Degenerated Spinal Discs and Nerve Compression- Really the Cause of the Pain?

08/10/2017

“Ann”, a fit and active senior woman recently came to see me for a consultation. She suffered from severe hip and thigh pain, shooting down to the knee and below, and atrophy and weakness of the leg. Lumbar MRI ordered by her primary doctor was dramatic, with a report full of fearsome terminology such as “severe”, “multilevel”, and “stenosis”. Her doctor had urgently requested a neurosurgical evaluation, but she wanted to explore all options and alternatives to spinal surgery, and therefore sought my opinion and recommendations. She had spent a lot of time and energy researching and reading books on back pain, non-surgical treatments, and holistic approaches to spinal conditions.

In a previous blog years back I wrote of the importance and necessity of a musculoskeletal health practitioner determining the pain generator and making an accurate diagnosis in order to formulate the most effective and efficient treatment plan. To do this, a comprehensive and thorough orthopedic history and physical examination must be carried out. Apparently this woman’s physician had abbreviated or skipped this step altogether and gone straight to imaging studies to make a diagnosis of severe spinal degeneration as the cause of her problem.

However, in the course of my examination, I found a severely abnormal painful and restricted hip joint. Simple Xrays confirmed the extreme bone on bone arthritis (probably responsible for most if not all of her symptoms), and I suggested to her a clear alternative to spinal surgery- a total hip replacement instead! Not exactly the holistic and alternative modalities she had hoped for, but utterly necessary and appropriate.

To be sure, the spinal MRI findings were significant and her symptoms more or less correlated. But: Correlation is not Causation! This case so clearly shows the importance of seeking a practitioner who will take the time to listen to the symptom history, do a thorough examination to assess objective signs, and use imaging (MRI, Xrays etc) and other diagnostics only when necessary to confirm, not make the diagnosis. Then, both you and your practitioner need to keep open minds to possibilities other than the most “obvious”.

Finally, be proactive, research your options, and get other opinions before passively submitting to a doctor’s recommendations. It is horrifying to think of the outcome if Ann had had an invasive back operation without addressing her hip first!