actually there. That distinction is most important in complex procedures — deformity correction, revision surgeries, and multi-level fusions — where the margin for positional error is smaller.
Navigation does not replace surgical skill or clinical judgement. It is a tool that supports both — providing information that allows more confident and accurate decision-making during a procedure. It is used where it offers a meaningful clinical advantage, not as a default for every case.