Back pain: Lumbar Spondylosis



The patient
Mr Glory Chinda suffers from back pain and leg pains. He had sharp pains in the whole of the left leg as if it was connected to the electricity. This had been on-going for 6 months and interfering with his life. Sleeping, walking, sitting, standing and work were all affected by unrelenting pain in the leg. Even pain killers only lasted a few hours in ameliorating the pain.

The patient
Mr Mohammed Ibrahim suffers from severe back pains and pains shooting down both legs. He could not sit for long periods, stand for long or walk even very short distances without this relentless pain. Life was gradually becoming unbearable and the pain was taking over every waking hour. This had gradually got worse over the past year and was now interfering with sleep.

The patient
Mrs Florence Chukwu is a charming lady with presented with a broken back. She also suffers from severe back pain which causes difficulty walking. Standing and walking were virtually impossible and only lying down ameliorates the pain. On standing, she hears a cracking noise as the spine appears to realign into some position. The cracking noise however is the bearer of pains which radiates through her whole being causing her to shake and break out in sweat.

The diagnosis
MRI scan and x-rays of the back is necessary in these cases to see exactly what is going on with the bones and nerves at the back/waist. Often the bones and joints are weak due to arthritis and cause pressure on the nerves leading to pain that travel down the legs.

Back pain: Lumbar Spondylosis
Lumbar is the medical term for the lower back. Spondylosis is the term referring to arthritis of the joints between the bones. Therefore, lumbar spondylosis is arthritis of the back. The back supports the body and helps keep us upright. It is therefore affected by the weight of the body especially when standing, sitting and walking. Pain in the back can radiate to the hips, the legs and the private parts. With pressure on the nerves, it can lead to numbness in the legs and weakness causing difficulty in walking. It can be so bad as to cause problems with passing urine and stool. It can also affect sexual function.

The causes of common back pain are as follows:
•        Poor posture
•        Improper lifting techniques
•        Back injury such as muscle sprains
•        Bone and muscle disease
•        Stress, anxiety and depression
•        Degenerative conditions such as osteoporosis and arthritis

Treatment of Lumbar Spondylosis
Resting: 1-2 days of bed rest is advisable and most pains will settle. Sleeping on a firm mattress is also good.
Over the counter drugs such as paracetamol and ibuprofen taken every 4-6 hours can also help reduce the pains.
Weight reduction, in people who are over-weight.
Physical therapy by a trained physiotherapist.

Life style changes
Stop smoking.
Stop alcohol.
Lose weight.
Exercise.

Drug treatment
Paracetamol
Aspirin
Ibuprofen
Voltarol or Diclofenac
Tramadol
Steroids like Prednisolone are Not Recommended Treatment for back or neck pains.

Surgery
Operations can be designed especially for each patient depending on their particular symptoms, signs and MRI. The operation is done to address the particular problem, be it, back pain, leg pain or both. The operation can range from a simple injection into the spine or around the nerves to removing a bulging disc, to decompression of the nerves that are under pressure and stabilization of the spine with screws as scaffolding. Pedicle screw fixation is for pains caused to instability (unstable, wonky or broken spines).

Spine: Plans for Nigeria
Many cases of effective and efficient management of spine problems abound in Nigeria. Patients do not need to continue to troop out to other countries in search of quality of care. At least for spine, we can now boast of the capability to manage most cases of spine problems to very high standards in Nigeria. There are surgeons in Sokoto, Enugu, Abuja, Lagos and Ibadan making huge strides in providing quality care. The surgeons are in public and private hospitals in Nigeria so making the service available in many areas. As usual, lack of information on what is available locally impairs access to good care.

Spine: Fixed in Abuja
There are several good quality diagnostic centres in Abuja. Medicaid, Kings Care Hospital, and Lifebridge Diagnostic Centre are all well equipped with CT and MRI for diagnosis of spinal conditions.
The operations on the spine can also be conveniently carried out at many hospitals including the Garki Hospital, Cedarcrest Hospital, National Hospital, Wellington Neurosurgery and Primus International Hospital. This is because there are trained surgeons in Abuja offering specialised spine care with a full surgical team backup and the necessary equipment. Neck and back pains can be conveniently managed in Abuja and Abuja is set to be the destination for Nigerians with spine trauma and degenerative diseases.
The patients mentioned above were all operated in Nigeria and returned home in better condition and minimal pain.

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