November 2016 147 www.bahrainthismonth.com Dr Samy Gouda, consultant in neurosurgery and spine surgery, sheds light on lower back pain, lumbar disc prolapse and sciatica. marketplace Living Pain Free MIDDLE EAST HOSPITAL Dr Samy Gouda Lower back pain is one of the most common complaints people have, coming in second after headaches as a reason for frequent absenteeism from work. There is a widespread belief that lower back pain is more often due to the prolapse of a disc in the spine, which is not true. Lower back pain can actually be attributed to various other factors. In 80 per cent of cases there is no obvious definitive reason. Nevertheless, sometimes the apparent reason is a spasm of the muscles or ligaments of the back, or mild changes in the fact joints (which are small joints between the vertebrae). Most of these are simple reasons which can be easily addressed, especially in non-chronic cases. However because of the significant repercussions of there being a lumbar disc prolapse, patients do need to consider it. The disc is like a cushion or a pillow between vertebrae, and it comprises two main portions; an outer tough capsule and the inner relatively soft nucleus. The purpose of the disc is to absorb shocks and withstand the axial load with less friction between adjacent vertebrae. At the same time, it also gives an extent of flexibility to the vertebral column during movement. The reasons behind a lumbar disc prolapse could be as simple as the wrong physical practises such as carrying or moving heavy weights, especially accompanied with bending or twisting movements. Occasionally, this problem is genetic. Excess weight is another contributing factor, as is sitting or driving for long periods. A disc prolapse usually leads to lower back pain; however, it may also be associated with pain in the leg, which is called sciatica. This issue can bring with it numbness or sensory changes. Very occasionally, and particularly in severe cases, it might be associated with weakness or problems in controlling urination. In such advanced or severe case, the patient should seek help from a specialised doctor as soon as possible, who will immediately carry out an MRI of the spine. Not every patient with disc prolapse needs surgery. Treatment of most cases is conservative; however, in advanced cases surgery may be necessary. Similarly, not every disc surgery is a major or complex one, or one that requires added fixation with screws, rods or cages. Surgery is commonly done under the microscope, targeting the prolapsed disc that is irritating or compressing the nerve root, which causes the patient’s leg pain, numbness and/or weakness. Very occasionally, fixation using metal screws and rods is needed, more so in cases of vertebral displacement (known as spondylolithesis). As with all bodily disorders, prevention is better than cure. We must all remember to avoid wrongly done physical activities (such as lifting heavy objects in the incorrect manner), keep our weight optimal and practice some kind of light sport which does not strain the spine or back. Call 17 362-233.
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