C1 Blog

This is an interesting article that I found in the Times.

“So-called slipped discs are a common result of overzealous DIY or gardening but a spinal operation is not always the best answer”
Dr Mark Porter

Dodgy ladders, reluctant lawn mowers, sledgehammers, strimmers and heavy patio slabs all exact a toll on the lumbar regions of the nation’s Bank Holiday DIY-ers and gardeners, and most surgeries will have at least one person in the waiting room this morning with a bad back. The lucky majority will have a simple sprain or strain, but an unlucky few will end up with a slipped disc.
Two years ago I was one of the unlucky ones. I would like to be able to report that I damaged my back kite-surfing off Cornwall but the truth is, I did it lifting a half-empty bucket at home.

One person in 20 develops at least one episode of back and referred leg pain (sciatica) from a slipped disc at some stage of his or her life, with most cases occurring in men aged 30 to 50. The discs are found between every vertebra in the spine, where they act as shock-absorbing spacers that allow the spine to twist and flex. They are subject to considerable mechanical forces, particularly in the lower spine, and it is these lumbar discs that typically cause trouble.

The term “slipped disc” is a misnomer. The circular discs never actually move, but a weakness in their tough outer wall allows the softer, gelatinous centre to bulge out or burst through (prolapse), compressing the surrounding nerves and causing pain and sometimes numbness and weakness, too.
Most damaged discs heal with time and there is little that medicine can do to accelerate that process, other than try to keep the person as comfortable as possible. Manipulative therapies such as physio can’t settle a damaged disc but they can help to alleviate accompanying muscle spasms and postural problems.

If symptoms do not improve in six weeks, I advocate referral to the nearest back pain clinic for further assessment, which often includes an MRI scan to look at the discs. If the symptoms are severe and show no signs of resolving, then surgery to remove a bit of the disc and relieve pressure on the nerve (a microdiscectomy) may be indicated. The results are excellent but it should be a last resort — most people who don’t have surgery eventually make a full recovery too, although this can sometimes take 12 months or more.

I have always advised patients of mine to grin and bear the pain in the hope that Mother Nature will eventually heal the wound and do a better job than a surgeon, but my experience has changed that stance and I am now far more pro-surgery than I used to be. My pain never settled despite throwing the British National Formulary at it — and when I started to lose feeling and power in my left leg, a neurosurgeon suggested a microdiscectomy and I agreed.

When I came round in recovery after the 90-minute operation, it was clear that it had been a success. The omnipresent sciatica in my left leg had vanished and, besides a bit of tenderness around the 3cm scar in the small of my back, I was pain-free.

Not every microdiscectomy goes so well and there were several factors in my favour. My problem was at the right level (damaged discs between the fourth and fifth lumbar vertebrae tend to do best); I am the right age (for once, being over 40 is associated with a better outcome); I had it done at the right time (surgery within 2-3 months of the injury is most successful); and I had an excellent surgeon.
Surgery is not needed for most people and is no better (and may be worse) than leaving things to heal naturally. But it provides almost instant relief when it goes well, and can prevent permanent nerve damage.

My sciatica may have gone but the strength in my left leg never returned completely and I nurse my back much more than I used to: lots of core stability exercises, no more marathons and no DIY or heavy gardening. Well, that’s my excuse, anyway.

Sciatica advice
Take it easy
As a general rule, 70-90 per cent of prolapsed discs will settle, or start to settle, within six weeks. Taking it easy will help the pain in the short term but bed rest should be avoided if possible.

Which drugs?
Paracetamol and ibuprofen are rarely strong enough alone for people with sciatica. Longer-acting, more powerful anti-inflammatories such as diclofenac work better, and you may need even stronger painkillers or muscle relaxants (low-dose diazepam).

Tingles and worse
Pins and needles, some loss of sensation and weakness in some muscles (particularly those working the big toe) are common in bigger prolapses and full recovery is usual, but such symptoms always warrant assessment by a doctor. If the symptoms affect both legs or you are having difficulty controlling your bowels or bladder, this suggests more worrying nerve compression and requires urgent assessment.”

So, he seems to have made a full recovery form the surgery except for the weakness in the leg, which stikes me as significant and not as trivial as he is perhaps making out. I also got the feeling that the surgery option is the one of last resort even thought it had a good outcome and I wondered why this was. Perhaps reading between the lines this is not as simple as it sounds and it may had some horrible risk factors that may mean it is onluy used if noting else works.

I liked the mention of the physio but the lack of decent spinal care not provided by those who know what they are really doing was a shame and it was telling that the pathway was: wait, drungs then surgery. I fail to see how the drugs could do anything for the underlying condiditon and no wonder it failed to resolve.

The best care must include Mackenzie exercises, precise manipulation and subsequent rehabilitation.