How is it diagnosed?

A clinical examination by your specialist or therapist will allow for a reasonable suspicion, but the only definite way is by doing a magnetic resonance imaging (MRI) scan (see the section Tests and Scans). Sometimes, because of technical factors, a CT scan is performed (see the section Tests and Scans). This is usually when an MRI scan cannot be performed due to the unavailability of an MRI scanner, when there are contra-indications to doing a scan or when technical factors such as the presence of certain metal fusion apparatus in the spine make an MRI scan unreliable. See the section Tests and Scans for the terminology that you will find on your MRI scan report and what it means in plain English.

Other tests that might be used are discograms and nerve blocks. Sometimes EMGs are also used (see the section Tests and Scans).

How is it treated?

There are always four options:

No treatment – This is acceptable if there is no serious nerve compression – therefore in the absence of spinal claudication or radicular symptoms. There are always people who choose this option for a variety of personal reasons. This is also the option that is chosen in people who have serious medical conditions that does not allow them to have a general anaesthetic. It is rare for this condition to become better without surgery and it usually follows a progressive course whereby the range and severity of symptoms increase.

Treatment that does not require intervention – Courses of painkillers and anti-inflammatory drugs can be combined with treatment from therapists to control symptoms. This is appropriate in patients with limited spinal claudication and radicular symptoms as well as in those patients who are medically unfit to undergo more invasive treatment.

Limited intervention – This include procedures such as caudal or sacral block, radiofrequency rhizotomy and Nucleoplasty. These treatments may be highly effective, have very few side-effects or complications and are performed as day procedures.

Intervention (surgery) – The indications for surgery are:

1. Failed conservative management. This is when painkillers, anti-inflammatory medication and manual therapy such as physiotherapy and chiropractic treatment have been utilised for at least six weeks without improvement.

2. Pain that does not respond to any other treatment modality and is sufficiently severe to the extent that it limits your daily activities and quality of life. This includes local lower back pain, referred pain and radicular pain.

3. Muscle weakness due to nerve compression (radicular weakness).

4. Cauda Equina syndrome and Conus Medullaris syndrome (see the section Lumbar Slipped Disc).

Does this treatment have any complications?

The most common complications of surgery are that of infection and wound haematoma (bleeding under the skin). The most feared complication is that of nerve damage, but this is extremely rare, although not unknown. The outer layer of the nerves (the dura) can also be torn and this will lead to a leakage of spinal fluid (cerebrospinal fluid). This needs to be repaired. Speak to your specialist about a more comprehensive list of possible complications (see the section Your Back Operation).

What are the long-term expectations?

This is a progressive disease that can be treated without surgery up to a point, but mostly ends up in surgery. Surgery is successful in halting deterioration and is effective in reducing pain in most patients. Walking difficulties in the aged population, may not completely recover, due to the long-standing nerve compression which may in some cases have caused nerve damage prior to surgery.