By Tedler D. Depaynos, MD
The patient has been complaining of slight left lumbar pain which sometimes radiate to her left posterior thigh. Because the pain was tolerable and she could do her usual daily routine she never thought of consulting an MD. It was just incidental that she sought consultation when she accompanied one of her “apos” for immunization to the hospital.
After a thorough physical examination and plain x-rays of her “lumbo-sacral” spine she was diagnosed to have slight “sciatica” where probably an exiting vertebral nerve which goes down to her leg is slightly “compressed”. The cartilaginous tissue found in between the vertebral bones may have “weakened” and this may be appreciated by the narrowing of the space in between the vertebrae resulting in slight compression of the nerve. The cartilaginous disk may not be seen on x-rays but the narrowing could easily be appreciated. Because she is already in her senior years most probably it is due to the “wear and tear” disease which is common to their age group called “osteoarthritis”. She was prescribed some analgesics and advised to undergo physical rehabilitation (rehab) treatment. For 3 weeks she underwent the treatment which gave her significant relief.
She just came from one of her rehab sessions and while walking home as usual, she suddenly felt a recurrence of pain at her left lumbar area radiating to her left leg. The pain was increasing in severity so that she had a hard time going home. Because of the severe pain, all she could do was to lie down when she reached home and was forced to do this for several days. Even while lying down sometimes with just a little movement of her hips the pain worsens. Because of the severe pain, her children brought her to an Orthopedic Surgeon who advised her to undergo Magnetic Resonance Imaging (MRI) of her lumbo-sacral spine which is more specific.
In the MRI, the vertebral discs could be seen unlike in plain x-rays and that one of them has apparently “slipped”. The discs in between the vertebra function as “shock absorbers” of the spine. They may not only be extensively compressed especially when weakened, but may also protrude or herniate or “slip” into the vertebral canal where a nerve passes, compressing it. Weakness of the disc may be due to trauma but in the elderlies like in this patient it is usually due to “Osteoarthritis”.
Because the protrusion of the disc as seen thru MRI is “minor”, surgery was not recommended to remove the “slipped disc” by the Orthopedic MD. Rehab treatment was advised where basically attempts to relieve the compression would be done by various procedures. Meanwhile to relieve the patient of the severe pain, anesthesia injections were made on the vertebral joints where the slipped disk is located. This was done with x-ray guidance so that the sites of injections were very specific. The results were very dramatic because the pain was reduced by 50 to 60% just after the procedure. She was suddenly with wider smiles especially her husband who served as her human cane.
The patient underwent extensive rehab treatment with the close guidance of the Rehab MD. Although the pain practically was relieved after more than a month long extensive sessions, the patient was still advised not to tax her spine by carrying heavy objects and avoid prolonged walking or even standing. This was also emphasized to her human cane who strongly agreed because he believes that her condition was due to her carrying of heavy objects. The strengthening of the supporting muscles thru certain exercises were also demonstrated which she faithfully followed. Likewise, she took the medications prescribed to strengthen her weakened bones regularly and in some instances she was tempted to double their dosage hoping to hasten their effect because she was warned that strengthening of the weakened bones with medications would take some time.**
