Finally, Back to Health

Cross-sectional MRIs of lower back region show, at one vertebra (top), a round, healthy spinal canal (center of image, in white) and, at another vertebra, the spinal canal pinched into a V (below) by vertebral dislocation and arthritic deposits.
Cross-sectional MRIs of lower back region show, at one vertebra (top), a round, healthy spinal canal (center of image, in white) and, at another vertebra, the spinal canal pinched into a V (below) by vertebral dislocation and arthritic deposits.
By Ken Ringle
Special to The Washington Post
Tuesday, June 7, 2005

The pain started about five years ago -- deep aches in her legs most noticeable at the end of a long day in the office. It was a core-deep pain, as if something were terribly amiss in the bone marrow. At night she'd awaken with shooting pains in her buttocks, shins and thighs. At first they were intermittent. Then the pain-free periods grew briefer and fewer.

At first she listened to her friends and her longtime internist, all of whom confessed to similar leg pains and blamed them on drinking cheap white wine with too many sulfites. Upgrade your cellar, they teased her, but she cut out white wine entirely for a while and the pains continued. And they seemed to get worse.

Roberta (a friend who agreed to cooperate for this story but declined to have her last name published in order to protect her medical privacy) is neither a sickly person nor a whiner. As her 50th birthday neared, she retained the energy, outlook and physique of the competitive swimmer, windsurfer, hurdler and rugby player she had been in her youth. She still sailed, hiked and swam regularly, went scuba diving on vacations and worked out at her local gym.

But she also traveled internationally for her job and from time to time would return from Africa or Asia with some minor but persistent tropical malady that confounded her doctors. She and they wondered if the pains might be due to yet another exotic bug loose in her system. Yet test after test turned up nothing amiss. She tried to block the pain with meditation. When that failed, she tried to just work through it.

At last, the pains became near-constant. They would ebb and flow in degree, but they now reached up into her buttocks and lower back. Her neck had always been a lightning rod for stress, and now the pains seemed to harbor there as well. They were so bad she often had to work from home, or miss work altogether.

By last November they had increased so much she could barely sleep. They were joined by burning sensations in her arms that turned almost any motion or gesture to agony, and by numbness and a tingling in her toes. She tried acupuncture, which improved things slightly for a week or so, then seemed to make things worse. She sought out a chiropractor who had helped a back problem years ago, but her whole body was so sensitive she couldn't bear to have him touch her.

Her internist referred her to an orthopedist. The orthopedist referred her to a neurologist. The neurologist referred her to an orthopedic rheumatologist. There were blood tests and urine tests and a colonoscopy and an MRI. The MRI turned up a mysterious, dime-sized cyst between her fourth and fifth lumbar vertebrae, but nobody seemed to think it significant.

One doctor gave her steroid pills, which only made her gain weight. Another put her in a whiplash neck collar for a week or so, but that did nothing. Another said she should be checked for Lyme disease. No one thought to order a spinal X-ray.

By this time she was drained and depressed from lack of sleep and cranky from the constant pain. Her always-erect posture had eroded to that of an 80-year-old. She could barely walk or drive.

Meet the Doctor

One day, seeking distraction at a movie with her 19-year-old son, she ran into one of his soccer teammates, who, alarmed at her appearance, asked what was wrong. When she began reciting symptoms, he reached into his wallet and pulled out the business card of Steven C. Ludwig, chief of spine surgery and associate professor of orthopedic surgery at the University of Maryland Medical Center (UMMC).

"It's your back," the former goalie said. "Call this guy immediately. I had exactly the same symptoms as yours, and he fixed me completely."

From the moment she stepped into Ludwig's Timonium, Md., office, Roberta said, she was treated differently. With the exception of her long-trusted internist, none of the specialists she'd been referred to had appeared either interested in her case or concerned about her symptoms. They treated her, she said, as if her mysterious pains stemmed from some sort of female hysteria. "I had begun to wonder myself if it wasn't maybe somehow all in my head," she said.

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