Harrison May 2000

Diagnosis

1. Adolescent idiopathic scoliosis with right thoracic pattern treated by Harrington rod and compression system (Mr R Jackson Treloar Hospital 1989)
2. Hyperaesthesia around region of left posterior iliac bone donor site, most certainly due to division or damage to the posterior branches of the L1, L2, 3 nerves that cross the pelvis at this point
3. Mechanical low back pain

Treatment Plan

1. Injection of painful scar with anti inflammatory medication as a first line treatment
2. Consideration for permanent ablation of the posterior nerve roots using radio-frequency coagulation
3. MRI scanning to look for possible discogenic causes of mechanical low back pain

Simone returned to the UK to see me with her partner Chris.

As you know she is living and working in the Costa del Sol area and has an administrative job in an open plan office working 5 1/2 hours a day. She keeps up regular exercises and can manage 10 minutes of walking on level and is most comfortable swimming in the sea, which she does as often as possible.

Her sleep is occasionally uncomfortable and she has a very firm mattress. She has reduced sitting tolerance and needs cushions and a high back chair and tends to avoid soft seats and sofas. When standing she fidgets because of left-sided low back and sacro-iliac pain and she is favouring balancing on her left leg, which is introducing some discomfort on that side also.

On clinical examination she stands with an obvious rotational tilit due to the scoliosis. There is a midline scar in the thoracic region to the upper lumbar region which is tender to the top where the upper end hook of the Harrington instrumentation is easily palpable. There is some spasm in the trapezius and slight limitation of rotation of the neck to the right and there is tenderness in the rhomboid muscular region on the inner aspect of both scapulae. She is exquisitely tender on either side of the transverse iliac crest and buttock. These nerves can be, and often are, injured in this kind of approach for the donor site to the iliac crest. Alternative methods of approaching this area have been used from the mid to late 1990s, but the approach used was perfectly standard and acceptable practice in 1989 when Simone had her treatment.

Simone needs re-investigation of her low back with MRI scanning. I would like to try anti inflammatory injection to her scar to see if this willl have any beneficial effect before moving on to something permanent and ablative with thermo-coagulation to the nerve roots.

Simone quite reasonably wants to know what the future holds and whether her back is in such a state that changing her occupation or indeed having a family would present added risks. I think we do need to investigate this further to be able to answer her questions.

We have to decide under what system we will investigate and treat Simone. I assume she is still eligible for NHS treatment in spite of living and working in Spain, through the reciprocal arrangements or the EEC, but we need to check on this so that she is not presented with some nasty bill.

I will also get fixed price quotes for Simone so she knows what she would be facing if she wanted to have private treatment and self fund it.