Degenerative spine at the lumbar and cervical levels
2008
I should be grateful for any advice that would help me tackle, at 92 years of age, a back problem which I have had, seemingly, for most of 75 years.
Question
I was born on 18 July 1916 and I should be grateful for any advice that would help me tackle, at 92 years of age, a back problem which I have had, seemingly, for most of 75 years. I have been married for 62 years to a lady who is 83 years old and herself in constant pain. I want very much to help her move about the house and to help her generally. I give below a brief historical summary of my problem, starting from now and working backwards.
I have a degenerative spine at the lumbar and cervical levels. From time to time, since 2004, I have had several facet joint injections and one epidural at the lumbar level and, in 2005, a facet joint injection at the cervical level. Any pain relief was never more than marginal. In January 2008 I had facet joint denervations at the lumbar level which increased my pains rather than reducing them. I no longer swim and reluctantly gave up golf four years ago. Weather permitting, I now try and walk for half an hour each day and to do simple trunk and back exercises and to play indoor bowls once a week.
I must have been aware, in my twenties, that my back was dodgy, for once or twice I visited Mathias Alexander who lived near me in London. The visits must have served me well for I survived the Army (1940- 46) mostly in the Middle East. It was after the war, when I worked and lived in foreign countries, that my dodgy back began to play up. It started, I think, in Havana, Cuba in 1954 after I had played tennis. The pain was diagnosed as sacroiliac strain for which I was prescribed a short corset. From then on the back pains returned sporadically. The diagnosis and treatments have varied over time but the pain was always centred in my lower back. Sciatica was the pain that lasted longest (1984-2000) and my denervation operation my greatest disappointment.
Over the years I have read books, tried a number of gadgets and seen several NHS experts but all of little avail.
Mr B – Kent
Answer
A This gentleman, now 92 years old, has had back trouble since before most of us were born; however, he has clearly led an active life in many countries around the world and now does his best for his 83 year old wife. As is usual at this age he has widespread wear and tear changes in his neck and back, often unflatteringly referred to as degeneration. The degree of degeneration surprisingly bears little relation to the amount of pain. You can have severe changes with little pain and vice versa. What to do?
- Keep active in moderation as he is doing, Pain is irritating but in this situation does not signify progressive damage. Lack of activity will cause increasing stiffness, pain and muscle weakness. Do a little often.
- Do not be afraid to take simple painkillers eg paracetamol under your GP's supervision. If you can tolerate stronger pills such as ibuprofen well and good, but again your GP should be consulted as elderly stomachs tend to be more sensitive. These pills are not addictive.
- Epidurals and facet joint injections are often helpful but sometimes for reasons which are not clear. You may find TENS (transcutaneous nerve stimulation) from a physio helpful for use at home.
I’m afraid that's about it at this age. If any of our readers have found useful remedies do let us know. “Keep batting on” as Winston Churchill said (in fact he used more colourful language!), but that is the best advice.
Alan Gardner
Consultant Spinal Orthopaedic Surgeon (Rtd)