HealthThe Stethoscope

On back pain, again and again!

A young woman presented with severe back and bilateral leg pains. The pain started over 10 years ago when she felt a sudden sharp pain and stiffness in her back; that restricted her movement.

Back then, she went to a Teaching Hospital in Nigeria and was diagnosed with slipped disc. She was placed on traction for 3 months. Her symptoms improved significantly and she was discharged home in good condition. Unfortunately, the pains returned subsequently thereafter and this time she went to another hospital for treatment.

At the hospital she was offered surgery and refused. The doctors told her it was a 50:50 chance of curing her back pain. She therefore opted for conservative care with bed rest and pain killers. This did not do much good and she continued to suffer on a recurring basis.

There were days of excruciating pain interspersed with days when she could dance salsa and run a marathon. However, the good days gradually decreased and the bad days stayed longer than necessary.
Life was miserable all round.

Lumbar spondylosis
I want to introduce you to Lumbar Spondylosis. There are people who complain of back pain and leg pains. The back pain is in the lower back and can radiate to the waist or the hip. The pain is worse with activity: sitting, standing etc. it is often better at night though it can sometimes disturb sleep and wake some people up in the morning.

Leg pain. Credit WebMD.

The pain can be sharp or dull and everyone feels it differently. For some people, walking aggravates the pain while for others it gets better as they move around sorting out their daily bread. In some people, the pain is associated with leg pains. The leg pain can be in one or both legs. It can be around the hip or go down the leg to the ankle and the toes.

The leg pain is often described as sharp: like knife or electric shock sensations down the leg. It may be associated with walking or sitting. In this way, for some, standing and walking makes the leg pain worse. For others, the pain is worse on sitting down. For those, they prefer to stand.


Age is not a barrier
This back and leg pain does not respect age. Often it starts at about 50 years but really, anyone can be affected. It can occur in teenagers where perhaps it follows injury. In many people however, there is no history of an injury. Many people wake up one day to realize they are battling with back pain and leg pains on a daily basis. Over the months and years, it gets worse and ‘managing’ does not quite work anymore.

In some people, they notice that their walking has changed. A man who walks straight and with pride suddenly finds himself bending forward. This is because bending forwards helps to relief the pain. Sitting down for a few minutes is also enforced by the pain after walking only a short distance. Some have to lean on a wall or sit as soon as possible to avoid the legs giving way leading to a fall.

Mild, moderate or severe
In mild cases, life is good and the person affected can still function without too much stress from the pain. There are little additional problems like numbness or leg weakness. In moderate cases, life is not totally happy as there are good days and bad days. The bad days become more frequent and the pains more and more unbearable. In severe cases, life is not worth living due to severe pains that cripple the sufferer. Some of these patients cannot sit, stand, lie down with pains and life is truly miserable.

What to do in your case?
You have to decide which category you belong to: mild, moderate or severe. The treatment of lumbar spondylosis depends largely on how this is affecting your legs or your life. Is it causing numbness, weakness or difficulty passing urine or stool? Is it affecting your sex life with numbness in the private parts or poor erection in men? Those may mean you are in the moderate or severe category and should see a doctor promptly.

Mild cases can be managed with simple sensible behavior like losing weight, stop
smoking and start some exercise program to keep the joints moving and lubricated.
Drugs like Panadol and Paracetamol can also help with mild pains and can be taken
once in a while. The key though is for a serious attempt at losing weight if you are
even slightly overweight for your height.

Moderate and severe cases need the services of a spine surgeon: usually a neurosurgeon, for assistance. A test called the MRI scan is indicated and will help in confirming the diagnosis. We can determine what is wrong, where and how bad on the basis of the symptoms, clinical examination and what we see on the MRI scan


Operation
Operations may be recommended for severe pains, leg weakness and disability.
The operations are designed for each individual and depend on the problem shown in the MRI scan.

Operations are safe and currently give over 95% good outcomes for the usual problems in lumbar spondylosis.

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