Author: denham

RADIATING PAIN and/or NUMBNESS DOWN THE LEGS as a consequence of worn-out discs

‘Doctor, for years I have had pain in my lower back and I could live with it, yet now I also have pain going down my legs and that I cannot take anymore’

Due to wear and tear, the discs will decrease in height and bulge all around (just like a flat tire). As a consequence the disc will bulge (protrusion) and the vertebra above will come closer to the vertebra below. This causes a reduction in the size of the opening through which the nerves leave the spine. When such a nerve becomes truly squeezed, there will be a burning sensation with numbness or a feeling of pins and needles in that part of the leg for which this specific nerve is responsible. Each nerve goes indeed to a specific part of the leg, and by indicating where the changes are on the leg, the patient makes clear to the spine surgeon which nerve is involved. After some time, there can also be pain radiating down the leg as well as a typical diminution of the walking distance (neurogenic claudication). 

In the beginning, the treatment is best followed by the general practitioner. Not only radiographs and scanners will be ordered, but also tests of the nerves such as EMG (insertion of tiny needles in the leg to analyse the function of the nerves). On the treatment menu you will find: medication, dieting, cease smoking, back muscle and abdominal muscle exercises, osteopathy, physiotherapy, acupuncture, epidural infections, a lumbar belt, improvement of work surroundings, a better bed etc

If all this does not help, one could wonder ‘CAN AN OPERATION BRING IMPROVEMENT?’ 

In most cases, yes. The principle consists of enlarging the opening through which the nerves pass on leaving the spine. This is being done WITHOUT altering the mechanics of the back. The discs and facet joint remain unharmed. The current state of the art techniques allow us to say that the odds that someone would feel significantly better at, let’s say some months after surgery, are around 95%. This does not mean that a specific person will be 95% improved, but that out of a hundred operated people, 95 are satisfied and 5 disappointed. These are mostly patients who either waited too long with their surgery, or those who form a large scar around the nerves (fibrosis) in the operated area. Strangely enough, these patients often also claim to have less back pain, whereas this was not the primary aim of the surgery. 

The operations are performed under general anaesthesia, are not really painful, and the hospital stay is only a few days. Patients walk home from the hospital and active revalidation is seldom required. Elderly patients who have nobody waiting for them may benefit from a short stay in a revalidation centre, prior to going home. 

‘Doctor, my neck is stiff and painful’

This often comes with a headache starting at the back of the skull as well as pain in the
shoulders and between the shoulder blades.

In the beginning, the treatment is best followed by the general practitioner. On the menu you
will find: medication, cease smoking, osteopathy, physiotherapy, acupuncture, a soft collar,
improvement of work surroundings etc

If all this does not help, one could wonder ‘CAN AN OPERATION BRING
IMPROVEMENT?’

In some cases yes. The principle consists of removing the painful disc and to fuse the
vertebra above and below. Also here there are, unfortunately, limitations to the surgery.
Indeed, only a few discs may be affected. Best is one, two or three levels. To operate more
levels is technically quite possible, but the results are not as good. The current state of the art
techniques allows us to say that the odds that someone would feel significantly better at, let’s
say one year after surgery, are around 90%. This does not mean that a specific person will be
90% improved, but that out of a hundred operated people, 90 are satisfied and 10
disappointed. The decision to have such an operation done does not lie with the back pain
specialist, but with the patient her/himself. The patient therefore also carries the responsibility
linked to this decision. Indeed, neck pain is not a life-threatening condition and an operation
is never ‘absolutely’ unavoidable as it can be the case in the presence of a malign tumour. The role
of the back specialist is one of explaining what is happening and why and what the alternative
treatment modalities are, each with their advantages and disadvantages. Once the patient
understands the situation clearly she/he can take an informed decision. From that moment
onwards, the surgeon will be totally dedicated to the case ensuring an excellent operation and
a good postoperative follow-up.

The wear and tear of the discs can lead to the following: 

1. Low Back Pain for the discs in the low back, and Neck Pain for the discs in the cervical spine
2. Radiating pain or numbness down the legs (for the low back) and down the arms (for the neck)

Let us discuss the problems of pain and radiating pain separately. We will first explain the dull ache, which becomes progressively more intense over the months and years, and then we will analyze the sudden acute pain in the low back or neck which makes all movement near to impossible and which can radiate down the limbs.

Dull LOW BACK PAIN due to wear and tear of the discs

‘Doctor, I want them to get off my back’

In the beginning, the treatment is best followed by the general practitioner. On the menu, you will find: medication, a diet, cease smoking, exercises for back and abdominal muscles, osteopathy, physiotherapy, acupuncture, a lumbar belt, improvement of work surroundings, a better bed etc. One thing is certain: BEDREST DOES NOT HELP AND IS HARMFUL

If all this does not help, one could wonder ‘CAN AN OPERATION BRING IMPROVEMENT?’ 

In some cases, yes. The principle consists of removing the worn out disc and fixing the adjoining vertebrae to one another (arthrodesis or spondylodesis). Alternatively, a mobile artificial disc can be inserted. Unfortunately, these operations have their limitations. Indeed, only a few discs may be affected. Best are one, two or three levels. To operate more levels is technically quite possible, but the results are not as good. The current state of the art techniques allow us to say that the odds that someone would feel significantly better at, let’s say one year after surgery, are around 80%. This does not mean that a specific person will be 80% improved, but that out of a hundred operated people, 80 are satisfied and 20 disappointed. That does not mean they are worse off, but that, of course, is a subjective experience.  Any specialist claiming a higher success rate is in fact not honest. The decision to have such an operation done does not lie with the back pain specialist, but with the patient her/himself. The patient therefore also carries the responsibility linked to this decision. Indeed, back and/or neck pain are not life-threatening conditions and an operation is never ‘absolutely’ unavoidable as it can be the case in the presence of a malign tumour. The role of the back specialist is one of explaining what is happening and why and what the alternative treatment modalities are, each with their advantages and disadvantages. Once the patient understands the situation clearly she/he can make an informed decision. From that moment onwards, the surgeon will be totally dedicated to the case ensuring an excellent operation and a good postoperative follow-up. 

The operative technique used for these interventions may vary from case to case and are best explained by the surgeon for each individual patient. The operations are performed under general anaesthesia, are not really painful, and the hospital stay is only a few days. Patients walk home from the hospital and active revalidation is seldom required.

The hospitals dispose of the most modern infrastructure with computer guided surgery and microscopes. The use of one or other instrument is evaluated for each case individually and discussed with the patient.

Only a few of us can really say this. Some people even call it ‘the disease of the century’. In most cases, the pain goes away by itself/spontaneously. At times, however, the symptoms can persevere, making a visit to the general practitioner unavoidable. A history will be then be taken, a clinical examination performed and some tests such as X-rays and scanners requested. Often medication will be prescribed as well as some form of physiotherapy or osteopathy.

Some people prefer alternative medicine. In fact, this is not too bad: back and neck problems are mostly benign anyway. The risk remains however to miss an important pathology. It is, therefore, best to always consult with the general practitioner.

Why is it that we get this pain in the back and in the neck and why does it sometimes radiate so persistently towards the limbs?

Let us first make a simple drawing of the structure of the spine. The spine has a triple function:

1. Stability, because it is the axis of the body
2. Mobility, because we want to be able to move swiftly
3. Protection, of the spinal cord, and the important nerves which are inside it

The vertebrae are kept together by means of intervertebral discs in the front and two facet joints at the back. The intervertebral discs are the cause of all our misery. They wear out, but the speed at which this happens varies from one person to the next. For some, this happens early (around 20-30 years), and for others much later. We all know at least someone who has grey hair before they reach thirty – which is hardly old! The same happens in the spine with the intervertebral discs. But there is more: everybody wears the discs out, yet it bothers some people and not others. It is not fair, but it is life and we cannot do anything to change it.

Arthrodesis: Fusion of one bone with another (here vertebrae).

Disc bulging: Uniform bulging of the disc as a result of disc sagging (a bit like an incompletely pumped up tire).

Discectomy: Operation whereby the offending protruding part of the disc (disc hernia) is resected.

EMG or electromyography is an electrical measurement of the function of a nerve.

Facets are small joints at the back of the spine.

Disc hernia: When a part of the intervertebral disc protrudes. This can cause pure backache or neck pain. It can also cause leg or arm pain if it pushes against a spinal nerve.

Epidural injection: Injection (made by an anesthesiologist) of medication around the nerves in the spine (like for giving birth, but with another product).

Laminectomy or laminarthrectomy: Operation whereby a narrow(ed) spinal canal that contains the cord and spinal nerves is being enlarged.

MRI or magnetic resonance: A scanner which works with a strong magnet and a sound wave (and thus no classic X-rays).

Radiculopathy: Abnormal working of the spinal nerve with pain, muscle weakness and a ‘pins and needles’ feeling.

Sacro-iliac joint: The joint between the pelvis and the sacrum at the bottom of the spine.

Sciatica: Pain in the area which the sciatic nerve covers. Can be along one or more spinal nerves.

Spondylodesis: Operation consisting of infusing one vertebra to another.