The Surgical Conundrum - A Patient Story of Severe Sciatica
My last blog on MRI results showed that on many occasions a person who displays no pain can have equally as bad MRI results as somebody who is experiencing pain. That leaves us in a pretty big conundrum; because a significant part of deciding on whether to have surgery or not, is based upon these MRI findings.
Brinjikji et al (2015)
Trying to explain this to someone is very difficult and trying to explain it to a friend is even harder. That was the case with my best mate, who was recently due to undergo an L5-S1 microdiscectomy to relieve the disc herniation onto his spinal nerves (the root cause of his sciatica).
Just over 10 years ago he was an ex England hockey player and avid all-round sportsman. He had a history of some general lower back pain, which presented more as a constant ache especially during sitting. A year ago, and still playing in the second-tier league, he lifted something heavy and immediately felt his back ‘go’. What quickly followed was excruciating radiating leg and back pain, that meant he struggled to carry out even the most basic physical tasks. Getting in/out of the car, walking, bending and even sleeping were proving exceptionally difficult.
After around 3-4 months of continued and unrelenting pain, he went for an MRI test and consultation with a spinal surgeon. Following this consultation, his mind was effectively made up. He was having surgery. The MRI results showed the disc protrusion was ‘impinging’ onto a spinal nerve and the leg pain was very unlikely to get better without surgical intervention.
This is a man, who was willing to have surgery, on his spine, regardless of many serious risks, because he believed that this ‘nerve impingement’ was now irreversible. See, the problem we have, and that we know from my previous blog, is that another person, may have an identical looking MRI scan showing all the signs of nerve impingement, but not have pain.
The reason for this is still very much unknown. The body is such a complex machine and it shows our brains processing platforms mean that it does not always link with the structural format that you would expect.
His due surgery date was 15th May 2020 and similar to most things, this was severely disrupted due to coronavirus; it was put on hold for at least 4 months until the UK pandemic played out. However, within those 4 months, he made 3 significant changes to everyday life:
1. He was no longer making long car journeys to work.
2. He committed to going for a walk every day, usually for an hour.
3. He worked from home at a sit/stand desk, consciously making use of the stand function.
Of course, you can already guess the rest of the story. From just becoming a little bit more active and reducing his time sitting, he went from the prospect of surgery, to wanting to build towards getting back on the hockey pitch. He managed to play his first hockey game last week following a progressive build up, with no leg pain.
So, what changed?
What we would like to know is whether the injury has repaired itself, or whether the MRI would look exactly the same, but the brain is just processing that information in a different way.
For him, it doesn’t matter. He can now play hockey again and the sleepless nights worrying about spinal surgery are over.
We are also not blind to the fact that he may have some reoccurrence issues in the future, but if there were some symptoms again, we now know that they can hopefully be overcome with a similar progressive strategy.
Moral of the story?
Spinal surgery, like a lot of other types of surgery, comes with a lot of risks. Surely it is better to exhaust all options of rehabilitation before even contemplating leaving your future in the hands of somebody who you don't even know?
Blog written with consent and input from the patient.
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., … Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology. https://doi.org/10.3174/ajnr.A4173