David Jobson wrote:
> 
> Advice for an old codger please;
> 
> Male friend 62 with long term history of back pain / sciatica,
> includng hospitalization for traction in the old days.
> 
> Bad sciatica in June with some back pain. 2 months off work.
> Foot drop for about 2-3 months.
> No longer in severe pain.
> Walking with a slapping gait.
> 
> Just had scan but no result yet.
> 
> Questions
> 
> 1.  Is surgery, even at this stage likely to be helpful
>     in terms of improving foot-drop?
> 
> 2.  Should this not, under Blair's bountiful NHS, have
>     been sorted urgently?
> 
> 3.  If surgery still a "good idea", how many waves should
>     be made to get it done urgently (i.e. is it now urgent?)
> 
> Thanks
> 
> 
> David Jobson
> 
I had a sudden deterioration of pre-existing back pain in 1991, ended up 
on traction and a leisurely approach was adopted in management, ie 
nothing done, despite going in in acute retention. Took about three 
months to get back to normal activity but the slappy gait took 18 months 
to resolve and I still trip up if I've walked all day.

My wife spotted the wasting in my Gastrocnemius the year after, I wasn't 
very introspective about my symptoms at the time, just glad not to be in 
much pain, and this means that since then I cannot run. (Not that I ran 
much before.)

The only benefit of surgery is if the nerve function is compromised by a 
physical lesion but MRI has so many false positives and the end results 
of surgery after 10 years or so are not a lot different to doing nothing 
that after this length of time I would have thought that improvement is 
not worth the knife.

Ideally it should have been sorted out promptly but the only 
circumstances where this seemed to happen in the past, in my experience, 
was where the patient was privately insured. The results of acute 
intervention always seemed to be good.

So much depends on the results of the MRI but at this stage I would be 
governed by the symptoms the patient has as well as the functional 
disability rather than relying just on the scan results.

The most important thing is to improve the function of what remains - 
for which Physio and active exercise are essential.

Allan Harris