How to manage pain due to spinal cord injury?
Q: My father is 90yrs old. He is diabetic and a heart patient. He suffered an injury 11 years ago in the right leg and below the knee a plate has been inserted. He has developed a spinal cord problem since 4 moths and his MRI report is as follows: -Degenerated lumbar disks with far left lateral annular bulges at L1-L2 and L3- L4, partially obliterating perineural fat, -posterior herniation with annular tear at L4-L5, indenting the thecal sac and abutting left L5 nerve root, -L5-S1 disk shows diffuse posterior herniation at L5-S1, indenting the thecal sac and abutting left S1 nerve root. -Gr. II degenerative changes at L4-L5 opposing endplates and L2 body associated with mild facet joint arthropathy at L3-L4 on right side and Schmorl’s nodes at L1 to L5 superior endplates as well as mild spondylostenosis at L5 He is in constant pain and was bed ridden earlier but is now able to walk with a walker. He is given these medicines: Nimuflex MR, Valus 20, Pentocid 20, Ramistar 2.5, Shelcal 500, Simedaonil, Contramal DT, Ecoprin 75. Pain killers have no effect and he was given epidural injection 4 months back which has given some relief. Please provide your advice for further treatment.
A:Your father appears to have pain from compressed nerve roots in his lower back, the compression being caused by degenerated intervertebral discs. Ordinarily, your doctor would have recommended an operation to relieve this pain, especially if the pain is associated with loss of muscle power or sensations in the lower limbs. The hesitation in the doctors mind to recommend surgery may be due to your fathers advanced age. If your fathers health is generally good and if he is in a condition to withstand surgery under general anaesthesia, please request your doctor to re-examine him. If severe pain persists and there is evidence of paralysis of power or sensations, surgery may be considered. Non-operative methods have already been tried and appear to have helped only in part.