Neil Dalton

Radiculopathy, surgical infection & managing it - a clinician's real world experience & observation: 1. Radicular pain - for some - is different level pain; like a rat gnawing your thigh & shin from the inside whilst a poorly gauged UV sun bed is applied externally 2. With these levels of pain, I couldn't care less about the foot drop; it doesn't even come in to the equation; however operating early makes sense esp with objective motor loss 3. Disciitis is hugely rare as a complication. Think re immunosupression, previous high doses of local region CS 4. As I've said a million times before, discogenic somatic pain behaviour is myriad - belt like, corset, groin thigh - my personal pain is worst in groin & thigh 5. If you've had a unilateral discectomy & you develop symmetrical pelvic pain, you've got an infection until proven otherwise - get blood markers at least 6. Disciitis pain is agonising - and equal to having a long bone fracture that can't be immobilised effectively - things start to fuse overnight then you move early am and you want to kill yourself 7. Early physio input is pointless - sleep, eat well, get your head in the right place. Give yourself the time it needs. I didn't. 8. Pain will lag well behind blood & imaging markers improving. Don't give up. 9. It's almost impossible to gauge / titrate load levels vs carry over effect the next few days. 10. Prioritise your mental - not physical health. You don't really have a choice. 11. If the disc infection is aggressive enough, the VBs will auto fuse (see image); but need to monitor which may it uses rg kyphotic - which in itself may require correction at a later date ) esp if causes foraminal stenosis 12. It takes time - I'm not patient!

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