By Tedler D. Depaynos, MD
The patient is a retired farmer who became a janitor of a government building. During his younger days, he indulged was also a private miner and had been carrying their sacks of mined soil on his back without any problem. Because of poor production he had to revert to planting vegetables to support himself and his family. His farm was located high up in the mountains so that they had to carry their heavy baskets of produce down to the road. Eventually, he gradually felt back aches which worsened with time so that he had no second thoughts and was extremely happy when his present job was offered to him.
Although he described his work as light and his back aches were much relieved he later began to experience transient pain from his right buttocks radiating to his feet. With time, the pain was eventually accompanied by numbness but no weakness. He had been taking the counter analgesics which gave him relief but one day, the radiating pain worsened and was aggravated by coughing and bowel movement exertion.
Actually he has been consulting their Municipal Health Officer or MHO who gave the diagnosis of “low back pain syndrome” due to “osteoarthritis”. He advised him that it is a “wear and tear” disease and of course aggravated by old age and heavy work. The tissues in between the vertebral bones “degenerate” so that the space lessens and the vertebral bones may come in contact with each other. They may also have been unknowingly traumatized in the carrying of heavy loads. Flexibility is sacrificed and pain may occur with movement. Besides there is outward growth at the edge of the vertebral bones called “spurs” worsening the condition. Because of pain, the muscles beside the spine continuously contract and harden aggravating the pain. This could be relieved by hot compress and massage but the vertebral pathology is permanent and may worsen with time.
The MHO further advised him that because of the radiation of pain to his right leg which is called “sciatica”, there may be herniation of the intervertebral tissues compressing a nerve root. This could be confirmed by x-rays of his spine and CT Scan and other possible causes like tumors and inflammatory diseases like tuberculosis or osteomyelitis could be ruled out. An orthopedic intervention maybe needed depending on its severity. Hence the MHO made a referral.
The patient has also been consulting their neighborly “herbolario” which has always been accompanied by butchering “native chickens” with the usual 4×4 San Miguel gin. But since there was no permanent relief of his radiating pain, his wife finally convinced him to follow their MHO referral.
The consulted Orthopedic Surgeon who incidentally was a classmate of the MHO at med school agreed with the diagnosis through the “straight leg raising test”. This was confirmed by the spinal x-rays done where defects were noted but the most apparent was between the lumbar (L5) and sacral (S1) vertebrae where an intervertebral herniation could probably be surmised. Actually this is the most common site of vertebral defect in sciatica. Further work-up like a CT Scan or MRI was suggested but because of budget limitation a conservative treatment by the prescription of anti-inflammatory and neural medicines was done. To make him constantly conscious to take care of his back, a back brace was fitted.
The patient, however, with the insistence of his wife promised to return for follow up even with significant relief of his condition. **
