As physicians, we are all invisible until we aren’t. I recently realized my weakness. In a simple moving of a box, I discovered what 1000s of patients have been describing to me for years. “Horrific back pain to the point of being unable to stand.” I walked hunched over for a day and dealt with all of my colleagues and patients offering up solutions. I, then, started to realize that I was my own patient. I start NSAIDs and inched through the first night. The second day was worse and now the pain had started to radiate down the lateral aspect of my thigh. (An L5 radiculopathy) I, immediately, checked my plantar flexion and dorsiflexion strength. I was neurologically intact with back and leg pain.
At that time, I was in denial. I underwent an MRI while hoping and praying for it to be negative. Unfortunately, I had a large L5 disc extrusion, ligamentous sprain, and collapse of my disc space. I was shocked and scared. Just like my patients, I wanted to feel better but I was scared of the idea of having surgery. However, just like I would for my patients' surgery was far from the next step.
I started with a muscle relaxant, physical therapy, and lifestyle modifications. Dietary changes to lose weight, added pilates and yoga to strengthen my core and took anti-inflammatory medications when needed. I am now two weeks into this episode and doing well. I have lost some weight, continue to work long hours, but have limited improper lifting techniques. I am now able to sleep through the night. If my pain persists or returns then my next step would be an epidural steroid injection and/or facet blocks.
Finally, if this conservative management fails, I would undergo a simple microdiscectomy. Luckily, I have direct access to the best neurosurgeons in the country in my own office and hopefully, I won't have to utilize any of them. This is the same regimen I prescribe for any patient undergoing what I am. The incidence of disc herniations is estimated to be up to 50% in at-risk populations. The natural history of this disorder has been well characterized. Ninety percent of patients will have a resolution of their symptoms without significant medical intervention.