2 year injury to low back. What should I do?

///2 year injury to low back. What should I do?
2 year injury to low back. What should I do?
Viewing 6 posts - 1 through 6 (of 8 total)
  • Author
    Posts
  • Avatarjmdockery2
    Participant
    Post count: 4

    Dr. Corenman,

    I am a 32 yo male and had an original injury to my left lower back 2 years ago while lifting in which I felt a pop. Later that evening I began to experience mild tingling in the medial aspect of my left foot. For the next couple months, the tingling in my foot became more constant and I experienced a progressive soreness and stiffness in my lower back.

    I tried an ESI that did not have an impact on my symptoms. I also did a bout of PT in which I didn’t respond to treatment. About 6 months after the original injury I began experiencing similar symptoms in my right leg and foot. There was no trauma or incident that I know of that lead to these right leg symptoms.

    As time went on, the nerve pain in both legs progressed. The symptoms of nerve pain in the feet/legs and soreness/stiffness in my lower back are exacerbated with standing and walking more so than sitting. The nerve pain is constant but is reduced with Lyrica (200 mg 3x per day) and lying down. Stinging/burning/aching is experienced in top of feet, medial arch, and plantar aspect of feet more so than in back of thighs and calves.

    I have had multiple supine MRIs that show no more than mild disc bulging at L4/L5 and L5/S1. They have also identified a small Tarlov cyst located in the left S1/S2 foramen. Since my symptoms were worsened in standing I got a standing/functional MRI that showed nothing more than the supine MRI per report. I had a discography performed at L3, L4, and L5 disc that revealed a Grade III (full thickness annular tear) at the L5/S1 disc. I attempted more epidurals and a PRP injection with no success.

    The neurosurgeons I have consulted with do not feel like there is anything surgical to consider. However, this is significantly impacting my quality of life and my activity level has severely decreased because of pain and discomfort.

    I have pushed through this for a long time but don’t know how much more I can stand. Any advice on what my next step should be, if any? I highly appreciate this.

    Avatarjmdockery2
    Participant
    Post count: 4

    Also,

    I have had NCV and EMG testing done. No abnormalities on NCV. Moderate to minimal chronic denervation noted at L4, L5, and S1 musculature. This was only performed in my left side.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7070

    It would be important to know the percentage of lower back pain vs. leg pain. That is, do you have 70% lower back pain and 30% leg symptoms that increases to 50% back and 50% leg when standing?

    Nerve symptoms that increase with standing and walking can be generated by lateral recess stenosis and/or foraminal stenosis. DO you have flexion/extension x-rays that can uncover instability?

    See https://neckandback.com/conditions/lateral-recess-stenosis/ and https://neckandback.com/conditions/lumbar-foraminal-stenosis-collapse/ and
    https://neckandback.com/conditions/lumbar-spine-instability/

    Negative NCVs do not rule out a peripheral neuropathy if the neuropathy is “small fiber disease”. that is, if the neuropathy occurs only in small diameter nerve roots, the NCV will not show any disorder even in the presence of significant symptoms.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    Avatarjmdockery2
    Participant
    Post count: 4

    I would say 70% leg pain and 30% back pain in standing and 80% leg pain, 20% back pain when lying down. The nerve pain is always worse as the day progresses and the more I’m on my feet.

    I’ve had a standing/functional MRI with flexion and extension views but the findings didn’t reveal any instability. Now these images were performed in sitting while flexing and extending and not in standing.

    I look forward to your response.

    Thank you!

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7070

    “Functional MRIs are not very helpful as the image acquisition time is so prolonged, you can’t stress the spine with motion well and results are commonly inconclusive. Standing flexion/extension X-rays are the gold standard for instability (if performed correctly). Leg pain greater than back pain that radiates to the feet that decreases (slightly) with standing could be root compression with spur or disc herniation but your studies don’t support that. You certainly can have peripheral neuropathy as a cause. I assume that you have no long tract signs (physical examination findings). Do covers touching your feet bother you at night or do the symptoms increase at night

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    Avatarjmdockery2
    Participant
    Post count: 4

    My nerve symptoms just increase at night. The covers don’t bother my legs or feet. Negative Upper motor neuron signs. Mild hyperflexia with patellar tendon reflexes. I can get a standing flexion/extension X-rays done to assess if there is any underlying instability.

    What are your thoughts on the full thickness annular tear? Is it possible the nucleus is leaking chemical irritants on the nerves?

    Thoughts on the Tarlov cyst?

    Again, thank you for your thoughts.

    • This reply was modified 4 weeks ago by Avatar jmdockery2.
Viewing 6 posts - 1 through 6 (of 8 total)

You must be logged in to reply to this topic.