Back injury Talk - main page
Do you ache in your back?
If so, it may cause loss of feet. So this is the time to treat it before it is too late, cautions Dr. K K Pandey
Backache and pain in legs have become a common problem these days. Not only old people, but also middle - aged, even younger ones do suffer from this problem of backache and lower limb pain. Never would you have thought in your dreams that this simple backache might lead to loss of your leg and feet, if not managed properly. Generally people think that backache occurs due to some problem with backbone or compression of some backbone nerve or sciatica or stretched out nerve from backbone, but this has never occurred to your mind that this backache might have been due to blockage of blood pipe (artery) situated inside your abdomen and that supplying pure blood to your legs and feet. If a vascular or a cardiovascular surgeon does not treat this condition promptly, the patient may reach a stage where no other choice is left, except for amputation of legs.
What a patient of backache generally does?
People often do not take backache seriously and keep on consulting different kinds of quakes, and in the process they are advised various types of medication and medicinal baths. As expected when there is no relief, and pain gets intensified and colours of skin of toes and feet becomes dark, they ultimately consult bone specialists who diagnose it as either sciatica or spondylitis and continues to treat that way, sometimes a traction with a weight is applied to feet to correct stretched-out nerve causing a so-called sciatic pain. Majority of the physician and family doctors diagnose this type of pain as arthritis or joint pain and casually refers these patients to a bone specialist. Some patients take the help of acupuncture. In spite of all these treatments, there occurs no relief in backache, and ultimately patients reach a stage, where amputation and loss of feet becomes inevitable.
Mother of all Backaches - Lerich Syndrome
This type of backache caused by blockade of arteries supplying blood to lower limbs is called LERICH SYNDROME. In Leriche syndrome, the main artery situated inside the abdomen, that carries blood to legs and feet either gets narrowed considerably, or gets blocked due to deposition of fat inside. This results into a decreased and inadequate supply of pure blood to legs, feet, and other organs situated in the lower part of abdomen. Because of this inadequate blood supply, a person starts complaining of backache. Slowly and slowly pain starts in thighs and after sometime feet also start aching. Gradually intensity of pain increases and later on it becomes unbearable. If timely treatment is not initiated under supervision of a Cardiovascular or a Vascular Surgeon, toes get swollen and start becoming dark and later gangrene develops in the feet. In the end, patient of Leriche syndrome loses his feet.
Caution Diabetics and smokers
According to one estimate in our subcontinent, 30 - 35% of diabetic population is suffering from Leriche syndrome. In a patient of Leriche syndrome, particularly if he happens to be a chronic smoker, the severity of backache increases while walking. These patients have pain in thighs also and get worse on walking or by exercise. Later on they develop severe pain in feet while walking. Though they are very comfortable while at rest, but as soon as they start walking, they feel onset of pain that keeps on increasing during prolonged walking. Pain becomes less if they abruptly stop walking. Patients of Leriche syndrome feel tremendous fatigue and weakness in legs and feet after exercise. In an advanced stage of Leriche syndrome, feet and toes develop swelling and tingling sensation and later on persistent pain in feet.
Lerich Syndrome reduces potency
Gradually with the passage of time, colour of toes and foot starts becoming dark and later on black. A wound develops in the feet that never heal with medication. At the same time, in patients of Leriche syndrome the blood supply to sex organs decreases considerably. This leads to lack of urge for sex as well as decline in sex performance. These patients therefore, are deprived of sexual pleasure.
Where to go first?
Always remember if a patient, who is suffering from backache, happens to be a diabetic and a smoker too, possibility of sciatica or spondylitis being the cause of backache is very less, but on contrary, the possibility of Leriche syndrome in such cases is very much. If such patients especially diabetic or smokers suffer from backache they must consult a vascular or a cardiovascular surgeon, instead of a bone specialist or a general surgeon, and get a special investigation called “Doppler Study” done under his supervision. Always go to a hospital where facilities for multi CT scan, MRI, and angiography are available. Before entering a hospital, make sure whether availability of a full-time vascular or a cardiovascular surgeon in that hospital is there or not.
An experienced echo cardiographer must do this investigation of Doppler Study. Only on the basis of the Doppler Study, a further planning of angiography is made. Angiography predicts accurately the severity and extent of blockage in the artery. This angiography also predicts the quantum of pure blood going to supply the feet and legs. Only after all these investigations, the correct management plan is decided and measures are taken to increase the blood supply to lower limbs, so that the patient may get rid of backache and keep his legs and feet safe and alive as well.
Latest Treatment
Generally, Leriche syndrome is treated on the basis of angiography report and finding, other factors like patient’s age, health and condition of other body organs such as heart and brain, do play a significant role in formulating a correct treatment strategy. Although a few patients of Leriche syndrome in certain circumstances, may be benefited from angioplasty and stenting, but the majority of such patients by and large require surgery.
In a few cases, during surgery, only cleaning of arteries gives a desired result and blood supply to limbs is enhanced, but majority of patients require bypass surgery, which has proved a real boon to such patients. Until bypass surgery was introduced, only the ultimate treatment of such patient in the past had been the amputation of limbs. Now with the introduction of bypass surgery, limb salvage has become a reality. In bypass surgery either a patient’s own vein is used or an artificial tube is utilized depending upon the situation. These artificial tubes are imported From America and Germany. Bypass surgeries are of various types such as Aortofemoral Bypass, Axillofemoral Bypass, Femoropopliteal Bypass & Obturator Bypass etc. The type of bypass surgery, a particular patient requires depends on the general condition of the patient and angiography results.
After bypass surgery, care of the arteries is of paramount importance. A patient of Leriche syndrome after operation must quit smoking and tobacco chewing, and at the sometime must keep blood sugar under control. Special measures including selective exercise and special medicines are taken to prevent deposition of fat in the graft and arteries as well.
(The author is Senior Cardiovascular & Thoracic Surgeon Indraprastha Apollo Hospital, New Delhi) Source: Greater Kashmir