Six years ago, an MRI scan confirmed that one of the discs in my lower back was worn out. As a result, I stopped doing all sports. I was offered surgery, but the prospect of a significant improvement sounded too low to make it worth the risk. At the age of 54, I now want to become a lot more active, at least to play the odd game of social tennis. Have techniques improved in recent years so that surgery might give a realistic prospect of improvement?
Alan Aplin, Gloucester
I suspect that the original issue was that you suffered from low back pain. The older one gets, the more likely one is to have more degenerated discs in the spine, especially in the cervical (neck), and lumbar (lower back) segments. However, only a minority of degenerated discs produce clinical problems. If they do,you could consider an operation.
Disc replacement surgery, instead of just excision of the disc or excision and subsequent fusion of the spine, has now become a reality and is a promising technique.
Disc removal is extremely good for relieving sciatica pain; ie, pain along the leg. Sometimes the difference is felt immediately after the patient has come round from anaesthesia. If the pain is localised to the spine, though, the procedure is less successful, and a proportion of patients never experience full recovery.
After disc surgery, one should really abstain from high-impact activities for ever. There is the danger in patients who have had the operation that the spine will develop degenerative joint disease and osteoarthritis: this would render the operation ineffective. For these reasons, and following excellent recent scientific research, the present approach is to undertake intensive appropriate physiotherapy instead and stay as far as possible from our surgical scalpels. Tennis, squash, badminton and other ball games are great fun, but the twisting loads imposed on the spine, coupled with the forced extreme bending in all direction and the loads imposed by hopping and jumping may induce more problems in the lower back.
Low impact, gentler-on-the-spine outdoor activities can be rewarding alternatives. Cycling, in-line skating, power walking and urban cross-country skiing can be equally taxing on the cardiovascular system but gentler on the spine.
· Professor Maffulli is a consultant orthopaedic and sports injury surgeon at Keele University medical school. If you have a question for him, email fitness@theguardian.com
