You can arrange an appointment with the London London Norwich Spine Clinic by contacting Mr Rai's secretarial team. Urgent referrals can be seen within a week of enquiry.
Please bring any X-Rays or MRI/CT scans you have that are related to your medical problem.
Mr Rai will liaise with your GP to keep them fully informed. You can have copies of the letters sent to your doctor.
If you have private medical insurance (PMI), please obtain pre-authorisation for the consultation from your insurance company before your appointment with Mr Rai.
You may be advised to have surgery. If you wish to proceed with this, and you have private medical insurance cover, you will again need authorization for the operation from your insurance company who will check the extent of your cover.
Hospital fees are billed to your PMI company by the hospital. These fees usually include nursing, room costs and theatre.
Consultant fees are separate to hospital fees. London Norwich Spine Clinic will bill you or your PMI directly for the specialised care provided by the consultant surgeon. You will be charged separately by your consultant anaesthetist.
Before your operation, we will give you the information required by your insurance company that will also include operation codes (OPCS) and the estimated consultant fees. When you're seeking pre-authorisation from your PMI company, you will need to establish how much of the consultant fees will be covered under your policy.
If you are funding your own private health care we can provide you with an 'inclusive care package'. This will cover all professional fees, follow up appointments, post op physiotherapy and the cost of any complications during the 6 week period.
Mr Rai, Consultant Spinal Surgeon explains the patient journey.
As I often explain to medical students, a skilled physician can diagnose an illness with ordered conversation, confirm by an examination and then further verify with specialist tests such as x-rays and scans.
It's very similar to a detective solving a crime. Indeed, Sir Arthur Conan Doyle, the author of Sherlock Holmes, was a doctor.
Your first consultation may be quite daunting so to reassure you, I have detailed what you could expect when you see me.
Following formal introductions, I will give you an opportunity to explain your problem and symptoms. I will need to know the history of your current condition, discuss your past medical history, family history, social history and any medication you are taking including any allergies.
Most physicians are able to diagnose 85% of illness by taking a careful history.
Following this I will carry out a spinal examination, correlate my findings to any previous imaging that you may have had done and then will discuss my initial findings and the most likely cause of your symptoms.
Confirmation of the diagnosis usually involves an up-to-date MRI scan with possible functional x-rays, CT scan or bone scan. I will then discuss treatment options and review you again after your investigations.
We can usually turn things around within a week but if it is urgent than we can diagnose within 24 hours.
The vast majority of patients are reassured and treated without any surgical intervention with allied professionals such as physiotherapists, chiropractors, osteopaths, personal trainers, yoga masters and reassurance.
If you require intervention then you can be reassured that it will be done in an expert and professional manner to give you the best possible outcome. And of course, you will be in the caring hands of a surgeon with over 25 years experience and outcome data to validate excellent results.
Spinal injections are performed as a day case procedure. The procedure will be discussed with you once it has been agreed that an injection is required. You will then receive instructions from the admissions team. This will include your admission time and any instructions regarding being nil by mouth.
On the day of the operation you must not eat after 06.30am and then between 06.30am and 10.00am you can only drink water. Admissions are normally at 11.00am. On admission the anaesthetist and myself will see you in order to go through the consent and talk you through the procedure.
You will then be taken down to the anaesthetic room where you will be greeted by the theatre team, and all the necessary checks will be performed for your safety. At this stage, the anaesthetist will place a small cannula in the back of your hand to allow the delivery of anaesthetic agents during the procedure. This will take the edge away from the anxiety and pain but you will feel some dull pressure.
I will then mark your back with a marker pen using the x-ray machine to guide me regarding the entry point for the spinal injections. I will then clean your back using standard surgical iodine. An injection of local anaesthetic and steroid is administered using a sterile technique.
Once you have had your spinal injection you will be helped back onto your bed and transferred to the recovery suite. As you have had an epidural injection, it is standard practice to monitor your blood pressure for about half an hour before being sent back to your room.
Once back on the ward you will be able to eat and drink in order to get your blood sugar levels up and you will be asked to rest for 90 minutes to allow the sensation to return to your legs and the effects of the anaesthetic to wear off.
Usually you will be discharged by about 3pm. You will need to arrange to be collected from hospital as you will not be fit to drive on the day of the injection.
Immediately after the injection it is not unusual to have a slight increase in back pain but often the leg pain is immediately relieved. I would advise you take a few days off after the injection to rest and during this time it is important to keep taking your anti-inflammatory medication (Diclofenac, Ibuprofen or Naproxen) as well as any painkillers. It is fine to drive the following day but I would limit journeys to less than 40 minutes.
I have had a number of patients who have flown short haul within one week of having an injection. Although this is not recommended, it is possible provided you keep well hydrated, keep mobile during the flight and wear compression stockings to reduce the chances of a deep venous thrombosis (DVT) and more importantly, a pulmonary embolism (PE).
In the weeks immediately following the injection I would advise you to walk regularly as your symptoms allow and to avoid any strenuous exercise in particular excessive bending, lifting or twisting.
Swimming is an ideal exercise as you are supported but if you cannot swim, walking widths in the pool at progressively increasing depths provides increasing resistance, which will help to build strength and stamina.
In the majority of cases any discomfort associated with the injection should have passed within two weeks and the effects of the steroid should be becoming more apparent.
If you need spinal surgery, I will discuss this with you in detail, including the procedure and what it involves. Surgery will require a minimum of an overnight stay in hospital.
If you have private medical insurance I will give you the procedure code, which will be required by your insurance company to ensure authorisation for funding the operation. I will explain the risks and any possible complications, how long you will need to be in hospital and what to expect after surgery.
I will take you through the consent process and this may involve a few outpatient appointments to ensure you understand the risks but also the benefits from the procedure. I use the British Association of Spinal Surgeons (BASS) consent, which will be sent to you.
It may be necessary for you to attend a pre-operative assessment clinic at the hospital. This will take place approximately one week before your operation and be arranged for you with a specialist pre-assessment nurse. The admissions team will send details of your admission to you in a timely manner prior to surgery.
On the day of the operation you must not eat after 06.30am and then between 06.30am and 10.00am you can only drink water. Admissions are normally at 11.00am. On admission the anaesthetist and myself will see you in order to go through the consent and talk you through the procedure and what to expect immediately after the operation.
You will be taken down to the anaesthetic room where you will be greeted by the theatre team, and all the necessary checks will be performed for your safety. At this stage, the anaesthetist will place a small cannula in the back of your hand to allow the delivery of anaesthetic agents during the procedure.
I will then carry out the procedure under x-ray control supported by my team of professionals. You are usually in theatre for approximately an hour.
After surgery you will be taken to the recovery suite to be carefully monitored before you can be taken back to your room.
You should be discharged the next day unless I consider you need to stay in hospital a little longer. Following your surgery, a post-operative consultation will be arranged for you about 10 days later when you will also see the physiotherapist.
It may be necessary for a graduated return to work programme after your operation and this will be discussed with you at your post-operative appointment.
The first thing to remember is posture. Remind yourself to stand up straight, and if you need support when you're sitting or driving, use a lumbar roll (a specialist cushion) to support your lower back.
If you're lifting things, make sure you know the correct technique to keep your spine straight. Avoid bending down for routine tasks. Instead, lower yourself by bending your knees, allowing your spine to keep relatively straight.
Also, 'no pain, no gain' was not a phrase designed for backs. An occasional twinge is one thing but if you find yourself in real, persistent pain do not try to push on through it. If possible keep mobile and seek specialist advice. Back pain associated with arm or leg pain will often benefit from a surgical opinion and any disturbance of bladder or bowel function requires an urgent appointment.
Your spine is a bit like the mast on a ship; long and tall and depends on the rigging around it to keep it stable. Similarly, our internal 'rigging' (the muscles in our back, abdomen, buttocks and thighs) has the job of holding the spine stable and straight. If they are out of condition or out of kilter, the forces on your spine are no longer neutralized, and it starts to hurt.
These muscles can be developed through exercises with a physiotherapist, chiropractor or osteopath. Pilates is an excellent alternative. Regular endurance-type exercise us also important, and even a 20-30 minute power walk can have a positive effect.
If you have an exacerbation of pain bed rest is not recommended. Reduce your activity for the first couple of days. Then, slowly start your usual activities after that. Avoid heavy lifting or twisting of your back for the first six weeks after the pain begins. You should start exercising again after 2-3 weeks.
The London Norwich Spine Clinic runs clinics from two hospitals.
The Spire Hospital Norwich is where our administration and secretarial team is located.
The London Norwich Spine Clinic in London is based at The Hospital of St. John & Elizabeth. It is situated in Grove End Road between the A41 Wellington Road and Abbey Road in North West London. St John's Wood underground is a two minute walk, Maida Vale 8 minutes and the nearest over ground is South Hampstead.
The London Norwich Spine Clinic in Norwich is based at the Spire Norwich Hospital. It is situated just off the A47 southern bypass, close to the University of East Anglia and just three miles from the city centre. There is ample car parking onsite.
In wider context, Norwich is 116 miles from London and London Stansted Airport is approximately 75 minutes by car.
Leave the A47 at the junction for the B1108 following road signs for Norwich city centre and the Hospital. At the junction of the B1108 with Colney Lane, turn right and continue straight down Colney Lane through the Norwich Research Park.