Pain from Disc Prolapse
Lumbar disc lesions become extremely common with increasing age. So does back pain. However, the connection between these two is not clear. The fact that a person shows a disc lesion on a CT or MRI scan does not confirm that the pain is due to the disc lesion. Even if the disc is the cause of the pain, there are often several other secondary biomechanical factors that are contributing. Contributors to pain radiating from the low back to the leg include:
- pressure on lumbar nerve roots
- trigger points in various muscles
- referred pain from some of the sacro-iliac ligaments
Similarly, pain radiating from the neck to the arm include:
- pressure on cervical nerve roots
- pain referred from various neck and shoulder muscles
- nerve entrapments by various muscles
Failure to address these factors will lead to treatment failure. It is therefore imperative to make sure that the findings on imaging match the clinical findings before any operative intervention is considered.
Resorting to operative intervention too hastily is unwise. Failed Back Surgery Syndrome (FBSS) is a syndrome in which pain after spine surgery either recurs soon after the operation, is the same as before the operation, or is even worse than before the operation. In cases in which the pain does not change at all since before the operation, although not classically a FBSS, one must consider the possibility that the diagnosis was incorrect in the first place. Causes of the true FBSS syndrome include, epidural scarring in the region of the operation, nerve root damage or even severage, and infection. In addition, several biomechanical changes within and around the spinal column resulting from surgery can all lead within months or a couple of years to further pain and dysfunction. True FBSS occurs in anywhere between 10 and 40% of cases.
Clear indications for urgent spinal surgery are the appearance of loss of urinary or bowel sphincter control or a new onset foot drop. However, for surgery to be effective, this must be performed within 8- 24 hours to get the best results.
Generally, studies of the success of surgery for the treatment of low back pain and sciatica show varying results. Some show a success rate of 90%, but others show no difference between operative intervention and non-operative treatment after 2 to 5 years. It is important to note that the success of subsequent operations is reduced with each successive operation, so if one should think at least twice before the first operation, one must think ten times before the second and the third.
It is Dr Wende’s belief that one must:
- First ascertain that the pain is congruent with pressure on a nerve root from disc lesions
- Treat other causes of pain present, even if a disc lesion is present. See sections on IMS and prolotherapy.
- Perform an epidural injection if necessary, and preferably under fluoroscopy
- Treat muscle imbalances and faulty ergonomics
Briuta (Mevasseret Zion): 02-585-2300
Sharap (Hadassah): 02-677-8899