​What kinds of symptoms do patients experience before receiving treatment?

Patients experiencing severe back pain may also experience fever and chills, unexplained weight loss, sudden bowel and/or bladder incontinence, and severe, continuous abdominal pain. Back pain may be caused by vertebrae, the small bones of the spine. The back conditions for which surgery is recommended include degenerative disk disease, spondylolisthesis, spinal stenosis, scoliosis, fracture, infection, and tumor.

​What is the impact on patients’ lives of living with these conditions?

Patients with severe back pain experience difficulty walking, sleeping, sitting, riding a motorcycle, working, going to school, and carrying out everyday tasks. If the pain affects a patient's ability to work or go to school, the patient will be unable to earn money to support his or her family or continue his or her education. Patients may experience discomfort and difficulty breathing.

What cultural or regional factors affect the treatment of these conditions?

Cambodian culture emphasizes the importance of working hard and earning money to support the family. When a patient is unable to work, he or she may feel helpless or may experience financial difficulty.

What does the treatment process look like?

There are several types of spinal surgeries performed to treat back pain: Spinal fusion: This is the most common surgery for back pain and is used to keep the spine stable after injury, infection, or a tumor. The surgeon joins the spinal bones (vertebrae) together. In a spinal fusion for scoliosis, the surgeon attaches rods, hooks, wires, or screws to the curved part of the backbone to straighten and stabilize the spine. Laminectomy: In this procedure, the surgeon removes parts of the bone, bone spurs, or ligaments in the back. This relieves pressure on spinal nerves and can ease pain or weakness. Foraminotomy: The surgeon cuts bone at the sides of the vertebrae to widen the space through which nerves exit the spine, relieving pressure on the nerves and easing pain. Diskectomy: A disk, the cushion that separates the vertebrae, can slip out of place, pressing on a spinal nerve and causing back pain. In a diskectomy, the surgeon removes all or part of the disk to relieve pain. Disk replacement: A surgeon removes the damaged spinal disk and inserts an artificial one between the vertebrae. Interlaminar implant: The surgeon implants a U-shaped device between two vertebrae in the lower back. This device helps keep the space between them open and eases pressure on the spinal nerves. Bone grafting will also be performed to support the spine and stimulate bone healing.

What is the impact of this treatment on the patient’s life?

The patient will be able to work or go to school without pain.

What potential side effects or risks come with this treatment?

As with any operation, there are potential risks associated with spinal surgery. These include: Infection: Antibiotics are regularly given to the patient before, during, and after surgery to lessen the risk of infection. Bleeding: A certain amount of bleeding is expected, but this is not typically significant. Pain at bone graft site: A small percentage of patients will experience persistent pain at the bone graft site. Recurring symptoms: Some patients may experience a recurrence of their original symptoms. Nerve damage: It is possible that the nerves or blood vessels may be injured during these operations. These complications are very rare. Blood clots: Another uncommon complication is the formation of blood clots in the legs.

How accessible is treatment in the area? What is the typical journey like for a patient to receive care?

Spinal surgery is not widely offered in Cambodia, especially for low-income patients who cannot afford treatment. Children's Surgical Centre (CSC) provides this procedure free of charge. Patients travel to CSC by bus, taxi, or motorbike from all over Cambodia.

What are the alternatives to this treatment?

Patients that do not seek a surgical procedure may try exercises and medication. However, these forms of treatment may not be effective.