Her challenge
A 50 year old lady with severe back and bilateral leg pains showed up in the clinic recently. She complained of severe back and legs pains of 6 months duration. She had gradually become unable to enjoy standing for longer than 10 minutes and unable to walk even a short distance without stopping.
Once she walks the length of an electricity pole, she feels increasing pains in her legs and they start to feel heavy. If she dared to continue to walk, she feels like the legs will fail to support her, leading to the risk of falling down. At that point of increasing fatigue in the legs, she has to stop and sit down for a while before being able to walk again.
Another problem was the back pains specifically. This she described as worse on sitting, standing and walking. The back makes some cracking noise as she attempts to stand up and she had to stay in a hooked position for a while before it rights itself. Once she has stood up, the pain settles a bit, then starts all over again increasing gradually till she has to sit. Walking is as described above.
We noted that she did not have a fall or an accident before all these problems started. Also, that she is only employed as a civil servant and not involved in any heavy-duty work. Her job involves mostly signing and moving files from one desk to another.
The real deal
So, let us work this out for you. She has back pains and she is hearing clicking noises on moving the back. The pains are pretty bad and are present whether she sits, stands or walks. This signifies some problem with her spine and also seems to imply that the joints in her back are unstable.
The pains in her legs and the fact that she cannot walk long distances without stopping means she has pressure on her nerves in the back. This we call spinal claudication.
So, there are two issues. One with the bones in her back and the other to do with the nerves in her back. In some people, this problem can also lead to paralysis, difficulty passing urine and difficulty passing stool.
MRI scan
The key tests we would ask for after the history taking and full clinical examination are x-rays of her lumbar spine and an MRI scan of her lumbar spine. Indeed, the MRI showed severe degenerative disease in the spine requiring surgical intervention. The spine was unstable with swollen joints and one bone was not sitting well on the other. the shock absorbers in the spine (discs) were totally worn out and black. This is what causes the noise and the back pains.
The MRI scan also showed significant pressure on her nerves which looked as if they were being strangulated.
Our challenge
Our challenge is to design the appropriate surgery that will help remove the back pains, stabilize the spines and decompress the nerves that were being choked to death.
The operation designed for her will be able to resolve the two problems of back and leg pains. It will enable her to be able to stand and walk as far as she wants to without being forced to stop.
The type of operation required is now possible and available in many centres in Nigeria, notably, in Abuja, Lagos and Kano. No one needs to travel outside the shores of Nigeria for spine surgery as the capacity now exists to deliver bespoke surgery as befitting for each person. And with good outcomes in the majority.
We will help her get rid of the back and leg pains: right here in Nigeria!