Intervertebral discs can tear through and through causing slipped disc sciatica as in case 3 or they can partially tear and cause complex patterns of back pain and sciatica, often bilateral. The history is of episodes of back pain and spasm (“my back goes out”) becoming more frequent and severe and finally pain is continuous with further episodes of worsening, often with trivial provocation or even spontaneously.
On MRI, these cases are often misdiagnosed and the report will be unhelpful.
Our patient was a 43 year old lady with a 13 month history of back and leg pain of this type. MRI reported degenerative changes at L4/5 but not at L5/S1 (figure 1). These changes (simply reduced disc hydration or “black disc” may or may not be painful (the appearnces at L4/5 are about 50/50, L5/S1 much less so). The MRI does not help to analyse the pain, but did show she was suitable for minimally invasive decompression – if I could prove the source of her pain.
As I have said elsewhere, you cannot take pictures of pain. To prove if a disc is abnormal is the source of pain you need to undertake pain provocation discography (this is described elsewhere). At disc provocation, both L4/5 and L5/S1 were found to reproduce her symptoms, a result you could not have known from the scan.
Both L4/5 and L5/S1 were treated by decompression ad heat denervation of the posterior annulus by the disc Fx system. This is a day case procedure, it is pretty sore after but recovery is much quicker than the alternative which would be 2-level disc fusion or replacement!
Her pain was resolved post procedure, she recovered excellently within 24 hrs. Her main complaint was she didn’t use the post-op analgesia I prescribed and she paid for! At 1-month review she reported herself almost 100% pain free.
This is an excellent result in a case which would be very difficult to anlayse or treat without the use of an innovative treatment technique such as Disc fx. The builds on my prior experience with Coblation decompression of bulging discs which has shown over 70% very good and excellent outcomes.