Spinal column

Ow my back!

In early 2001, I began to feel pretty constant sciatic pain. At that time, it was an annoying pain around the top of my right buttock whenever I stood up, which eased after a few minutes.

I’d had occasional bouts of similar pain before, which only lasted a few days. I expected the same this time, but no such luck. Over the following weeks and months the pain became very slowly worse: the pain took fractionally longer and longer to ease off, and got fractionally worse and worse.

I don’t think a single incident caused it, although it started in earnest soon after I went skiing. I’m pretty sure it was a combination of things: my tendency to lean forward at my desk rather than sit properly; my slouch-inducing sofa; and my inability, shared with most people, to pick things up properly.

Fool that I was and am, I just hoped it would go away and didn’t do anything about it – except occasionally moan about my bad back to my mates.

Two years later

By summer 2003, the pain was stronger and longer-lasting, and spreading down my right leg. When I played badminton, it took half an hour of running about for the pain to ease off – and it returned with a vengeance after our session was up.

During one badminton game I really hurt myself twisting for a shot. I could hardly bend down. I thought I’d pulled a muscle, and maybe I had, but the sciatica got worse at the same time (I only really noticed this after the muscle-pull had cleared up). One thing struck me more than everything else, even after I had “recovered”: I could no longer put socks on while standing up; I just couldn’t reach down that far any more.

In August 2003 I was made redundant and the office in which I worked was closed. Consequently there was quite a lot of equipment to dispose of. I tried to carry as little as possible during this process, and was helpfully indulged by my friends at work. But undoubtedly I carried too much – and some equipment, including a 19-inch CRT monitor, was heading back to my flat. One thing someone with a bad back shouldn’t do is carry a 19-inch monitor up two flights of stairs.

The pain got worse, and spread further. And without a job to distract me, it became more annoying too.

Avaragado finally sees sense

Flat on my back, the pain went away after ten minutes or so. Sitting down, the pain went away after a few minutes or so. But standing up again…

The pain went from the top of my right buttock into the outside of my right thigh, down the outside of my right calf, and into my right foot.

It now took an hour’s walking for the pain to ease off. I’d walk into town to peruse the oh-so-familiar shelves of the local Borders, and be unable to stand up because of the pain. Every step hurt. Standing still hurt. Sitting down could also hurt. At all times, even when the pain had eased, I could feel a niggling something: a difference between my left and right leg.

Finally the mists cleared and I saw sense. This was silly, and stupid. I made an appointment with a physiotherapist.

Serendipity

My first physio session was on September 8, 2003. By good fortune, I’d made an appointment with Jean Oliver (Achilles Physiotherapy), who immediately spotted or was keen to understand my various interesting skeletal features (my externally rotated hips, my out-of-kilter left forearm) and who recognised my left-handedness by the slope of my shoulders.

She told me that based on my symptoms, it was likely that I had a disc problem: the squishy innards of a lumbar disc may have oozed out to press against a nerve root. Because it was a chronic condition (I’d had it for so long) she’d have to be careful how she treated it; she couldn’t throw me around the room wrenching me this way and that, as the pain had extended below the knee (a Bad Thing). She tried some mobilisation – simple spinal massage – to try to get things moving. It was clear that this wouldn’t be a five-minute fix.

I returned several times, each time reporting no real improvement, but some change – pain at different times or places. Jean tried more mobilisation, but she strongly recommended I see a specialist and get an MRI scan. She’d write him a letter; all I’d need is an appointment and a referral from my GP. I agreed to do it.

As soon as I got home I made the arrangements. To my surprise, I could see the specialist only a few days later. Privately, of course. Luckily my former employer operated a private health scheme, and allowed me (and my ex-workmates) two months’ cover post-redundancy. I got my GP to scribble the necessary referral on some headed notepaper – there was no time for anything formal.

On September 25, 2003 I saw the specialist, Dr Adrian Crisp. At his command I performed all the usual Stupid Patient Tricks, bending this way and that, etc, until he’d seen enough. He agreed that a disc problem was likely, and wanted me to have an MRI scan to prove it. A pelvic X-ray would be good too. I had the X-ray straight away, but would need to return for the scan on October 1. I’d see him again a few days afterwards for the results.

Scan results

On October 4, 2003 I saw Dr Crisp again, at 8am (ugh). He showed me several slices through my body; the one I’ve included here on the right highlighted the problem most clearly. It was just as expected.

The accompanying radiology report said…

At L4/5 the disc is dehydrated with a minimal non-compressive midline protrusion.

At L5/S1 the disc is dehydrated and slightly reduced in height. There is a small focal herniation in the midline which narrows the right lateral angle displacing and mildly compressing the S1 nerve root. The thecal sac and neural foramina are not compromised.

The remaining lumbar discs are normal. The distal cord and conus are normal.

In plain English: the creamy caramel inside two of my discs had oozed out of the crispy shell, and in one case (the disc between L5 and S1) was squashed up against a nerve. Result: pain.

Two possible solutions were offered: the physio or the knife. Dr Crisp said that in my case it was unlikely that physio would completely solve the problem. If I didn’t see real improvement after about eight sessions, I never would (I was four sessions into physio at that time).

Surgery wouldn’t be too bad. A little incision here, scrape out the caramel, ping the nerve loose, scalpel, suction, close please, golf. Out of hospital in a couple of days, bouncing about pretty much immediately with instant improvement. But I’d have to stay off work for 6-8 weeks, were I doing anything so foolish as working, and avoid overdoing it (eg long car journeys, skiing trips, etc). The success rate is about 90-95% in someone of my immense youth and vitality.

The plan

My plan was to carry on with the physio for another month, then have the surgery. But after a week of still-increasing pain and general grumpiness, I decided not to wait any longer. I went to my GP for another referral (she said she’d fax it through), and made an appointment with the neurosurgeon, Mr Peter Kirkpatrick, for a few days later.

On October 15, 2003, I saw Mr Kirkpatrick. There was no sign of the GP’s referral fax but he carried on anyway. After taking yet another history from me, prodding me with needles, and examining my scan, he agreed to perform the surgery. The earliest he could squeeze me in would be the following Wednesday, but he’d have to check the scheduling with the hospital and his secretary. It was all finally agreed – by everyone including my private health company – just the day before I was to be admitted.

If in doubt, cut it out

Just three weeks after the scan, and less than two months after I finally pulled my finger out and did something about it, on Wednesday October 22, 2003, I had surgery. (For a blow-by-blow account of the surgery and its aftermath, start reading Avaragado’s blog for October 22 and thereafter.)

There was an incision of no more than a couple of inches, everything done through a microscope. Discectomy, laminectomy, foraminectomy: the neurosurgeon cleared away the disc leakage, cut away a bit more of the disc, and cut away a bit of bone to allow the nerve root a bit more room to move. And here’s exactly what he cut out, nicely preserved Damien Hirst stylee.

Here’s what the scar looked like, nine days after surgery (just after removing the dressing):

Update: Three weeks after the surgery

Immediately after the surgery I wasn’t allowed to drive (in case I suddenly got a stabbing pain and careered into some pedestrians), or to carry anything heavier than a saucepan of water. I had some sciatic pain, but entirely different to before and nothing like as bad as it was.

In my first follow-up appointment with the surgeon, on November 12, everything went well. I was given the all-clear to drive again, and to start to do a bit more exercise (more – but moderate – walking, cycling and swimming; except I don’t cycle or swim). The residual sciatic pain should diminish over time.

More stressful and spine-jarring activities, like jogging or badminton, are banned until about six months after the surgery. I should be able to go skiing in January though, as long as I take it easy.

The neurosurgeon said I don’t need to see a physio any more, but I’m thinking about going back to Jean Oliver anyway for advice on posture, exercises, etc.

Update 2: Three months after the surgery

Everything’s going fine. I successfully skied in Verbier in January 2004, and then the following week returned to see the surgeon for the final time (I couldn’t get an appointment with him before the holiday).

I’m still banned from badminton for another three months, and free from the scourge of gardening for a long, long time. I am officially excused heavy lifting (CRT monitors, furniture etc) forever.

I haven’t been back for physio; I don’t seem to need any. I still get twinges but nothing serious. It’s easy to be oversensitive and worry unnecessarily about every last pain, but I try to be relaxed about it.

Update 3: Three years after the surgery

Doesn’t time fly? It’s all going well. I occasionally have a few days, sometimes up to a week, with a little sciatic pain. Sometimes it’s down the left rather than down the right. In my mental model one of the discs floats around a bit. Occasionally it pushes against a bit of nerve, then after a few days shuffles back into position.

Only once has it got annoying and painful enough to contemplate seeing a physio: I made an appointment, which was the cue for the pain to disappear overnight.

I’ve been skiing every year since the operation. I now play badminton again, though I’ve resolved not to play singles matches. There are no longer any CRTs in my humble abode (getting rid of them involved a wheely chair, the Amazing Power of the Lever, and Freecycle).