Sciatica, Back Pain & Failed Back Surgery


Clinical Key Points

A case of disabling sciatica where the patient was referred for palliative Chronic Pain Management only because the MRI scan failed to show a conventionally accepted cause for his pain.

History & Prior Treatment

Terence, a Diabetic, had suffered with right sided sciatica without back pain since 1978. He underwent a Conventional Disc exploration (Fenestrectomy) in 1979 with a good result. However, in 1995 he pulled his back and had annual exacerbations of pain thereafter, but the pain recurred significantly in May 2007 with radiation into the right leg and right knee in August 2007 and into both legs by December 2007 with the result that he was virtually wheel chair bound. He had not been able to work since October 2007.

Distribution of symptoms

90% of his problem was sciatic leg pain with additional stabbing pain at the lumbosacral junction, aching in both knees. This resulted in a walking distance of 50 metres at a slow pace. Inclined walking is 50 metres at a slow pace. Re-start time is 30 minutes. Post activity penalty is 30 minutes


Weight bearing X-rays revealed L5/S1 Retrolisthesis and jack-knifing at L5/S1 in the presence of short L5 pedicles.
MRI scan revealed a radial tear in the midline and on the right side at L5/S1

Endoscopic Minimally Invasive Spinal Surgery: - September 2008

A right Endoscopic Lumbar Decompression & Foraminoplasty at L5/S1 revealed a large swollen red nerve, compressed by the overgrown (hypertrophic) facet joint and densely attached to the Superior Foraminal Ligament, posterior foraminal ligament, the disc and inferior pedicle. The disc was very injected at the “shoulder” and attached to the nerve particularly at this point. The Safe Working Zone was filled with densely hyperaemic young scar tissue (granulations).

  • The facet joint and Superior Foraminal Ligament were cut away until a positive fat sign was reproduced. The Safe Working Zone was cleared of granulations and the nerve was liberated throughout its course.
  • Endoscopic Intradiscal Discectomy was carried out with 0.5 gms of blue stained disc removed and a 500 Joule 20W laser shrinkage of the posterior wall was performed.


He has made a full recovery and moved house and is playing golf, biking and enjoying sea water sports – pain free.