These are real stories from our patients describing their journey from having a problem to reaching a diagnosis and having successful treatment. Only the names are changed for privacy.
Perhaps you have a similar problem.
‘I just wanted to take this opportunity to thank you for your fantastic work in stabilising my slipped disc.…
“‘I just wanted to take this opportunity to thank you for your fantastic work in stabilising my slipped disc. It is now just over a year after my operation, and I have recovered fully – without the need for pain medication! – I cannot thank you enough.’”Edward
Edward presented with six months of back and sciatic leg pain.
Prior to this problem he was very fit and healthy and played lots of sports.
His life was on hold and he couldn’t even work. He had seen physiotherapists, osteopaths…but he wasn’t getting better. He was living on ‘horrible’ pain killers.
Making a clear diagnosis is crucial to having the right treatment.
I examined him carefully. It was clear that he was pinching a nerve.
We arranged same day imaging including a standing X-ray and an MRI scan.
I went through the imaging in detail with Edward so that he could also understand his problem. He had a slipped disc (disc herniation) pressing on a nerve root.
Edward and I carefully considered his options.
This included ongoing conservative treatment with physiotherapy, spinal injections, stronger pain killers etc.
However the problem had been going on for more than six months so he chose a microdiscectomy. This had the best chance of relieving his problem quickly and reliably. The operation took 45 minutes. His sciatica was immediately better. He went home after only a few hours. Six weeks after surgery he was back doing everything and he wrote to us about a year later.
‘The result of your back operation has been a great success and has certainly been put to the test…
“‘The result of your back operation has been a great success and has certainly been put to the test over the last weekend. I am playing a certain amount of golf and have not had the back comfort I now have for a number of years. I sincerely thank you for what you have done for me. You may have noticed that you have two more patients as a result of my success!’ ”John
John was retired but a very active man and a keen golfer.
For more than one year he had developed worsening back and leg pains when standing and walking. This has stopped him doing many things including playing golf.
Back exercises were not helping.
John looked well but fed up. There was little to find examining him and he could even bend and touch his toes.
He told me that sitting down always helped.
His story was very suggestive of spinal stenosis. This is common in an ageing spine with nerves becoming compressed.
We arranged same day imaging. A standing X-ray to assess the alignment of his spine when upright. An MRI looking for pinched nerves (Stenosis).
I went through all the findings with John so he could understand the problem, in his case spinal stenosis.
I discussed the different treatments for spinal stenosis which included appropriate exercises and spine injections. Pain killers don’t work well for this problem.
We always consider surgery the last resort, however sometimes a physical problem requires a physical solution. His stenosis was also severe. Having carefully weighed up the risks and benefits he opted for surgery.
John underwent a minimally invasive lumbar decompression. The operation went well and took less than one hour. He was up and walking within a few hours and home the same day. He returned to playing golf six weeks after surgery.
‘I wanted to take this opportunity to say how much I have enjoyed working with your team. It has…
“‘I wanted to take this opportunity to say how much I have enjoyed working with your team. It has been a real pleasure speaking with you and I know how many of the patients we have sent to you have enjoyed their experience. CA called into our osteopathic practice this week to give us an update and thank us for endorsing you! He is considerably improved from the lumbar pain and has now returned to work part time. We do appreciate the communication and feedback that we have received from you and enjoy the prospect of a future working relationship over the years.’”Chris
Chris had suffered with back pain for many years. He had seen everyone and tried everything. Back attacks occurred all the time now. He was a plumber and hadn’t worked for months. He was feeling increasingly fed up and depressed. This also impacted on his close relationships.
He had been told many different and conflicting things about his back. He had no clear understanding what was wrong or how best to help himself.
It was immediately obvious the situation needed taking in hand. Understanding the impact of Chris’s mechanical back pain in the context of his work and life was so important. What does he believe? What has he tried?
Imaging is important but only part of the jigsaw when considering the individual and how they may be helped and empowered in the years ahead.
For Chris this started with unpicking the misconceptions he had about his back problem and starting afresh.
This takes time, patience, and consideration. I used models and pictures to help Chris understand better. We discussed work, life, exercise, physio, pilates.
Of course we have a range of interventional options depending on the problem which we can offer including spinal injections, facet joint denervation and stabilisation.
Injections were ‘magic’ for Chris and the improvement demonstrated he could be better. This lifted his spirits and he felt empowered to help himself. Returning to work was a fantastic step in the right direction.
‘I could barely stand or walk due to the pain…it wasn’t a pulled muscle…my back was broken! Almost immediately…
“‘I could barely stand or walk due to the pain…it wasn’t a pulled muscle…my back was broken! Almost immediately after the procedure my back pain was gone. I definitely feel taller and can stand up straighter. How clever you are. I’m so so grateful to you all.’”Aida
Aida was an active independent 85 year old who did everything for herself. Seven weeks before we met she got up one morning and developed severe low back pain. She struggled to stand and walk. Her GP visited and diagnosed a muscle strain. The previous day Aida recalled a minor stumble but had not fallen.
The following weeks were very difficult and painkillers didn’t work and had nasty side effects. Her back pain persisted and Aida’s mobility quickly deteriorated because she wasn’t walking regularly.
This is a very typical history of what is known as an insufficiency fracture in the spine. This is a very common problem in the ageing spine with thinning of the bones (osteoporosis) and weakening. You don’t need to fall to break your back! This problem is commonly missed.
Immediate X-rays and MRI confirmed our suspicions.
These type of fractures will often heal but the tendency to stoop persists. Aida’s pain was not improving and she was stuck in a chair.
She opted for Balloon Kyphoplasty. This is a excellent procedure which involves injecting a special cement into the fractured vertebra.
Aida’s procedure took only 20 minutes under sedation. Her back pain was immediately better and she could walk and stand comfortably. She quickly returned to normal living and stopped all painkillers.
Play it again..!
‘I was wondering if you could do me a favour and let the team know that I am well…
“‘I was wondering if you could do me a favour and let the team know that I am well and have been since the very next day after my surgery. It has been a year since my operation and I just wanted to say a big Thank You!’”Sarah
Sarah was a happy and healthy mother of two young children. She was also a county netball player. The first thing she noticed was pain in the shoulder. This became worse, with pain spreading down the arm with pins and needles in her thumb and index finger. Driving became impossible because she couldn’t turn her neck. Pain killers made her sick and didn’t work anyway. Everything became a struggle.
Sarah’s problem was typical of a pinched nerve in the neck. The symptoms in the thumb suggested the C6 nerve root. The most common cause for this in a young adult is a slipped disc.
This was promptly confirmed by same day imaging which Sarah and I went through together.
Slipped discs can get better. Unfortunately not in Sarah’s case with pain persisting for several months despite good quality physiotherapy and pain killers.
A targeted steroid injection can work very well in some people but may not work or last in others.
Sarah was clear that she wanted ‘fixing’. Traditionally this is an operation through the front of the neck to remove the disc. The level is then fused. This often solves the problem but can lead to consequences later. I prefer a disc replacement to keep everything moving as before.
Sarah’s procedure took one hour. Her arm pain was immediately better. She went home the same day and returned to playing netball three months later.
I love my fusion
‘Just a note to thank you so so much for sorting my back out. You have indeed done a…
“‘Just a note to thank you so so much for sorting my back out. You have indeed done a wonderful job. I can honestly say that apart from obvious operation pain for the first 10 days I have had no pain whatsoever and this has to be attributed to your fine surgical skills.’”David
David was a colleague and friend. It came as a surprise when he told me about his back problems. He’d had low back pain on and off for years but now it was getting worse and even affecting his legs. He was obviously putting a brave face on, but it was clear he was ready for help.
David already knew that he had a vertebral slippage (spondylolisthesis). He had always looked after his back and done back strengthening exercises. But this was not helping anymore.
We arranged up to date imaging which included a standing X-ray and an MRI. The X-ray showed us how much his vertebra had slipped at the bottom level of his spine.
David had done his homework. He knew what he wanted – a fusion.
We discussed in detail what this involved and the different ways of fusing his spine. The importance of fusing his back in a good position. Not fusing him with a flat back. Fusion can be done well or badly. We discussed the risks and benefits but his mind was set.
He underwent a minimally invasive L5/S1 fusion with cages. This restored the position of his spine and the natural curvature.
It was great to see him recover so well afterwards.
Care and attention
‘Just a quick note to thank you for all the care and attention you have shown since I first…
“‘Just a quick note to thank you for all the care and attention you have shown since I first came to see you in June last year. I am eternally grateful for the advice you have given me, the procedures you have done and the support you have shown in the decisions I have made.’”Rachel
Rachel suffered with severe back pain and sometimes leg symptoms. She worked really hard on yoga and exercises and avoided pain killers. She never saw her GP because she wanted to self-manage her back problems.
It was a big step for her when she self-referred herself to our clinic.
Rachel was clearly getting a lot of back pain but also some nerve pain in the legs. It was clear that she was doing everything possible to help herself but this wasn’t enough. She was obviously a highly motivated individual which makes my job easier.
Within a few hours she had imaging and we sat down together to discuss.
Her problems were coming from one very degenerate level in the spine. The rest of her spine looked great.
There are many ways to manage this type of problem and we discussed Rachels options at length.
It is nearly always best to try simple and safe things first, taking small steps together. Excellent relief with targeted injections helped me confirm the problem level and demonstrated that Rachel could be better. However symptoms returned. The next step was rhizolysis which is a technique of denervating painful joints. This worked really well for her in conjunction with a programme of specific back exercises.
The devil’s in the detail
‘Thank you for all your detailed reports on my aged lumbar spine. I have now decided to go ahead…
“‘Thank you for all your detailed reports on my aged lumbar spine. I have now decided to go ahead privately, with an operation. I feel great confidence in your judgement’ ”Peter
Peter was 80 years old and a retired chemist. A man where detail mattered, who always traveled with a note book. A logical thinker but with a back problem which defied his logic. He craved a more better understanding than its ‘old age’ or ‘wear and tear’ which simply frustrated his curiosity.
The combination of back and leg symptoms hinted at a nerve root problem.
The ageing spine requires very careful consideration. Many changes are evident on imaging and working out what is important and what is not requires time and experience.
Peter had imaging taken both standing up and lying down. This demonstrated deformity in his spine when he was upright and walking. I was able to show this to Peter and demonstrate with models of the spine.
Peter had a degenerative scoliosis and was catching an exiting nerve root.
A targeted injection was very helpful and confirmed the diagnosis. This lasted nearly six months and Peter enjoyed a pain free summer.
When his symptoms eventually returned we considered a further injection and stepping up the back exercises.
In a younger patient with stronger bone we sometimes offer big operations with rods and screws to correct the deformity. This however is not a sensible or wise option in an octogenarian. The half way house was a minimally invasive decompression and stabilisation with a spacer to support but not fuse the spine.
Peter did really well with surgery, and still carries his notebook!
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