The sciatica I described recently didn’t settle down. Instead it got worse and the pain intensified. I initially visited the physio and although the first session seemed to help the second two didn’t and the pain continued to a crescendo where walking was almost impossible and I required urgent medical intervention and IM analgesics. Eventually after two weeks of pain and virtual bed rest I had an MRI which showed a substantial prolapsed disc at L5-S1. Apparently this is where the vast majority of disc herniations occur toward the bottom of the spine at L4- L5 or L5– S1 levels. It’s confusing because terms are used interchangeably to describe the same thing including herniated disc, prolapsed disc, ruptured disc and slipped disc. Other phenomena are closely related and include disc protrusion, pinched nerves, disc disease and disc degeneration. I found out that a slipped disc usually occurs between the ages of 30 and 50 and involves the outer case of the disc rupturing  resulting in the gel inside bulging and protruding out of the disc – so not really a disc that has slipped rather a leakage of contents. The damaged disc often puts pressure on the whole spinal cord or on a single nerve root. In my case the sciatic nerve was severely hit! But why did it happen. People made suggestions – I moved to fast and erratically; I drove too much; I sat down at my desk for too long. Looking online it would appear that  as you get older, your spinal discs start to lose their water content, making them less flexible and more likely to rupture – so watch your back or you could be next! So what will happen to me next? The evidence is not great! Lumbar discectomy is the most common surgical procedure in the United States, but the efficacy of the procedure relative to nonoperative care remains controversial  (1). Surgery may provide faster pain relief and perceived recovery in patients with herniated disc and is very appealing at the moment (2). I await my surgical appointment.

1. Surgery Vs Non-Operative Treatment for Lumbar Disk Herniation: The Spine Patient Outcomes Research Trial: A Randomized Trial” JAMA 296(20):2441-2450, 2006. http://jama.jamanetwork.com/articleReports.aspx?doi=10.1001/jama.296.20.2441&isRedirect=True&journalId=67

2. Peul WC, van Houwelingen HC, van den Hout WB, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med 2007;356: 2245–56.