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Last Updated: Sunday, 3 February 2008, 01:10 GMT
Inside Medicine: The spine consultant
Andrew Quaile
In a series focusing on medical specialisms, BBC News meets spinal orthopaedic surgeon Mr Andrew Quaile.

Orthopaedic surgery is the branch of surgery concerned with problems with the musculoskeletal system - the skeleton, its joints and the muscles attached to bones by tendons.

Mr Quaile's branch concentrates on the spine specifically.

WHAT IS YOUR JOB?

I am a spinal orthopaedic surgeon based at the Hampshire Clinic of BMI Healthcare in Basingstoke.

WHAT IS THE MOST COMMON CONDITION?

The most common condition we deal with is spinal stenosis.

This is basically a narrowing of the spinal canal - the space in the bones that make up the spine through which the spinal cord passes. It leads to trapped nerves.

I do about one operation on patients with this condition a week.

They won't do something because they are frightened they will do damage and therefore they sit at home and become a couch potato
Andrew Quaile

It is basically caused by age-related change: as people get older the discs in the spin are more likely to collapse, causing the spinal canal to get tighter and narrower.

It is a bit like the analogy of a car tyre - as the car ages, the car tyre will deflate and in time it will end up on its rims and that is more or less what a disc is doing.

The condition is most likely to affect people from their mid-50s onwards, and as the population is ageing, it is becoming more of a problem.

WHAT IS THE MOST COMMON PROCEDURE?

Although the most common condition is spinal stenosis, this can be dealt with through pain management.

The most common procedure however is for a condition known as decompression, which means me removing anything that is pressing on a nerve, be that a bit of bone or a ligament pressing on the nerve.

And at the same time you often put in a stabilising device, such as a Wallis ligament, to try to prevent it collapsing any further. This basically acts as a shock absorber.

WHAT IS THE HARDEST THING ABOUT YOUR JOB?

The hardest thing about my job is explaining to people that their back won't become young again and that their suffering is related to the ageing process.

Although we attempt to get them to live with their back, they will not be 21 again. We can't reverse general wear and tear.

View of a skeleton
'We attempt to get them to live with their back'

We do not have the miracle cure.

There is an awful lot of misconception currently in circulation that pain equals damage.

People feel that because they are suffering pain, they can't exercise because they might increase the pain and do more damage, but that is not correct at all.

You have to tell them that reasonable exercising is good for them and if they do experience any pain as a result, it is likely to be temporary and nothing to worry about.

Sitting at home being a couch potato is very counter-productive.

WHAT IS YOUR MOST SATISFYING CASE?

Carrying out a discectomy, a procedure to remove fragments of disc from the nerves, can be very satisfying.

You tend to get an instant response. The patient wakes up from the operation and they are in instant recovery.

Therefore they tend to be quite cheerful.

WHY DID YOU CHOOSE THIS SPECIALTY?

I spent 14 years in the Royal Navy and operated on a lot of knees as a result of sporting injuries, but there were a lot of people in the services with back pain and there did not seem to be anyone dealing with the pain, so it became a bit of a niche for me.

The more I got into it, the more interesting it became.

It is still interesting now because there are only 15 full-time spinal orthopaedic surgeons in the UK.

IF YOU HAD YOUR TIME AGAIN WOULD YOU CHANGE YOUR SPECIALTY?

No, I enjoy it as I like talking to people.

I only operate on about 5% of the people I see. The remaining 95% I examine and often send for an MRI scan to determine the cause of their problem. Then I offer a detailed explanation about how physio treatment or other non-surgical treatments can help.

WHICH SPECIALTY WOULD YOU HAVE GONE INTO IF NOT YOUR OWN?

If it were not in medicine, there are thousands of things I would like to do.

I would love to own a vineyard, but if it had to be medicine I would probably stay in orthopaedics, but specialise in knees.

HOW DO YOU SEE THE ROLE DEVELOPING IN THE FUTURE?

As the population is ageing, more people are getting back pain, but I have always felt that the treatment for back pain is a Cinderella service.

I would like to see the role developing so that we have more opportunity to educate people about backs and the ability to co-ordinate return-to-work programmes for people with back problems.

In particular, we need to educate people so that they stop thinking that exercise will damage their backs.

I would like to see a lot more rapid access for people with back pain and far more rapid treatment.



CV - Mr Andrew Quaile
1978 : Qualified from Charing Cross Hospital, London
1992: Became a consultant orthopaedic surgeon and then gained experience as a consultant in orthopaedics with a specialist interest in spinal surgery in Brisbane, Australia, where he had his own private practice
1995: Took up a consultant post in general orthopaedics with a special interest in spine, at the East Somerset NHS Trust for three years.
1998: Went to work at Frimley Park Hospital NHS Trust, in Surrey, as a consultant spinal orthopaedic Surgeon
Present: Mr Quaile is now in full-time private practice.


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