A Question of Health: the risks of disc surgery

SLIPPED-DISC CONCERNS

SLIPPED-DISC CONCERNS

I have had a prolapsed disc (between the third and fourth lumbar vertebrae) for 12 months, which has trapped the femoral nerve root to the right leg. After one epidural injection and three dorsal root ganglion block injections, I am no better. My consultant now advises a microdiscectomy (or laminectomy) by a neurosurgeon, to cut away the disc and relieve the pressure on the nerve. What are the risks and possible outcomes?

The disc that is designed to act as a cushion between the vertebral bones of your spine is bulging outwards and pressing against an important nerve. This is usually called a slipped disc. The commonest symptoms are pain and numbness. But slipped discs can also cause muscle weakness and considerable disability. Many slipped discs heal themselves over time. But if you are still suffering after 12 months, I think the problem is unlikely to go away without more radical treatment. I hope you have had an MRI scan, which will have shown exactly where the problem is. The proposed operation is designed to make more room for the nerve root that is under pressure. If the operation is 100 per cent successful, you will be completely cured and all of your symptoms will disappear. If the nerve root has been permanently damaged already, it will not fully recover, even after the pressure is relieved. So you may be left with some residual weakness or numbness, although your pain is likely to be relieved. If things go wrong, or if it is not possible to completely free up the nerve, the operation may not help much at all, but this is a very unlikely outcome of what is fairly routine surgery. As with all operations, there are tiny risks associated with general anaesthetics, particularly if you have any other medical problems such as heart or lung disease.

A MYSTERIOUS LUMP

I have had a small lump on one side of my forehead for nearly a year. It isn't causing any discomfort and it's too small to be all that noticeable. I'd like some advice on what it might be and whether anything ought to be done about it. I'm 50, and I've noticed other men around my age with similar lumps. I've never noticed women with them.

Your lump could be a sebaceous cyst, it could be a fibroma or papilloma, or it could be the remains of a previous infection. Sebaceous cysts are caused by a blocked pore in the skin. These pores normally secrete the natural oil that lubricates the skin. When they get blocked, the oil accumulates and forms a fluid-filled bubble or cyst under the skin. Sebaceous cysts are common on the forehead, around the ears and on the scalp. They can also occur almost anywhere else on the body. Fibromas and papillomas are minor benign skin growths that tend to become more common with age. All of these things occur equally in both men and women. The skin around the forehead is particularly susceptible to damage from sunlight, and it is possible that your lump is an early sign of this. Usually sun damage causes a roughed or red area on the surface of the skin. Sun damage can progress to localised skin cancer. If your lump is not itchy, not bleeding, not growing, not unsightly and not crusted, I think it is safe to leave it alone. If it starts behaving in an unexpected way, show it to your GP or a dermatologist. If either is worried, it can easily be removed.

RISKY FACE-SAVER

I've read that celebrities use haemorrhoid ointment as a quick-fix "face lift" for the evening. I'm quite tempted to try it, but could it be harmful?

This is not a question that I have ever been asked before. Haemorrhoid creams and ointments that you can buy over the counter in a chemist contain a variety of chemicals. Essentially they are designed to relieve itching, reduce inflammation and relieve pain. Some of these ingredients are very old-fashioned and obscure. Bismuth oxide, for example, is one of the ingredients in Anusol ointment. It was first introduced into medicine in 1785. Some preparations, such as Boots haemorrhoid ointment, contain lignocaine, which is a local anaesthetic. Preparation H, one of the most popular haemorrhoid ointments, contains shark liver oil and yeast cell extract. I suppose it is just possible that some haemorrhoid ointments might make the skin of the face a bit less red or puffy for a few hours. But I think it is equally possible that your planned "face lift" could turn into a minor cosmetic disaster. Ointments that make the anus feel good might well make the face look red and horrible. If you are determined to try something, I suggest you give it a trial run first.