Dr Rinesh Chetty & associates- orthopaedic surgeons

30/06/2026

When can I expect to return to driving after my surgery?

NB: USA Study performed on left hand drive vehicles so would apply to the opposites limbs to operate a right hand drive vehicles eg: South Africa, Uk.

https://osmsgb.com/ortho/doctor-when-can-i-return-to-driving-after-surgery/?fbclid=IwZnRzaASw5wlleHRuA2FlbQIxMQBzcnRjBmFwcF9pZAo2NjI4NTY4Mzc5AAEe29nruFvNZeMaOFg6wkU9UPEeCosGolaNnNmYTbjtghioa2yrI6X5E7pbUW4_aem_07hoQ_AEEBoIVOFXy8s3Tw

03/06/2026

Doing 90 minutes to two hours of weight training per week can slash the risk of an early death, according to a new study.

https://news.sky.com/story/do-you-even-lift-it-turns-out-you-probably-should-13550301?fbclid=IwdGRjcASM31tleHRuA2FlbQIxMQBzcnRjBmFwcF9pZAo2NjI4NTY4Mzc5AAEekNZC2nFcwNtdmpl2B3vcE-6sJGx7ECG2K_95-C9I7lAKfgYNF6HJEV-t2rU_aem_WS2Nsb1ifWclGoI6b24eaA

Doing 90 minutes to two hours of weight training per week can slash the risk of an early death, according to a new study.

03/05/2026

I have back and leg pain.
I think they call it sciatica.
They did a Mri scan.
I have arthritis of the spine…
A pinched nerve, disc bulging..
Do I need surgery?
They say surgery is 50/50…
Someone says if I dont do it, I will have a stroke.

Spontaneous Resorption of Lumbar Disc Herniations: Why Conservative Care Matters

A 2024 systematic review by Zou et al. reported that 76.6% of lumbar disc herniations demonstrate spontaneous resorption during conservative management.

This process is primarily biological, not biomechanical.

Herniated nucleus pulposus—particularly when extruded or sequestrated—is exposed to the epidural space and recognized as non-self tissue. This triggers:
• Macrophage-mediated phagocytosis
• Neovascularization
• Inflammatory cytokine activity

The net effect is progressive reduction in disc volume, with corresponding reduction in nerve root compression. In many patients, this correlates with clinical improvement.

What Conservative Care Actually Does

Conservative treatment does not “shrink” the disc directly.

It creates the conditions for natural recovery by:
• Maintaining mobility and function
• Preventing deconditioning
• Modulating pain to allow participation in rehabilitation

Structured programs (e.g., DBC-style rehabilitation), combined where appropriate with some form of short to medium term adjuvent pain therapies:
• Targeted injections (nerve root, facet, trigger point)
• Radiofrequency rhizotomy neurolysof the facet joints.
• Adjuncts such as acupuncture

Treating the pain allows for seamless functional spinal conservative treatment with rehabilitation.
It can delay or avoid surgery, particularly in patients who are poor surgical candidates.

Adding a pain relief procedure also allows a chance for earlier return to work (even light duty), during the conservative treatment process.

In obese patients, weight reduction is not optional—it is prognostic. It significantly influences both symptom burden and long-term outcomes, regardless of treatment pathway.

Low Back Pain vs Radiculopathy: A Critical Distinction

Isolated axial low back pain:
• Rarely has a single, reliably correctable structural cause
• Best managed with a biopsychosocial, function-first approach
• Emphasis on rehabilitation, behavioural modification, and long-term conditioning

Radicular pain (sciatica), particularly when progressive:

This is a different clinical entity and often warrants a different threshold for intervention.

Indications for surgical consideration include:
• Progressive motor deficit (e.g., foot drop, weakness)
• Intractable radicular pain refractory to appropriate conservative care
• Neurogenic claudication with functional decline
• Cauda equina syndrome (urgent surgical emergency)

With the evolution of minimally invasive and endoscopic techniques, the threshold for targeted decompression has appropriately lowered in selected patients—particularly where prolonged conservative care risks permanent neurological deficit or prolonged disability.

Important Clinical Nuances
1. Population ≠ individual
A 76.6% resorption rate still means a substantial minority will not improve sufficiently without intervention.
2. Radiology ≠ symptoms
Imaging improvement does not guarantee pain resolution. Pain is a multifactorial output, not a direct surrogate for morphology.
3. Red flags override statistics
Malignancy, infection, trauma, or evolving neurological deficit require immediate investigation and escalation.
4. Conservative care is active care
It requires structured loading, patient education, and adherence—not passive observation.

Bottom Line

Most lumbar disc herniations improve because the body resolves them biologically.

Our role is not to “fix” the disc in most cases—but to:
• Maintain function
• Control symptoms
• Identify the minority who need timely surgery

The real skill lies in knowing when to wait—and when not to….. e

26/04/2026

Advice I give patients, after most lumbar spine surgeries:

No BLT’s for at least 6 weeks.
(BLT’s Bending/Lifting/Twisting)

Wait for the wound to fully heal before driving.
(Use this as a window into the healing of the disc or spine)

Use the lumbar brace liberally to prevent sudden movements and let it remind you: what you can do and can’t do during recovery.

Keep it around and close by: ie: at work, school, gym etc. use if you getting episodes of spasm or pain in the lower back.

Walking, stationery cycling and aqua therapy to start at 6 weeks, an excellent self rehab programs to do until 12 weeks.

Start physio, bio and/or chiro rehab after 12 weeks, which ever works for you.

No forcing, direct pressure or manipulations of the lumbar spine, work on rehab for muscles and nerve recovery on the lower limbs.

After 12 weeks return to light duty, keeping the brace close by, lumbar cushion for the office chair, lumbar support during driving.

Use 12-24 weeks to learn what you can do and can’t do, keep the weight down, understand the pathology and listen to your body.

24 weeks use a weightlifting belt to augment your rehab and gym sessions.

Avoid deadlifting, abdominal crunches and lumbar extensions. Let the belt dictate the range of motion.
https://www.spine-health.com/blog/avoid-these-7-exercises-if-you-have-sciatica?fbclid=IwdGRleARbMrZleHRuA2FlbQIxMQBzcnRjBmFwcF9pZAo2NjI4NTY4Mzc5AAEeMjnhBWQoeahBQfpPp0MY7_2gnitdu9J97Yw3SdKfcyBCgYV1wY4hHLJqcKQ_aem_OlfmXMa27w9YpguQ18pmLw

Saying that: Do post-op restrictions after surgery actually help?
Patients will self regulate, we can only give advice.

Post-operative precautions don’t eliminate risk, but they provide a structured framework that reduces early avoidable strain during tissue healing. Patients ultimately self-regulate, but guidance improves the quality of that regulation.

Your spine isn’t fragile—but it is healing.
The goal isn’t restriction—it’s timing.
Restrictions don’t “guarantee” outcomes—but they shape safer behaviour early on
The real value is not restriction—it’s structured progression

• 0–6 weeks:
No BLT’s → not absolute, but a reminder to avoid uncontrolled loading
Brace = movement awareness tool, not immobilisation
• 6–12 weeks:
Low-impact aerobic (walking, cycling, water) → restore baseline function
• 12+ weeks:
Rehab focus → muscle control, endurance, neural recovery
Avoid aggressive lumbar loading/manipulation early
• 12–24 weeks:
Gradual return to work + activity → load tolerance building phase
• >24 weeks:
Strength training with constraints (belt, controlled ROM)

kground Data. Lumbar microdiscectomy effectively treats lumbar radiculopathy, improving leg pain and functional outcomes. However, 20% of patients experience residual sciatica and 5% require redo discectomy. Persistent sciatica causes suffering, increases healthcare costs, and results in work absent...