Along with the prolongation of life expectancy in industrial societies, health problems have also gained diversity. In addition, the lack of movement brought about by mechanization and development, and obesity due to nutritional disorders have led to an increase in both the diversity and severity of health problems.
The problem of the joints, which we call calcification (arthrosis), which is one of the most common problems especially in the middle-aged population, causes complaints and findings depending on the place it takes in patients. Patients may not always be able to distinguish exactly where these complaints originate from. The reason for this is that the pain is not punctual, it is mostly felt away from the cause of the pain by spreading or reflecting elsewhere.
The event we call calcification is also known by names such as decreased fluid in the joints, cartilage meltdown, joint degeneration or joint narrowing. Although the joints that are most exposed to calcification are variable, the joints that show symptoms due to calcification are generally the joints of our body that are exposed to the most load and move the most (which we use the most).
Low back pain, pain in the legs, pain in the knees and shoulders are among the most common pains. And these pains are in the interest of different areas of expertise.
Although there are many causes of low back pain; The most common causes are lumbar hernia, spinal canal stenosis due to calcification that occurs with age, lumbar slippage, pain caused by wear and calcification in the lumbar joints and intervertebral cartilages. In these diseases that occur in the waist, the pain does not stay in the waist, it can spread to one or both legs, thighs or feet. Therefore, the cause of pain radiating to both lower extremities may be disorders of spine origin in elderly patients.
Likewise, diseases in the knees or hips may also cause thigh, knee, leg or foot pain. For this reason, in patients past middle age with low back and/or leg-knee-hip pain, both the lumbar region, spine and lower extremity joints should be evaluated and the differential diagnosis should be made well. Such patients should be evaluated by both a neurosurgeon and an orthopedic specialist. After the differential diagnosis is made and the cause of the pain and other complaints is determined exactly, treatment should be done by the appropriate branch physician.
While the treatment of patients with either spine or lower extremity disorders is carried out by the appropriate branch physician, the main problem arises in the patient group with problems in both regions, which is a substantial proportion of this patient group. How should the treatment order be:
Medication and non-surgical treatments of patients who have lower extremity problems such as waist and knee-hip but do not require surgery can be performed by both fields of expertise at the same time.
BUT
It is necessary to determine the priority of treatment very well in patients with osteoarthritis that requires surgery in the waist and causes pain in the waist and legs, as well as in patients with osteoarthritis that requires surgery in the hips or knees. Unfortunately, there are many mistakes in this regard. There are patients who have undergone surgery due to pain in both knees and have prosthetics, but whose pain does not go away, as well as patients who have undergone waist surgery and still cannot walk comfortably and have pain in their legs and knees. Therefore, the factors that determine the priority of surgery in patients with calcification-degeneration-problems that require surgery are very diverse.
The patient’s age, weight, progressive neurological damage (paralysis-urine-stool incontinence-loss of sensation-loss of erection…), patient’s request….etc. Although factors are effective in determining the priority:
If we consider the spine and its nerves (the spinal cord and the nerves that go out of it to the legs) as the trunk of a tree, our legs and the pain-sensing or motor-inducing nerves in it should be considered as branches of this tree. In other words, while there is a damage to the trunk of the tree and a damage to the branch, you cannot treat the branch and remove the complaints caused by the damage to the trunk, and when you repair the damage to the trunk, there is a possibility that some complaints caused by the damage to the branch will improve. In other words, some of the pain in the knees or hips will go away in patients who have had surgery on the back, and perhaps the need for surgery of the knee or hip pathology can be postponed, as the pain regresses to a level that the patient can tolerate.
THAT’S why
Patients who applied to an orthopedic specialist with the complaint of pain in the legs or knees and decided to have surgery due to wear or calcification in the knee or hip MUST see a neurosurgeon before the operation and contribute to the pain in their legs and other complaints. It should be checked whether there is a back problem.
Likewise, every middle-aged patient
who applied to a neurosurgery with complaints of pain in the legs and calcification in the waist, MUST undergo an orthopedic evaluation for the success of the treatment.
