When spinal nerves get compressed*

*When spinal nerves get compressed*

Advances in keyhole surgery mean more options for pain relief from pinched nerves in the spine

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2025-08-27

Akshita Nanda

Correspondent

E-paper

The Straits Times 

Page 36 (C2 and C3)

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Pinched spinal nerves can manifest as discomfort for a long time before suddenly incapacitating ​active people.

Take, for example, Mrs Jess O’Reilly, who had a niggling ache in her lower back for years. It did not stop her from enjoying high-​intensity exercise. The 38-year-old thought the pain came from tight glute muscles and addressed it through deep tissue massage or physiotherapy. In 2025, she did the Tokyo Marathon in March and fitness competition Hyrox Singapore in June.

She had no idea that a few weeks later, the ache would suddenly turn into a severe pain that left her unable to stand easily, let alone walk.

“The thing that shocked me most was how quickly the downward spiral happened,” she recalls of her experience in early July.

“It was a niggle, nothing that stopped me from achieving things. Then I woke up on a Monday and I could barely stand. I’d be walking hunched over or crawling. I was trying to take work calls in a foetal position,” adds Mrs O’Reilly, an Australian who works for a human resources, finance and planning tech company in Singapore. She has been here since 2014 with her husband, who works in finance.

Similarly, Mr Jamshid Medora, who turns 85 in September, stays active despite age-related aches and pains. The retired accountant enjoys gardening and prides himself on doing chores like scrubbing the floor.

Then in October 2024, the Singaporean experienced excruciating pain in both legs. “I had to crawl on all fours to get to the loo and back,” he recalls. “I was given powerful painkillers, but they didn’t work.”

Mrs O’Reilly’s and Mr Medora’s pains were caused by pinching or compression of spinal nerves because of changes to the spine. In her case, the problem was a herniated disc. In his case, it was age-related narrowing of the spinal ​canal, known as spinal stenosis, and bone spurs.

Both needed more than painkillers to relieve their distress. Removing the bulging parts of the disc or shaving the bone spurs could help decompress the nerves and relieve the pain.

Traditionally, spine surgery meant cutting through layers of muscle to expose the bones and discs. Patients must recover from wounds that are often large, leading to greater post-operative pain and a higher risk of infection.

Mr Medora needed three levels of decompression and has a curved spine. The surgeon would have had to make large incisions in his back and put in about 20 metal screws to align the vertebrae, all of which are risky at his age.

However, Mrs O’Reilly and Mr Medora were able to benefit from another option – minimally invasive spine surgery or keyhole spine surgery.

Using these techniques, surgeons target the spine through smaller incisions and use a surgical microscope or camera system to aid their work. Patients can recover faster and return to work and normal activities more quickly. There is less muscle damage, less post-operative pain and a lower risk of infection.

Mrs O’Reilly had a minimally invasive procedure in July with her surgeon, who is in private practice, using a surgical microscope. She was allowed to swim after three weeks and start physiotherapy to prevent recurrence of the issue. “All the pain down my side is gone,” she says.

Mr Medora had a newer procedure at NHG Health – endoscopic surgery, which uses even smaller incisions and damages less tissue around the spine. Surgeons from NHG Health say it can be more suitable for older patients, even those in their 80s. It can cost 10 to 20 per cent more than traditional surgery.

When Mr Medora woke up in January after the endoscopic surgery, he was delighted by the absence of pain. “I tossed the blanket aside and waved my legs in the air,” he recalls. “I told the team: ‘See, I can do this without pain.’”

About nine days later, he was back home and even able to take the stairs without a problem. “You have no idea how grateful I am,” he says.

Spine problems common in Singapore

Doctors say the risk of developing spine issues such as impinged nerves is high in Singapore. There are many desk workers prone to poor posture and sedentary ​behaviour; an ageing population; and also many who participate in high-impact activities such as CrossFit training and running.

Neurosurgeon Colum Nolan says another risk factor is smoking, which may impair blood supply to spinal discs. He adds that slipped discs or herniated discs are among the most common problems he treats. The bones of the spine are separated and cushioned by discs, which act like shock absorbers. If the lining of the disc weakens or tears, the contents can bulge out and press on the spinal nerves.

In patients, this presents as ​sciatica with shooting pain down one or both legs, says Dr Nolan, who is senior consultant neurosurgeon and medical director at Oxford Spine and Neurosurgery Centre. He operated on Mrs O’Reilly.

“The pain may be accompanied by pins and needles or numbness in the leg or even weakness. This can also occur in the neck with similar symptoms down the arm,” he adds.

Dr Jacob Oh, senior consultant and deputy head of Tan Tock Seng Hospital’s department of orthopaedic surgery, says other risk factors for spine issues include ​obesity, which increases stress on the spine; heavy lifting; and repetitive strain.

He gives the example of American golfer Tiger Woods, famous for his swing. Woods has had several spine surgical operations over his career to address lower back pain, probably caused by repetitive motions.

Dr Oh, who treated Mr Medora, says people should stay active and play sports, and that it is important to stretch, warm up properly and move with good technique to reduce strain on the spine.

At the NHG Health cluster, age-related wear and tear is the most common cause of back pain in patients, he adds.

Dr Nolan is seeing more patients with degenerative spinal conditions such as spinal stenosis, which he attributes to the ageing population.

“Osteoporosis-related compression fractures in the spine are also increasingly common among older adults, especially women,” he adds.

Treating pain from pinched nerves

Treatment for pain caused by slipped discs or other conditions that compress spinal nerves includes conservative approaches such as physiotherapy and ​lifestyle changes.

Physiotherapy can help patients improve their posture and alignment, as well as strengthen supporting muscles. Lifestyle changes include using ergonomic seats and not sitting for long periods of time.

Patients typically consult specialists when the pain is persistent and affects their quality of life, and can no longer be managed by over-the-counter medications, Dr Nolan says.

If oral pain medications and physiotherapy do not sufficiently reduce the pain, there is the option of targeted injections of local anaesthetics and steroids around the nerves and joints in the spine, he adds.

Radiofrequency ablation might also help. In this procedure, radio waves are sent precisely to nerves via a needle to disrupt the pain impulses. It may also be used to shrink some disc bulges that cause pain. Surgery is considered only if conservative treatments fail or the symptoms are very severe, Dr Nolan says.

It is also considered if there is instability of the spine or progressive neurological compromise due to nerve compression, he adds.

Singapore General Hospital’s (SGH) Spine Service performs about 1,000 spine surgical operations a year, says Dr Lim Yee Gen, consultant at the hospital’s department of orthopaedic surgery.

“About 90 per cent of these are performed for relieving pain, ​either back pain or limb pain from nerve compression,” he adds.

Minimally invasive discectomy and decompression surgical operations started at SGH in 1999 using a surgical microscope. SGH Spine Service has done about 4,000 such operations since.

Endoscopic spine surgical operations, using an endoscope or camera visualisation system, have become more common since 2020. Dr Lim says about 500 have been conducted at SGH.

While endoscopic surgical operations are more expensive because of the specialised equipment and consumables used, the patient has a shorter stay in hospital, he adds.

The institutions in the NHG Health cluster conduct about 1,000 spine operations a year, says Dr Oh.

Endoscopic surgical operations now make up a fraction of these, with about 1,000 conducted since 2021. However, demand is growing for procedures that are less painful and have shorter recovery times, especially from older patients, says Dr Oh.

“Endoscopic surgery has opened up new possibilities for older patients, especially those in their 80s,” he adds. “In the past, open surgery was often too invasive or risky for them, and the only options were painkillers or injections.”

Older people want to be self-​reliant, he says. He has observed that his patients become depressed not just because of the pain they suffer. They are also affected by the loss of independence and mobility. “They don’t want to rely on others,” says Dr Oh.

Mr Medora agrees. He says the thought of losing his independence is worse than the physical pain. “People tell me to get a walking stick. Who wants a walking stick? Not yet,” he adds.

“It’s my pride. I walk on my own.”

akshitan@sph.com.sg