David was a 50 year-old chartered accountant and company director who otherwise led a relatively active life as a long-distance walker and volunteer leader with the Scout Association.
In January 2013, while handling heavy bales of animal feed, David suffered a sudden and debilitating lower back injury. Initial presentation at the GP resulted in prescriptions of painkillers and initial physiotherapy to deal with torn muscles in the lower back.
The physiotherapist initially suggested that a slipped disc was the most likely injury to have sustained from a combination of lifting and twisting a heavyweight unexpectedly. However, in the absence of one or more of the normal set of diagnostic symptoms, early treatment concentrated on the more obviously torn groups of muscles.
This injury was compounded later in January 2013 by a fall on ice, which was initially diagnosed as a potentially fractured sacrum. Increased doses of painkillers were unable to stop the spread of debilitating pain and muscle weakness, which began to spread into the left leg.
Aside from the spread of severe sciatica and pain from lower back to calf muscle, the more significant symptoms involved sudden, unpredictable, complete losses of muscle function in the left leg, leading to force.
By April, David had spent a week in hospital for a possibly unrelated infection, but CT scans done at that time showed that there were no pelvic fractures, which would explain the pain or weakness. In early May, and on increasing doses of painkillers, David was unable to continue to drive any significant distance, or continue to work.
Physiotherapy and visits to the GP continued through the summer and autumn. In autumn 2013, the physiotherapist suggested that the initial suggestion he had made of a slipped disc and lumbo-sacral radiculoapathy was now the most likely cause.
By late autumn, David was unable to walk more than 50m, and even then walking mostly with the aid of a hiking pole. Quality of life was seriously reduced by the significantly disturbed sleep from the pain. David was facing other side effects and disturbances from taking the maximum permitted doses of several painkillers.
Unable to work and enjoy life, and beginning to be dependent on others for simple care – like putting on socks, David accepted that a surgical solution was probably required.
David used his GP Referred services through Aviva private health insurance to obtain a lower spine MRI at a very convenient local hospital. This was followed by consultation with Rodney Laing at Spire Cambridge Lea hospital.
Minimally invasive lumbar decompression was offered, and - after careful consideration of the very well explained, benefits and risks of the procedure – arranged within two weeks.
Mr Laing was clear, unambiguous, optimistic, but realistic as to the risks and benefits of surgery and the lower spine. David took some days to check to published papers, and medical best practice reports, and was pleased to accept the proposed surgery.
David was treated as a day patient, going in for surgery early in the morning, and going home early in the evening (with only minor issues, as are normally associated with anaesthesia).
The following day, David was able to walk one mile completely unaided, with only local surgical pain. While the sciatica symptoms were immediately relieved by over 90%, they did return, on and off, over the next two to three weeks, but never with this same intensity or consequences, as previously.
Within a month after surgery. David had ceased taking painkillers, and resumed normal sleep pattern, was walking 6 miles comfortably with the aid of hiking poles, and the surgical wound was unnoticeable.
Physiotherapy could now be very effectively targeted on building up core abdominal muscles, strengthening David’s lower back, and relieving the tightened muscles and tendons caused by year of pain.
Four months later, David is enjoying life to the full, has started an already successful and fast-growing accountancy and advisory business, is regularly walking 20 miles or more, and, if asked, would say that he is 99.5% free of pain and symptoms.
It was also clear from speaking to friends and relatives who had had lower back surgery many years ago, that they had experienced significantly more serious surgical complications and long-term issues with healing.
Follow-ups with Mr Laing were both informative and empathic. David found that the combination of direct factual information, and a clear understanding of the effects of the injury and the impact of surgery, were an extremely important part of the process. The consultations afterwards went a long way to giving David the confidence to resume his normal life – albeit with a firm intention to manage his own weight and pay attention to personal fitness.
- Having a sedentary job is no excuse for not maintaining fitness levels of the lower back and core abdominal muscles.
- Being overweight, even slightly, not only increases the chance of injury, but makes it harder to find out what has gone wrong and to recover.
- Never, ever, lift a heavy object and twist from the waist at the same time.
- Seek diagnostic scans earlier where possible, as the underlying causes of back pain and sciatica may not be obvious to a GP or therapist.
- Friends who have had back pain, and surgery, may not have had the benefit of the most effective and modern surgical techniques and may therefore give an overly gloomy view of life after surgery.
- Always consider surgery carefully, but be sure that you have up-to-date facts from a reliable consultant.
- Treat recovery, and post surgery follow-ups, as seriously as the surgery itself.