Surgery for sciatica

In January, with pain in my hip and thigh haunting me all day and waking me up in the middle of the night, I struggled to stay positive. My blood pressure was up from the constant discomfort. I had planned to embrace the winter stomping along Boston’s Emerald Necklace in snow shoes, but instead, I spent hours soaking in a hot tub with a novel to relieve the sciatica.

My doctor sent me to a neurosurgeon, who showed me scary images of my vertebrae with a blob bulging between them where it clearly didn’t belong. This was the infamous herniated disc. And there was something else I had long suspected. Anatomy books show the vertebrae stacked up neatly like poker chips, but my lower ones were skewed in a spiral shape.

It explained why I tend to lean to one side, and why my blouses always look a bit crooked. I’m a bit crooked.

I’m also a poor candidate for the surgery usually done for sciatica, in which part of the bone is removed to give the nerve root extra space and relieve the pressure. The surgeon thought this was a bad idea for me because the joints in my spine don’t meet up quite right, and hollowing out a bit of bone (called a laminectomy) would make them too unstable. He would have to fuse a couple of vertebrae together, a more extensive operation with greater risks.

Although my surgeon did not suggest them, there are a couple of other surgical procedures for sciatica caused by herniated discs:
Discectomy, removing the damaged disc and fusing the vertebrae. The pesky discs may slip and cause trouble, but they are the spine’s shock absorbers, and if one is removed, the adjacent bones have to be joined.
Disc replacement. This is a new procedure, replacing the bad disc with an artificial one.

Like my regular doctor, the surgeon was concerned about the lack of reflex when he tapped my knee with the hammer. That, he said, combined with the MRI image, would prompt a less conservative surgeon to schedule the procedure immediately.

But he wanted to try physical therapy first. In spite of the pain, I was still walking to work and had not lost bowel or bladder function, and weakness in my right leg was negligible.

I started physical therapy two days later, and it worked. Last weekend, 12 weeks after I fell in December, I hiked seven miles.

The knee-jerk test

It’s the stuff of slapstick comedy: the doctor hits the knee with a hammer, and the lower leg bounces up. When my doctor struck my left knee, the leg jerked robustly, but a rap on the right knee brought no response. She glared at the hammer accusingly, but she knew the tool wasn’t the problem.

It was my nerves.

The so-called “knee-jerk reflex” happens when the patellar tendon, which runs over the kneecap from quadriceps to the lower leg, is struck just below the knee. The impact sends a signal from the muscle to the spinal cord and back, setting off an electrical pulse that contracts the thigh muscle, yanking the tendon and pulling the lower leg upward.

If that doesn’t happen, it’s a sign that the circuit is broken. In my case, it turned out that a herniated disc between two lower vertebrae was squeezing down on the sciatic nerve root and disrupting the signal. This hefty nerve runs across the buttocks and down the leg, and pain, tingling, and weakness caused by its irritation is called sciatica.

Ignoring sciatica symptoms

On a festively snowy afternoon a few days before Christmas, I was walking down a Boston street when I slipped and landed hard on my right knee, sprang back up, and walked another mile home. After half an hour on the sofa, I tried to stand and nearly puked from the stab of pain in my right hip.

At the hospital emergency room, X-rays showed that my hip was not broken. The doctor diagnosed a severe sprain and prescribed large doses of ibuprofen and rest. He expected that I would be better in a week or so and told me to call if I developed swelling or fever, or if the pain increased or traveled down my leg.

I hobbled through the holidays and seemed to be getting better, but after a few days, my thigh started aching. A little voice reminded me about calling if I had leg pain, but it was Christmastime, and I was lazy. I decided that I must have pulled something when I fell, and after all, at 54, I couldn’t expect to bounce back like a teenager.

But days turned to weeks, and I was still limping. I finally called my doctor.

I sat in her office exactly a month after my spill. Even before she examined me wearing her tsk tsk face, she suspected sciatica, and an MRI showing a bulging disc in my lower spine confirmed it.

Ignoring the pain in my leg was not one of my brighter moves. It delayed diagnosis and treatment and could have had serious consequences like permanent muscle weakness and incontinence.

The birth of the Sciatica Diary

I joined the sciatica club in December 2008 with a fall on a snowy street. The impact forced the squishy disc between my L4 and L5 vertebrae to ooze out, pinching the root of my sciatic nerve, which runs across the buttocks and down the leg. The nerve is not taking it well. Sometimes screaming, sometimes whimpering, it is rarely silent. The spine injury is known as a herniated disc, and the pain is called sciatica.

Sciatica is a real pain in the ass. Seriously. For me, it’s concentrated on a small muscle in the right buttock, the piriformis, and radiates down the hip and outer thigh, occasionally reaching the calf and foot. Others may experience weakness, numbness, and loss of bowel and bladder control.

If you are a member of the club, I’m sorry, but I hope the information in this blog will help you. I invite your comments.