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A new treatment for back pain involves injecting gel rods into the spine.
Val Tovey, 57, a former secretary and homemaker from South Shields on Tyneside, had the operation in March 2013.
Martin Knight is consultant endoscopic spinal surgeon at BMI Fawkham Manor Hospital in Kent.
Millions of Britons have back pain, costing the NHS around £480 million every year. It is often caused by degeneration in the fluid-filled discs that separate and cushion the vertebrae of the spine.
As we age, these discs can weaken and flatten, and bulge (or prolapse) outwards, pressing on the nerves running through the spinal cord. And this can cause inflammation, which leads to scarring, which can trap the nerves.
The fluid in the discs can also seep out and irritate the nerves. As the nerves carry pain messages around the body, you may feel pain in a completely different place.
Initial treatment is with painkillers and perhaps physiotherapy to strengthen the muscles in the back. Losing weight can help reduce pressure on the discs; patients can also be taught to sit, stand and lift properly.
If the problem doesn't resolve, surgery can be used to remove the damaged disc.
It can then be replaced with a prosthetic disc or the neighbouring vertebrae can be fused together to keep pressure off the nerve. But both operations usually mean a large incision and a recovery time of up to 18 months. There's a 11 to 16 per cent risk of complications, including infections and stroke, as well as a 40 per cent chance it will fail, requiring further surgery or pain management.
Another option is a new implant, Gelstix. Pioneered in the U.S. and so far used on 400 patients worldwide, this involves injecting a rod made of soft hydrogel - a material that absorbs water - into the damaged disc.
These implants quickly absorb water from neighbouring tissues and the general circulation, swelling to three times their original size and bulking up the disc to stop it bulging sideways and pressing on a nerve.
We inject it using a fine needle just 2mm in diameter, which allows us to simply part the fibres of the disc wall, rather than puncturing them. We now believe that once cells in a disc start to die, they release acid, which damages other cells in the disc and speeds up the degeneration.
This hydrogel implant reduces acidity by acting as a chemical buffer - soaking up the acids and allowing other cells to recover.
The Gelstix procedure itself takes around ten minutes. We operate with the patient awake but sedated, so they can tell us exactly where the pain is.
Even though we can also see the damaged discs on a scan, feedback from the patient reduces the chance of the procedure not working. Once we've located the pain, we can increase the anaesthetic.
First, we inject powerful sedation into the patient's veins, and inject a local anaesthetic into the front of the neck, using a natural gap to reach the discs in the spine.
Then, under X-ray guidance, I make a 2mm incision in the front of the neck and put in a guide wire to reach discs and touch them to find out from the patient which one is causing the pain.
I inject up to three Gelstix into the damaged discs. The rods swell fast, so I have to work quickly before they become too big to insert.
This procedure works for around 90 per cent of patients, and since the hydrogel causes no harm in the human body, we can repeat it if necessary.
In Val's case, there was a second bulging disc where the soft material inside was leaking out - what most people would understand as a slipped or prolapsed disc.
We couldn't use Gelstix here, as this, too, would have leaked. So instead we trimmed the bulging material, then used a laser to seal the leak - in future we may be able to use the Gelstix with these kinds of prolapsed disc after sealing the leak.
Gelstix should give Val around 15 years of relief and active life, fattening the disc and delaying degeneration.
Read more: [url]Me and my operation: Gel jabs in your spine can treat chronic back pain | Mail Online[/url]