Many patients present with low back pain combined with leg pain; often the pain is confined either to the leg alone or to the lower back alone. These symptoms disrupt patients’ lives considerably \u2014 they are frequently unable to work, or to manage their daily activities.<\/p>\n
The first step with any symptom is to investigate the underlying cause. In many cases MRI reveals a neurosurgical problem: a herniated disc, vertebral slippage (spondylolisthesis<\/strong>), or spinal stenosis<\/strong>. In simple terms, the space through which the nerves travel has been reduced.<\/p>\n Although these causes are termed neurosurgical, their management is not always surgical.<\/p>\n Several therapeutic options exist: different classes of medication, image-guided injections at the site of the problem, and a range of non-surgical measures. Among the simplest are strengthening the abdominal and back muscles through walking in water, swimming, and forms of exercise that emphasize the core (such as Pilates) \u2014 as well as simple observation, since in a substantial proportion of cases, close to 60\u201370%<\/strong>, these symptoms resolve on their own over time.<\/p>\n Should these measures fail, and provided the patient has tried an adequate range of options for at least six months without satisfactory results, surgery becomes an option. Using specialized instruments, we create space for the nerves by removing the bone, ligament, or disc material causing the compression. Relief is typically immediate, with excellent short-term success rates exceeding 90%.<\/p>\n The choice is rarely straightforward: it must be made individually, according to each patient’s needs. In certain cases surgery yields long-term results similar to those of non-surgical options, and it carries a small risk of complications. Older patients with comorbidities carry a higher complication risk, which must be weighed when deciding on management.<\/p>\n Best practice is for the patient to be informed of the advantages and disadvantages of every option \u2014 surgical or otherwise \u2014 and to reach the decision jointly with the doctor. Their needs and expectations should be discussed and realistic, individualized goals set. Each option is then weighed according to how closely it serves those goals, and its benefit compared against the risk it carries. The final choice always belongs to the patient, who decides, once informed, which option best serves their needs.<\/p>\n Consider an elderly patient with severe spinal stenosis and vertebral slippage alongside multiple comorbidities such as diabetes and coronary artery disease. They would be informed of the substantially elevated surgical risk. Their goals, if they are already largely housebound because of their other health problems, are more modest \u2014 which reduces the value of a potential operation. They would also be informed of the safety profile of image-guided spinal injections and of the relief these can offer: comparable, though more gradual in onset. For this patient, the recommendation would be injections rather than surgery.<\/p>\n Consider instead a young, athletically active patient with no comorbidities and a disc herniation causing severe symptoms. Their goal is a prompt return to an active life. For this patient, the recommendation would be surgical management.<\/p>\n In this way we offer individualized solutions, tailored to each patient’s needs and to the life they actually lead. This is the philosophy that neurosurgery \u2014 and medicine more broadly \u2014 should adopt, in order to increase both its contribution and its benefit to society.<\/p>\n","protected":false},"excerpt":{"rendered":" Many patients present with low back pain combined with leg pain; often the pain is confined either to the leg alone or to the lower back alone. These symptoms disrupt patients’ lives considerably \u2014 they are frequently unable to work, or to manage their daily activities. The first step with any symptom is to investigate […]<\/p>\n","protected":false},"author":1,"featured_media":3306,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[20,19],"tags":[],"class_list":["post-3305","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles","category-information"],"_links":{"self":[{"href":"https:\/\/blionas-neurosurgery.com\/en\/wp-json\/wp\/v2\/posts\/3305","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blionas-neurosurgery.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blionas-neurosurgery.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blionas-neurosurgery.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blionas-neurosurgery.com\/en\/wp-json\/wp\/v2\/comments?post=3305"}],"version-history":[{"count":4,"href":"https:\/\/blionas-neurosurgery.com\/en\/wp-json\/wp\/v2\/posts\/3305\/revisions"}],"predecessor-version":[{"id":4857,"href":"https:\/\/blionas-neurosurgery.com\/en\/wp-json\/wp\/v2\/posts\/3305\/revisions\/4857"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blionas-neurosurgery.com\/en\/wp-json\/wp\/v2\/media\/3306"}],"wp:attachment":[{"href":"https:\/\/blionas-neurosurgery.com\/en\/wp-json\/wp\/v2\/media?parent=3305"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blionas-neurosurgery.com\/en\/wp-json\/wp\/v2\/categories?post=3305"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blionas-neurosurgery.com\/en\/wp-json\/wp\/v2\/tags?post=3305"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}