How crushing your bones could beat misery of back pain
Surgery for a slipped disc is the most common spinal operation in the UK, but sometimes the pain persists.
Business consultant Hannah Meeson, 41, who lives with her husband Martin and their three young daughters in County Durham, underwent a new procedure for this.
'My back pain began when I was 25,' said Hannah Meeson
My back pain ruled my life for years.
It began when I was 25 on the day my husband Martin and I were visiting relatives.
I was sitting cross-legged and pulled his two-year-old cousin on to my knee.
One quick movement and suddenly there was a really loud crack — something had snapped in my lower back.
It was excruciating and I couldn’t stand up without being helped.
After a couple of weeks, the back pain had disappeared, but I started to find it painful to bear any weight on my left leg.
Within a couple of months I was unable to walk, sit or stand for any length of time without extreme pain.
I saw a consultant, who found I had a prolapsed disc at the base of my spine.
One of the discs between the vertebrae had split.
The gel-like substance inside it had leaked and was pressing on my sciatic nerve, which runs down the back and legs.
I needed a discectomy to remove the part of the disc that’s bulging.
But I faced an 18-month wait, so Martin and I decided to raid some of our wedding fund and pay for the operation privately, which cost £3,000.
I had the surgery a couple of weeks later, rested completely for the prescribed six weeks, and was back at work within three months. All seemed well.
But after a couple more months, despite getting fit and swimming regularly, the sciatica started to creep back.
After six months I went back to my consultant, who said I was simply one of those the surgery didn’t work for, and that I’d just have to learn to live with it. I felt incredibly downhearted.
Over the next few years my back continued to give me problems, and I became increasingly dependent on medication.
'The operation took two hours - I woke in pain, but it was post-operative, not the mind-numbing pain I've had for so long,' said Hannah
At one point I was taking 36 tablets a day — painkillers, anti-inflammatories, nerve suppressants, muscle relaxants and antidepressants for nerve pain and depression as well as morphine patches.
I suffered side-effects, such as stomach problems.
When I was 30 I had our first daughter. This was against medical advice, but we so wanted a family.
Either as a result of childbirth, lifting babies or just getting older, my back became increasingly painful.
My world got smaller — I didn’t go back to work, couldn’t walk any distance and became reliant on crutches. Life was miserable for my family and me.
Finally, in 2006 — ten years after the pain began — I was referred to see Manoj Krishna, a spinal surgeon.
He said I had Post Discectomy Syndrome, where the part of the disc that was left after my original operation had disintegrated and become inflamed.
The remaining disc was unable to properly support the load placed on the spine, causing pain and pressure on the sciatic nerve.
He suggested completely removing the damaged disc along with two tiny joints alongside it, and replace them with a small cage of carbon fibre, filled with crushed bone from the removed joints.
The new cage would take on the role of the disc and the joints, supporting the vertebrae.
I was apprehensive about more spinal surgery, but it was my only chance and I was only going to get more disabled.
The operation took two hours — I woke in pain, but it was post-operative, not the mind-numbing pain I’ve had for so long.
By the next morning I could bear weight on my left leg for the first time in years.
Three days later, I was allowed home. It was only when I stopped taking painkillers after three months that I realised I’d been living in a mental fog. I could now think clearly again.
Within weeks I was walking my daughters to school, taking them to the park, swimming and going to the gym. I’m also now back working a few days a week.
I have no pain now except for the occasional twinge.
I now do everything I want — including wearing high heels, trampolining, ice-skating and snowmobiling.
Manoj Krishna, consultant spinal surgeon at Nuffield Health Tees Hospital and the University Hospital of North Tees, says:
Our vertebrae are separated by discs made of rubbery tissue.
The disc is a shock-absorbing cushion that allows motion and supports loads going through the spine, such as when we lift things.
Persistent pain in the spine can be due to degeneration and tears in the disc or a prolapsed disc, in which the inner gel-like part bulges out. The disc fragment can press on a nerve, causing pain.
Disc degeneration is often due to ageing, as discs dry out over the years and lose strength. But it can also be caused by injury, as in Hannah’s case.
Most patients respond to simple interventions such as spinal exercise, modifying their activity, simple painkillers or steroid injections into the spine. Surgery is only a last resort.
In the past, surgeons would remove the whole disc, but the results were poor, because the disc has to support all the load transmitted through it — sometimes up to ten times a person’s body weight — and so the more of the disc taken out, the less there is to support the load.
So instead people are now given a discectomy, where only the prolapsed part is removed.
Every year, several thousand are carried out, but about 15-20 per cent of patients develop pain after their operation, often because the disc keeps degenerating.
Many patients are told nothing can be done and are left on strong painkillers, which are addictive and can cause side-effects.
Chronic pain can also impact people’s relationships, work and social lives.
With this new technique, we remove the damaged disc but replace it with a small carbon cage to take on the role of the disc in keeping vertebrae apart and supporting loads on the spine.
Once the patient has been given a general anaesthetic, we make an incision in the middle of the lower back.
After cutting through the muscle and ligaments on either side of the spine, we remove the two facet joints around the affected vertebrae to get to the disc.
These joints, about the size of a thumbnail, help support the spine, but their role is taken on by the cage.
We crush these facet joints and use this substance, mixed with artificial bone chips, to fill the carbon cage. This means it will fuse easily with the existing vertebrae.
We then remove the disc, and insert the cage, which is 25 mm by 11 mm, about the size of a little toe.
We keep it in place with two titanium screws in the vertebrae above and below it.
Two to four per cent of patients experience complications such as infection, nerve injury or irritation and leakage of spinal fluid, but these can be treated.
Patients can usually drive after a week, walk a mile after a fortnight, start light gym exercises at six weeks, and play sport after three to six months.
We tell them to expect to be about 70 to 80 per cent better, but many like Hannah are 100 per cent better.
The operation is technically challenging, but there are now several surgeons performing it in Britain.
It has good outcomes and it’s wonderful people who expected a life of pain and disability have the chance to get their lives back.
The surgery is offered on the NHS and privately at a cost of £20,000.