By Tedler D. Depaynos, MD
The patient is a middle aged retired farmer who became a janitor of a government building. During his younger days, he worked as a private miner and carried their heavy sacks of mined soil on his back without any problem. Because of poor production he had to revert back to planting vegetables to support himself and his family. His farm was located high up in the mountains so that he had to carry 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 janitorial work as light and his back aches were much relieved, he later began to experience transient pain from his right buttock radiating to his right foot. 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 became persistent which was even aggravated by coughing and bowel movement exertion.
Actually he had been consulting their Municipal Health Officer or MHO who originally gave the diagnosis of “low back pain syndrome” due to “osteoarthritis”. He advised him that it was a “wear and tear” disease and of course aggravated by old age and heavy work. The cartilaginous tissues in between the vertebral bones called vertebral disc “degenerate” so that the space lessens and the vertebral bones may come in contact with each other causing pain. They may also have been unknowingly traumatized in the carrying of heavy loads. Flexibility is sacrificed and pain may occur with movement. Besides there may be 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.
Because of the sudden radiation of pain from his right buttock to his right lower leg, a nerve called “sciatic nerve” may be compressed hence the term “sciatica”. The vertebral disc is actually the vertebral “shock absorber”. It is made up of a “fluid” at the center called “pulpos” surrounded by hard tissues so that with compression it may herniate and compress the adjacent root nerves. This was the impression of the MHO so that he referred the patient to an Orthopedic Surgeon.
The patient instead consulted a neighbor “herbolario” who butchered “native chickens” taken with bottles of 2×2 gin and he experienced some slight relief. His wife was however adamant and insisted that it was the 2×2 which gave him transient relief so that finally she forced him to visit an Orthopedic Surgeon.
Plain x-rays revealed lessening of the space in between the vertebrae specially 5th lumbar (L5) and first sacral (S1) so that obviously there was degeneration of the cartilaginous tissues in between. Actually, this is the most common site of vertebral disc herniation. In general the cartilaginous tissues cannot be seen on plain x-rays. It could be seen in the more sophisticated imaging procedures like an MRI which was later done confirming the herniation. It was fortunate that the herniation was considered “mild”, so that a conservative management was done. Analgesics and vitamins for the nerves were prescribed and a referral to a Rehabilitation Specialist was done. Massage is usually done with traction.
In severe cases, the herniation may have to be excised by the Ortho Surgeons and in worst cases the disc has to be removed and the adjacent vertebrae would be fused.
The patient was severely ecstatic that he will not undergo surgery and he promised his wife he will not miss any follow up as advised by his MDs.
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