Sunday 25 August 2019

Dear Dr Nina: Would a microdiscectomy help with my chronic back pain?

If you sit all day at a computer, try a standing desk to help alleviate back pain
If you sit all day at a computer, try a standing desk to help alleviate back pain

Nina Byrnes

Q I'm a 47-year-old woman and I have continuous back pain. I've had an MRI done recently and it came back with disc protrusion resulting in L5 nerve root compression. I've had physiotherapy and a right-sided L5 selective nerve root block last year, which was very successful. My problem is I'm always in low-level pain and it's stopping me from doing the things I love. I feel quite restricted. The spine surgeon has recommended microdiscectomy, yet my physio has warned against it. I believe the operation is very successful, but I'm conflicted. Do you have any advice?

Dr Nina replies:  Back pain is one of the most common causes of chronic pain in Ireland. It causes discomfort and disability to those affected, but it is also has a significant impact on society, employers and the healthcare system as a whole. Twenty-seven percent of those who claim income support do so for back pain.

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The majority of people with back pain do go to their GP and 70pc of them will have tried painkillers before they get there.

Simple back strain is usually treated with a combination of painkillers and physiotherapy sessions, and X-rays or scans are not usually necessary. Chronic pain is pain that has persisted for more than 12 weeks. Back pain occurs most commonly in those aged 30 to 50 and occurs equally in men and women.

Leading a sedentary lifestyle, being obese, poor posture or heavy lifting makes back pain more likely. If pain or disability is prolonged, further tests may be necessary. X-rays will looks at the bones of the back, but the better test is an MRI scan, which can also look at the discs nerves and tissue surrounding the spine.

If there is a nerve element to the pain, there are a number of prescription drugs that may help, and so, if simple painkillers aren't working or physiotherapy hasn't helped, do talk to your doctor about other options.

Lifestyle can help with back pain. Prolonged bed rest is no longer recommended. Simple exercises like walking or swimming can be beneficial, and exercise that focuses on strengthening the muscles of the abdomen and lower back will help support the spine.

Specialist appointments are only usually required if there are worrying features, or other measures haven't worked.

Spinal surgery may be advised if more conservative treatment hasn't helped or if there is significant disc, bony or nerve change. If you have exhausted other treatment options, the decision whether or not to proceed is a very personal one. If you have doubts or concerns, it is essential to discuss these with the surgeon who will be taking care of you.

Microdiscectomy (minimally invasive procedure to remove material) is usually a well-tolerated, successful procedure. Back care remains essential, even after surgery.

Keep up the healthy, active lifestyle and the chance of further back problems down the line will be reduced.

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