Dr Colum Nolan
Senior Consultant Spine & Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)
Spine surgery is seldom the first step in treating back or neck pain. Many patients respond well to conservative treatments such as medication, physiotherapy, and rest. However, surgery may be necessary when these measures fail or when severe nerve compression causes symptoms like radiating pain, weakness or numbness. Learn when spine surgery may be considered in this article.
What Are the Non-Surgical Treatments to Try First?
Singapore spine doctor Dr Colum Nolan focuses on relieving symptoms through conservative, non-surgical treatments whenever possible. Spine surgery is only considered after a thorough and structured course of non-surgical care has been completed and found insufficient in providing lasting relief.
Common non-surgical options include:
- Physiotherapy
This approach targets the biomechanical causes of pain by improving core strength, muscle balance, flexibility and posture. A structured physiotherapy programme can help stabilise the spine, reduce nerve irritation and often restore function without the need for surgery.
- Medications and Injections
Pharmacological management includes nonsteroidal anti-inflammatory drugs (NSAIDs) and nerve-pain medications. Furthermore, targeted interventional procedures, such as epidural steroid injections or nerve blocks, can provide powerful, localised pain relief, offering a window for patients to engage effectively in physiotherapy.
- Lifestyle Modifications
Sustainable, long-term relief depends on a patient’s commitment to meaningful lifestyle changes. This includes maintaining a healthy body weight to reduce stress on the spine, quitting smoking to protect disc health and fusion rates, and making ergonomic adjustments to support proper posture and spinal alignment.
What Are the Signs That Spine Surgery May Be Necessary?
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Persistent Pain Despite Conservative Treatment
If severe pain persists for 6 to 12 weeks despite diligent physiotherapy, medication and injections, it may signal a more significant issue, such as a structural problem in the spine. In these cases, non-surgical treatments may no longer provide adequate relief. -
Neurological Symptoms (e.g., Weakness, Numbness)
The progressive loss of motor function (muscle weakness) or sensory function (increasing numbness) is a major concern. This indicates sustained compression of a nerve root or the spinal cord, threatening permanent neurological damage. -
Loss of Bladder or Bowel Control (Medical Emergency)
Sudden or progressive loss of bladder or bowel control, often accompanied by severe back pain and saddle anaesthesia (numbness in the groin/buttocks area), suggests cauda equina syndrome. This is a surgical emergency demanding immediate decompression to preserve neurological function. -
Progressive Deformity or Instability
Rapidly progressing spinal curvature (deformity) or evident structural instability (such as severe spondylolisthesis, where one vertebra slides over another) requires stabilisation to prevent catastrophic failure or chronic pain.
What Are the Common Spine Conditions That May Require Spine Surgery?
A broad spectrum of spinal pathologies can lead to symptoms severe enough to warrant surgery for the spine. These conditions often involve structural compromise leading to nerve root or spinal cord compression.
Degenerative Conditions-
Herniated Disc (Bulging or Slipped Disc)
A herniated disc occurs when the soft, gel-like centre of a spinal disc pushes through a tear in its outer layer. When this material presses on a nearby nerve, it can cause pain that radiates down the leg (sciatica) or discomfort, weakness or numbness in the arm or neck, depending on where the disc is located. -
Spinal Stenosis
Spinal stenosis refers to a narrowing of the spinal canal, which can compress the spinal cord or nerve roots. It commonly affects the neck (cervical) and lower back (lumbar) areas, producing symptoms such as pain, tingling or weakness that often worsen when walking or standing. -
Degenerative Disc Disease (DDD)
Degenerative disc disease occurs when the spinal discs lose their ability to cushion over time. This breakdown can lead to chronic pain, reduced flexibility and a feeling of stiffness that limits movement. -
Spondylolisthesis
In Spondylolisthesis, one vertebra slides forward or backwards over the one beneath it. The slippage can result from degeneration, a small fracture or a congenital defect, often leading to instability, nerve compression and persistent back or leg pain.
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Scoliosis and Kyphosis
These conditions involve abnormal curvatures of the spine. Scoliosis creates an S or C-shaped sideways curve, while kyphosis results in an exaggerated forward rounding, often referred to as a hunchback. Mild cases may only require monitoring, but severe or rapidly progressing deformities that cause pain or pressure on internal organs may need surgical correction and stabilisation. -
Vertebral Compression Fractures
A vertebral compression fracture occurs when one or more vertebrae collapse, usually due to osteoporosis or trauma. These fractures can lead to intense pain, loss of height, and spinal deformity. In cases where healing does not occur naturally, procedures such as vertebroplasty or kyphoplasty may be considered to restore spinal stability and relieve pain.
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Spinal Trauma or Fractures
Major injuries from accidents or falls can cause instability or severe compression of the spinal cord and nerves. Surgery may be needed to realign the spine, stabilise fractures and relieve pressure on affected nerves. -
Spinal Tumours
Both cancerous and non-cancerous growths within or around the spine can compress the spinal cord and nerves, leading to pain, weakness or even paralysis. Surgical removal is often performed to relieve pressure and prevent further neurological damage. -
Spinal Infections
Infections affecting the spine or surrounding tissues can cause severe inflammation and destruction of bone or disc structures. When antibiotics are insufficient, surgery may be required to drain infected areas, remove damaged tissue and stabilise the spine.
Common Spine Surgery Procedures
Advances in technology have made spine surgery in Singapore safer, more precise, and less invasive than ever before.
- Minimally Invasive Spine Surgery (MISS): Also known as keyhole surgery, this technique uses small incisions and specialised instruments for procedures like microdiscectomy, laminectomy and fusion. It offers less blood loss, shorter hospital stays and faster recovery.
- Spinal Fusion: This procedure permanently joins two or more painful or unstable vertebrae using bone grafts to eliminate motion. It is often performed using minimally invasive techniques to reduce surgical impact.
- Disc Replacement: Also known as disc arthroplasty, this surgery removes a damaged disc and replaces it with an artificial implant to preserve motion. It is commonly performed for localised cervical or lumbar disc disease.
- Decompression Surgeries: Procedures such as laminectomy and foraminotomy relieve pressure on the spinal cord or nerves by removing bone spurs, thickened ligaments or part of the vertebra. These are often used to treat spinal stenosis.
A thorough evaluation by a spine specialist in Singapore is essential before surgery. Factors such as age, health and lifestyle play a major role, and conditions like diabetes or smoking must be addressed beforehand. To explore the best treatment for your condition, book a consultation with a qualified spine specialist today.
Our Spine Specialist in Singapore
Dr Colum Nolan
Senior Consultant Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)
Dr Colum Nolan is a Senior Consultant Neurosurgeon and the Medical Director of Oxford Spine & Neurosurgery Centre. He undertook specialist neurosurgery training in Ireland and Australia, and later on completed a complex spine surgery fellowship at Addenbrooke’s Hospital in Cambridge, UK.
Dr Column held key leadership roles including Director of the Spine and Spinal Disorders Programme at the National Neuroscience Institute (NNI), as well as the Head of Neurosurgery Service at Sengkang General Hospital.
With his depth of experience, Dr Colum is committed to guiding each patient towards the safest and most effective treatment for their needs.
