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Brain and spine articles

112 articles, written for patients rather than for search engines. Every one opens with a short answer to the question in its title, and says plainly when surgery is not needed. Written for the practice of Dr. M. Abdur Rehman, consultant neurosurgeon, Faisalabad.

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New to this? These 6 answer what almost every patient asks first.

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Conditions

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Recovery & living with it

17 articles →

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13 articles →

Cost & practicalities

10 articles →

Microscopic & microdiscectomy

8 articles →

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8 articles →

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Filter above, or open a category as its own page: Brain · Conditions · Cost & practicalities · Endoscopic surgery · Laser & other procedures · Microscopic & microdiscectomy · Recovery & living with it · Spine health · Symptoms & diagnosis.

medical illustration: skulls
Brain

Head injury: when a CT scan is needed

A CT scan is needed after a head injury if there was loss of consciousness, repeated vomiting, a fit, confusion or drowsiness, weakness or slurred speech, clear fluid or blood from…

· 13 min read
medical illustration: ischemic Stroke
Brain

Stroke: the hours that decide the outcome

A stroke is a sudden loss of blood supply to part of the brain. Look for a drooping face, a weak arm, slurred speech. Note the time symptoms started and get to a hospital with a CT…

· 14 min read
medical illustration: vertebral column
Conditions

Adult scoliosis and back pain

Most adults with scoliosis never need surgery. A curve you have carried since childhood rarely becomes dangerous on its own. When back pain comes with scoliosis, it usually settles…

· 13 min read
medical illustration: brain
Conditions

Brain tumour warning signs that are worth checking

Most headaches are not brain tumours. Get checked if a new headache is worse in the morning, wakes you from sleep, or keeps worsening over weeks, or if it comes with vomiting, blur…

· 14 min read
medical illustration: vertebral column
Conditions

Cauda equina syndrome: the back emergency

Cauda equina syndrome is a rare emergency where the nerve bundle at the bottom of the spine is squeezed, usually by a large slipped disc. Warning signs are trouble passing or contr…

· 14 min read
medical illustration: vertebra
Conditions

Cervical myelopathy: the warning signs people miss

Cervical myelopathy is pressure on the spinal cord in your neck. The early signs are easy to miss: buttons and zips become fiddly, handwriting gets messy, you drop things, and your…

· 14 min read
medical illustration: rheumatology - Osteoarthritis
Conditions

Degenerative disc disease: is it really a disease?

Despite the name, degenerative disc disease is not a disease. It is the term used for normal age-related drying and flattening of spinal discs. Most people over forty show it on MR…

· 12 min read
medical illustration: rheumatology - Normal joint
Conditions

Facet joint pain: the back pain that hates standing

Facet joint pain comes from the small joints at the back of your spine. It is worse when you stand, walk or lean backwards, and eases when you sit or bend forward. Most cases settl…

· 14 min read
medical illustration: vertebral column
Conditions

Lumbar spine: the five discs that cause most back pain

Most lumbar spine problems come from the two lowest discs, L4-L5 and L5-S1, because they carry the most load and bend the most. Wear, bulging, or herniation here causes kamar dard …

· 10 min read
medical illustration: disc herniation
Conditions

Neck disc herniation: arm pain, tingling and weakness

A cervical disc herniation presses on a nerve in the neck, sending pain, tingling or weakness down one arm. Most cases settle within six to twelve weeks with medicine, physiotherap…

· 13 min read
medical illustration: vertebra
Conditions

Neck disc surgery: what is removed and what replaces it

In cervical disc surgery, the surgeon removes the damaged part of the disc that is pressing on a nerve or the spinal cord, working through the front or back of the neck. What repla…

· 11 min read
medical illustration: disc herniation - Extrusion
Conditions

Preventing a second slip disc

A second slip disc is not inevitable. Most people who recover, with or without surgery, never herniate the same disc again. Your best protection is the first year: walk every day, …

· 14 min read
medical illustration: sciatic nerve
Conditions

Sacroiliac joint pain or sciatica? Telling them apart

Sacroiliac joint pain sits low, just beside the dimple above your buttock, and usually stays above the knee. Sciatica from a slipped disc travels down the back of the leg, past the…

· 13 min read
medical illustration: sciatic nerve
Conditions

Sciatica: why the leg hurts more than the back

Sciatica hurts more in the leg because the problem sits at the nerve root in your spine, not in the leg itself. A disc bulge presses the root, and pain travels down the path that n…

· 15 min read
medical illustration: disc herniation
Conditions

Slip disc: symptoms, causes and the treatment ladder

A slip disc happens when the soft centre of a spinal disc pushes out and presses on a nerve, causing kamar dard and taang mein dard. Most cases settle within six to twelve weeks wi…

· 13 min read
medical illustration: vertebral column
Conditions

Spinal stenosis: the pain that eases when you sit

Spinal stenosis is narrowing of the spinal canal that squeezes the nerves to your legs. Standing and walking make the pain worse; sitting or bending forward opens the canal and eas…

· 14 min read
medical illustration: oncology - Cancerous cell
Conditions

Spinal tumours: rare, but this is how they present

Spinal tumours are rare. The pattern that raises concern is back pain that wakes you at night, pain that does not settle with rest, and weakness or numbness that is getting worse w…

· 14 min read
medical illustration: vertebra
Conditions

Spondylolisthesis: when one vertebra slips forward

Spondylolisthesis means one vertebra has slipped forward over the one below it. Most cases are mild and settle with physiotherapy, weight control and time. Surgery is considered on…

· 13 min read
medical illustration: infectiology - Bacterium
Conditions

TB of the spine (Pott disease) in Pakistan: what to know

TB of the spine, or Pott disease, is treated mainly with anti-TB medicines taken for many months, not with surgery. Most patients recover well if treatment starts early and is comp…

· 15 min read
medical illustration: vertebra
Conditions

Thoracic spine: the mid-back problems that get missed

Thoracic spine pain is pain in the mid-back, between the shoulder blades, from the twelve vertebrae T1 to T12. It is usually muscular, postural, or arthritic rather than disc-relat…

· 12 min read
medical illustration: disc herniation
Conditions

You have been told you have a disc problem. What now?

A disc problem usually means a slipped or bulging disc pressing on a nerve, causing kamar dard and taang mein dard. Most cases improve in six to twelve weeks with rest, physiothera…

· 9 min read
medical illustration: people - Surgeon
Cost & practicalities

How to choose a spine surgeon in Pakistan

Choose a spine surgeon in Pakistan by checking their formal qualification (FCPS, MS, or fellowship in neurosurgery or spine surgery), confirming which hospital they operate from, a…

· 10 min read
medical illustration: vertebral column
Cost & practicalities

Insurance and panel cover for spine surgery in Pakistan

Most Pakistani health insurance and employer panel policies do cover spine surgery, but only when it is medically necessary, documented on MRI, and approved before admission. Cover…

· 13 min read
medical illustration: people - Surgeon
Cost & practicalities

Neurosurgeon or neurologist: which one do you actually need?

A neurologist diagnoses and manages nerve and brain conditions with medicine, tests and rehabilitation. A neurosurgeon, or spine surgeon, is trained to operate when surgery is need…

· 9 min read
medical illustration: vertebral column
Cost & practicalities

Private or government hospital for spine surgery in Punjab

Both can work. Government hospitals in Punjab cost far less but usually mean a long wait and less choice of technique. Private hospitals give you a fixed date and options like endo…

· 13 min read
medical illustration: vertebral column
Cost & practicalities

Spine surgery cost in Pakistan: what drives the number

There is no single price. Spine surgery cost in Pakistan is driven by the procedure itself, whether implants are needed, how long you stay, and the hospital's room and theatre char…

· 13 min read
medical illustration: vertebral column
Cost & practicalities

Travelling abroad for spine surgery: is it actually cheaper?

Spine surgery abroad in Egypt, Turkey or Dubai can look cheaper until flights, hotel and lost income are added, and until you ask who examines you if something goes wrong two weeks…

· 7 min read
medical illustration: people - Doctor
Cost & practicalities

Travelling to Faisalabad for spine treatment

If you are travelling to Faisalabad for spine treatment, plan one consultation visit with your MRI films and reports in hand. Most patients do not need surgery. A careful examinati…

· 14 min read
medical illustration: people - Surgeon
Cost & practicalities

Twelve questions to ask before you agree to spine surgery

Before you agree to spine surgery, ask what your diagnosis is, which disc level, whether the MRI matches your symptoms, what happens if you wait, what non-surgical care you have no…

· 13 min read
medical illustration: people - Doctor
Cost & practicalities

What to bring to your first spine appointment

Bring your actual MRI films or CD, not only the report. Add X-rays, any older scans, a written list of every medicine and dose you take, old prescriptions and discharge papers, and…

· 11 min read
medical illustration: equipment - Endoscopy
Endoscopic surgery

Am I a candidate for endoscopic spine surgery?

You are likely a candidate if leg pain is worse than back pain, an MRI shows a disc or bone pressing on a nerve that matches your symptoms, and six weeks of medicine and physiother…

· 12 min read
medical illustration: vertebral column
Endoscopic surgery

Awake spine surgery under local anaesthesia: is it safe?

Yes, for selected patients awake endoscopic spine surgery is safe. Local anaesthesia with light sedation avoids the risks of general anaesthesia and lets you tell the surgeon if a …

· 12 min read
medical illustration: people - Nurse
Endoscopic surgery

Day-care spine surgery: home the same day

Day care spine surgery means you are admitted, operated and discharged on the same day. It is possible for selected patients having endoscopic discectomy or a small microdiscectomy…

· 16 min read
medical illustration: disc herniation - Sequestration
Endoscopic surgery

Endoscopic disc surgery versus open disc surgery

Endoscopic disc surgery removes the disc fragment through a tube about 8 millimetres wide, guided by a camera. Open disc surgery, usually a microdiscectomy, uses a small cut and a …

· 15 min read
medical illustration: vertebra
Endoscopic surgery

Endoscopic spine surgery cost in Pakistan: what to ask

There is no single price. In Pakistan, endoscopic spine surgery is quoted in rupees as a package that depends on the hospital, the level operated, the anaesthesia used and how long…

· 13 min read
medical illustration: people - Surgeon
Endoscopic surgery

Endoscopic spine surgery in Faisalabad: how to arrange it

To arrange endoscopic spine surgery in Faisalabad, send your MRI report, X-rays and a short note about your symptoms for review, then come for a clinical examination. Surgery is on…

· 12 min read
medical illustration: vertebral column
Endoscopic surgery

Endoscopic surgery for spinal stenosis

Endoscopic spine surgery treats spinal stenosis by widening the narrowed canal through a cut of about one centimetre, using a camera and fine instruments. It relieves leg pain and …

· 15 min read
medical illustration: equipment - Microscope
Endoscopic surgery

Full-endoscopic versus microscopic spine surgery

Studies comparing full-endoscopic discectomy with microdiscectomy show similar leg pain relief and similar rates of repeat surgery. The endoscopic route uses a smaller opening, cau…

· 13 min read
medical illustration: equipment - Endoscopy
Endoscopic surgery

How to choose an endoscopic spine surgeon in Faisalabad

Choose on training and honesty, not advertising. Ask the surgeon how many endoscopic cases they do each month, who operates if a problem arises, and what happens if the disc comes …

· 13 min read
medical illustration: equipment - Endoscopy
Endoscopic surgery

How well does endoscopic spine surgery work?

For a properly selected patient with a disc pressing on a nerve, endoscopic spine surgery works well: most people get significant or complete relief of leg pain, and studies compar…

· 13 min read
medical illustration: disc herniation
Endoscopic surgery

Is endoscopic disc surgery safe? The honest answer

Yes, endoscopic disc surgery is safe for correctly selected patients. It is done under local or spinal anaesthesia through a needle-sized opening, so muscle and bone are barely dis…

· 10 min read
medical illustration: rheumatology - Orthopedics- Crutches
Endoscopic surgery

Recovery after endoscopic spine surgery, week by week

Most people walk within a few hours of endoscopic spine surgery and go home the same day or the next. Sitting and light desk work usually return in one to two weeks. Driving and no…

· 13 min read
medical illustration: equipment - Endoscopy
Endoscopic surgery

What is endoscopic spine surgery, and how is it different?

Endoscopic spine surgery removes the piece of disc pressing on your nerve through an opening of about 7 to 8 millimetres, using a camera and instruments passed down a thin tube. Mu…

· 12 min read
medical illustration: MRI
Laser & other procedures

The metal in your back: implants, MRI scans and airport gates

Most spine implants used today, screws, rods, cages, are titanium, which is MRI-safe and rarely triggers airport metal detectors. After endoscopic spine surgery no implant is left …

· 10 min read
medical illustration: equipment - Microscope
Microscopic & microdiscectomy

How well does microdiscectomy actually work?

For sciatica caused by a proven disc herniation, microdiscectomy works well: published trials show most well selected patients get major relief of leg pain, often within days. It i…

· 15 min read
medical illustration: spongy bone - Trabecular bone - Osteoporotic trabecular bone
Microscopic & microdiscectomy

Is microdiscectomy dangerous? Risks explained

Microdiscectomy is considered a low-risk spine operation. Serious complications such as nerve damage or paralysis are rare. The common risks are infection, a tear in the dural cove…

· 11 min read
medical illustration: equipment - Microscope
Microscopic & microdiscectomy

Microscopic disc surgery: what the microscope changes

Microscopic disc surgery, or microdiscectomy, uses an operating microscope so the surgeon can see the nerve and disc clearly through a small incision instead of a large open cut. T…

· 10 min read
medical illustration: equipment - Microscope
Microscopic & microdiscectomy

Recovery after microscopic disc surgery

Most patients walk within hours of microscopic disc surgery (microdiscectomy) and go home within one to two days. Bending, lifting and long sitting are avoided for four to six week…

· 12 min read
medical illustration: disc herniation
Microscopic & microdiscectomy

Revision disc surgery: what changes the second time

Revision disc surgery is a second operation on a disc that was already treated. What changes is the tissue. Scar from the first surgery replaces the clean planes a surgeon works in…

· 14 min read
medical illustration: spongy bone - Trabecular bone - Osteoporotic trabecular bone
Microscopic & microdiscectomy

What is a microdiscectomy?

A microdiscectomy is an operation that removes the small piece of slipped disc pressing on a nerve in your lower back. The surgeon works through a cut of about two to three centime…

· 13 min read
medical illustration: disc herniation - Degeneration Prolapse Extrusion Sequestration
Microscopic & microdiscectomy

When a disc herniates again: recurrent disc herniation

A recurrent disc herniation means disc material pushes out again at the same level after earlier surgery or after a disc had settled on its own. It usually shows up as the same leg…

· 12 min read
medical illustration: rheumatology - Orthopedics- Crutches
Recovery & living with it

Back pain in drivers and factory workers

Most back pain in drivers and factory workers comes from long hours of sitting, engine vibration and repeated bending, not from a disc that needs surgery. It usually settles with m…

· 15 min read
medical illustration: equipment - Walker
Recovery & living with it

Diabetes and blood pressure before spine surgery

Diabetes and blood pressure do not rule out spine surgery. They need to be controlled first. Most surgeons want sugar reasonably steady and blood pressure settled before operating,…

· 13 min read
medical illustration: people - Runner
Recovery & living with it

Exercises to avoid when you have a disc problem

With an active disc problem, avoid anything that bends your spine forward under load: sit-ups, crunches, toe touches, heavy deadlifts, leg presses and twisting with weight. Bending…

· 12 min read
medical illustration: equipment - Wheelchair
Recovery & living with it

Going back to work after spine surgery

Most people who have endoscopic spine surgery for a slipped disc return to desk work within one to three weeks, and to heavy manual work in roughly six to twelve weeks. Open microd…

· 14 min read
medical illustration: disc herniation
Recovery & living with it

Life after disc surgery: lifting, gym, namaz and long drives

Most people return to normal life after disc surgery. Walking starts the same day or the next. Namaz on the floor, sitting cross-legged and driving usually return within four to si…

· 16 min read
medical illustration: severe osteoporosis
Recovery & living with it

Lifting and posture that protects your back

Protect your back by moving the load, not your spine. Hinge at the hips, bend your knees, keep the back straight, hold the weight close to your chest, and turn with your feet inste…

· 14 min read
medical illustration: people - Sedentary
Recovery & living with it

Namaz, sitting cross-legged and squatting after spine surgery

Most patients pray sitting on a chair within the first few days after endoscopic spine surgery or microdiscectomy, and return to full sujood on the floor at around four to six week…

· 13 min read
medical illustration: people - Physiotherapist
Recovery & living with it

Physiotherapy for a slip disc: what actually helps

Physiotherapy helps most slip disc patients. The parts that work are guided exercise, a gradual return to walking and normal activity, and being taught how to move safely. Passive …

· 15 min read
medical illustration: people - Elderly person
Recovery & living with it

Spine surgery after 60: is age really the problem?

Age alone is not the reason surgery is refused or recommended. What decides is the patient's heart, lungs, kidneys, bone strength, and how well controlled conditions like diabetes …

· 9 min read
medical illustration: synapse
Recovery & living with it

The best sleeping position for back and leg pain

For most back and leg pain, sleep on your side with a pillow between your knees, or on your back with a pillow under your knees. Both keep the lower spine in a neutral position and…

· 12 min read
medical illustration: equipment - Walker
Recovery & living with it

The day of your spine surgery, hour by hour

On surgery day you arrive fasting, change into a gown, and meet the anaesthetist and Dr Rehman for a final check before going to theatre. Endoscopic discectomy usually takes under …

· 10 min read
medical illustration: disc herniation - Degeneration
Recovery & living with it

Weight, smoking and your discs

Smoking and extra weight both make back pain worse. Your discs have almost no blood supply of their own, so nicotine narrows the tiny vessels that feed them, and extra weight loads…

· 13 min read
medical illustration: people - Surgeon
Recovery & living with it

Will I need a second operation?

Most patients who have spine surgery do not need a second operation. Repeat spine surgery happens in a minority of cases, usually when the same disc herniates again, scar tissue fo…

· 10 min read
medical illustration: people - Runner
Recovery & living with it

Will I wake up? The anaesthesia question nobody asks out loud

Yes. Modern spine surgery anaesthesia is designed so you wake up as soon as the operation ends. An anaesthetist stays with you throughout, monitoring your heart, breathing, and oxy…

· 10 min read
medical illustration: vertebral column
Spine health

L4-L5 and L5-S1: why these two levels break first

L4-L5 and L5-S1 sit at the base of the spine, where the lower back carries most of the body's weight and does most of its bending and twisting. This constant load wears these two d…

· 11 min read
medical illustration: spinal cord section
Spine health

Spinal injury: the first hours decide a lot

After any fall, road accident, or heavy blow to the back or neck, keep the person still, avoid bending or twisting the spine, and get them to a hospital with a spine or neurosurger…

· 10 min read
medical illustration: people - Surgeon
Spine health

What a spine surgeon actually does all day

A spine surgeon spends most of each day in clinic, not the operating theatre: reading MRIs, examining patients with kamar dard or taang mein dard, and deciding who needs surgery an…

· 9 min read
medical illustration: synapse
Spine health

When spine surgery does not fix the pain

Sometimes back or leg pain continues after spine surgery. Doctors call this failed back surgery syndrome. The usual reasons are that the wrong problem was operated on, the nerve wa…

· 11 min read
medical illustration: equipment - Radiography
Symptoms & diagnosis

Back pain red flags that need attention today

Most back pain is not dangerous. But go to a hospital today if you have loss of bladder or bowel control, numbness around the groin or inner thighs, weakness in a leg or foot that …

· 15 min read
medical illustration: rheumatology - Osteodensitometry
Symptoms & diagnosis

Back pain that is worse at night

Most back pain that is worse at night is mechanical, from a tired spine, a sagging mattress or a disc that hurts when you lie still. But pain that wakes you every night, comes with…

· 16 min read
medical illustration: equipment - scanner
Symptoms & diagnosis

Foot drop: when the foot stops lifting

Foot drop means you cannot lift the front of your foot, so the toes catch or slap when you walk. In back patients it usually comes from a compressed L5 nerve root. It needs urgent …

· 14 min read
medical illustration: rheumatology - Muscle fiber
Symptoms & diagnosis

Kamar dard: causes, and when it is more than muscle pain

Most kamar dard is muscle or ligament strain and settles within a few weeks with movement, heat and simple painkillers. It becomes more than muscle pain when it travels down the le…

· 14 min read
medical illustration: nerve
Symptoms & diagnosis

Nerve tests (EMG and NCS) for back and leg pain

EMG and NCS measure how well your nerves and muscles are working. For most sciatica they are not needed, because MRI plus a proper examination usually decides treatment. Nerve test…

· 15 min read
medical illustration: neuropathy
Symptoms & diagnosis

Numbness and tingling down the leg: what it means

Numbness or tingling down the leg usually means a nerve in your lower back is being pressed, most often by a slipped disc or spinal stenosis. The pattern of numbness tells us which…

· 16 min read
medical illustration: rheumatology - Osteodensitometry
Symptoms & diagnosis

Taang mein dard: leg pain from the back, explained simply

Leg pain that runs from your lower back into the buttock, thigh or calf is usually a nerve being pressed in the spine, not a problem in the leg itself. Most cases settle within six…

· 16 min read
medical illustration: rheumatology - Male pelvis
Symptoms & diagnosis

When back pain is not coming from your spine at all

Not all back pain starts in the spine. Kidney stones, urine infection, gallbladder, a swollen aorta and gynaecological problems can all cause kamar dard. The clue is usually the pa…

· 15 min read
medical illustration: equipment - Radiography
Symptoms & diagnosis

X-ray, MRI or CT for back pain: which one and when

For most back pain, no scan is needed in the first six weeks. An X-ray shows bone: fractures, alignment, wear. An MRI shows discs, nerves and the spinal cord, so it is the scan tha…

· 15 min read
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