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With our normal lifestyle, however, things do go wrong. Medicine has led us to believe that back problems originate from the vertebral joints (facet joints) and from discs and their related complications. They say the discs degenerate because of wear and tear, lack of exercise and traumas. Backaches are therefore referred on to orthopaedic surgeons, who either operate or refer patients to related specialists. The entire spine is treated by orthopaedic surgeons if the bones or joints are involved, or by neurologists and neurosurgeons if the nerves (irritation by discs) are involved. If muscles and inflammation of joints are suspected, physiotherapists are involved. If the spine has impacted the circulatory system, however, the case should be (but rarely is) referred to a cardiologist, immunologist or psychiatrist, as such a concept is completely outside the purview of the orthopaedic surgeon. Dr Hamilton Hall, an internationally established back specialist in Toronto, defined an orthopaedic surgeon on page 1 of his famous book The Back Doctor as a bone and joint doctor. Need I say more?
An English girl, Betty, was taken to the Accident and Emergency Department in a leading hospital in a Commonwealth country with severe spinal spasms and pain. Her condition was diagnosed as a 'Slipped Disc'. She was admitted and put on traction. Later she was taken to physiotherapy during which a knee was dislocated. The orthopaedic surgeon said the tendons of the knee were too slack and had to be tightened. He performed the operation. Two days later he apologised to the girl's parents for having operated on the wrong knee and with their permission repeated the operation on the other leg. The screw he had put in the first knee soon came loose and a third operation had to be performed. Betty was in the hospital for five months, after which she went back to England to recuperate. Here her condition was diagnosed by an immunologist as Systemic Lupus Erythmatosis (SLE), an autoimmune disease that can affect the joints. She has been registered as physically disabled for the last 20 years and spends much of her time in a wheelchair. It turned out to be a case of a wrong referral presenting the orthopaedic surgeon with a problem outside his purview.