6 weeks post surgery, pain remains!

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  • Shellyc
    Participant
    Post count: 6

    Hi Dr. Corenman,

    A few months ago I posted my spine MRI results here which you graciously responded to and I had a referral in to come and see you but was able to get in with a surgeon here in Grand Junction much quicker so I consulted with him and he sent me to a hip specialist. I am now 6 weeks post hip surgery for a completely detached labrum and after 4 weeks on crutches I began walking again only to experience the pain that I had prior to surgery once I began to put pressure on my leg. My hip surgeon is concerned that I have a back issue due to the pain which begins in my right buttock and extends down through my hamstring but also lingers down into the lower extremity with prickly sensations. I’ve met with 2 spine surgeons already and have had an epidural with no success. I’m just wondering what your thoughts might be on this and am again considering engaging in my referral to come see you. Thanks for your continuing help! (My MRI findings are below.)

    FINDINGS:
    MRI examination of the lumbar spine is performed without intravenous gadolinium enhancement.

    L1-2: Broad-based disc bulge with a central disc disc protrusion with annular fiber tear. This
    flattens the anterior thecal sac but there is no significant spinal stenosis or neural foraminal
    narrowing. No frank disc herniation. This could be a site of pain however.

    L2-3: Broad-based disc bulge with a small annular fiber tear. No disc herniation. No spinal
    stenosis.

    L3-4: Mild spinal stenosis due to accommodation of broad-based disc bulge and facet joint
    hypertrophic change. Neural foramen are patent.

    L4-5: Mild to moderate spinal stenosis due to broad-based disc bulge and facet joint ligamentous
    hypertrophy. This causes significant narrowing of the lateral recesses and conceivably L5 nerve
    root impingement within the lateral recesses bilaterally. The neural foramen are patent.

    L5-S1: Mild facet joint degeneration. No spinal stenosis. No neural foraminal narrowing.

    IMPRESSION:

    1. Moderate multilevel degenerative disc and facet changes, with moderate spinal stenosis at
    L4-5. Significant narrowing of the lateral recesses at this level due to facet joint osteophyte/
    hypertrophic change.

    Dr. Corenman
    Moderator
    Post count: 6274

    Your MRI does not live in a vacuum. The symptoms have to be related to the MRI. What are your symptoms? Please be specific in your symptom descriptions. See https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-lower-back-and-leg-pain/.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    Shellyc
    Participant
    Post count: 6

    Thank you Dr. Corenman, I hope this helps!

    My pain started when I tipped over on my road bike in July 2016. My toe clip got stuck and I fell on to my left side. The next morning both my hips and lower back hurt. I eventually sought treatment with a physical therapist who discovered my SI joint had seized up and helped me with pain relief but without a diagnosis she couldn’t help too much. I eventually met with an orthopedic surgeon who first told me surgery wouldn’t help me and so we proceeded with an epidural in February 2018. When the epidural was ineffective, he then gave me my 2 spine surgery options. This felt inconsistent to me so I continued to seek information/answers. I sought help from a trusted chiropractor earlier this year who encouraged me to get hip xrays. In the meantime, I also met with a different spine surgeon who believed the issue lied in my hip so I got xrays and MRI of my right hip and met with a hip surgeon who diagnosed me as having a completely detached labrum and cyst in my right hip socket. I am now 6 weeks post hip surgery and have been off crutches for less than 2 weeks. Since I began walking off crutches, the pain I describe below is what I am experiencing. It is important to note that this pain existed prior to my surgery after the bike fall but seems to be worse now. This has been a very frustrating 2 year process for me and even after surgery I’m struggling significantly so I am hoping you can give me some direction on where to go next.
    Presently, my right buttock has a constant sharp pain in the center which radiates downward to the lower end of the buttock. The hamstring is tight (2-4) and I get pins and needles in my calf, mostly on the lower outside. My highest level of pain in my buttock has been 10 to where I couldn’t stand or walk at all and had to get to a chair immediately. That has been within the last week. Prior to my hip surgery, the pain levels ranged more 6-8. Presently on a moment by moment basis I would probably rate it is a consistent 8/9 but only when standing or walking, and walking incline or upstairs is increasingly aggravating. When sitting or laying, there is no pain. I cannot walk any distance and have to sit for 10-15 minutes after any activity (walking, cooking, cleaning, shopping). Percentage wise I would say the buttock carries about 80% of the pain then the other 20% goes down the back of my leg. I have about a 20-30% weakness in this leg as a result of the pain. My back is not experiencing any pain but the 1st ortho I met with suggested the bulging discs were pressing on a root nerve (forgive me if my terminology is incorrect) and that was causing the butt and leg pain.

    I should also tell you I frequently experience blotchy purple, white, and red feet and my lower legs and feet are cold most of the time.

    I am a fitness nut and enjoy all types of activities such as running, bicycling, weightlifting, dancy cardio classes, and I used to engage routinely in extreme power moves. I completely ceased exercising about 3 months ago and all I’m doing now in my surgery recovery is light spin bike and 5-8 lb upper body weight training. No core/abs or legs. One of the most painful things for me to do is bend over and pick something up off the floor.

    As for my work, I am a real estate agent and spend about 50% of my time at a desk and the other 50% of my time in the car showing houses etc. I am only able to work a few hours a day right now due to surgery recovery and continuing pain.

    I am very grateful for your time!
    Shelly

    Dr. Corenman
    Moderator
    Post count: 6274

    “Presently, my right buttock has a constant sharp pain in the center which radiates downward to the lower end of the buttock. The hamstring is tight (2-4) and I get pins and needles in my calf, mostly on the lower outside, When sitting or laying, there is no pain”. Standing and walking pain cn occasionally radiate from the hip but commonly is caused by foraminal and lateral recess stenosis of the spine. See https://neckandback.com/conditions/lumbar-foraminal-stenosis-collapse/ and https://neckandback.com/conditions/lateral-recess-stenosis/.

    Your quote “I should also tell you I frequently experience blotchy purple, white, and red feet and my lower legs and feet are cold most of the time” would not fit with a hip or nerve disorder in the spine.

    Copy and paste your spine MRI results here and we can discuss possible nerve involvement.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    Shellyc
    Participant
    Post count: 6

    Thank yo so much! I just don’t know where to go from here. Below are my MRI findings:

    FINDINGS:
    MRI examination of the lumbar spine is performed without intravenous gadolinium enhancement.
    L1-2: Broad-based disc bulge with a central disc disc protrusion with annular fiber tear. This flattens the anterior thecal sac but there is no significant spinal stenosis or neural foraminal narrowing. No frank disc herniation. This could be a site of pain however.
    L2-3: Broad-based disc bulge with a small annular fiber tear. No disc herniation. No spinal
    stenosis.
    L3-4: Mild spinal stenosis due to accommodation of broad-based disc bulge and facet joint hypertrophic change. Neural foramen are patent.
    L4-5: Mild to moderate spinal stenosis due to broad-based disc bulge and facet joint ligamentous hypertrophy. This causes significant narrowing of the lateral recesses and conceivably L5 nerve root impingement within the lateral recesses bilaterally. The neural foramen are patent.
    L5-S1: Mild facet joint degeneration. No spinal stenosis. No neural foraminal narrowing.
    IMPRESSION:

    1. Moderate multilevel degenerative disc and facet changes, with moderate spinal stenosis at
    L4-5. Significant narrowing of the lateral recesses at this level due to facet joint osteophyte/
    hypertrophic change.

    Shelly Cross

    Dr. Corenman
    Moderator
    Post count: 6274

    L4-5 “significant narrowing of the lateral recesses and conceivably L5 nerve root impingement within the lateral recesses bilaterally”. Lateral recess stenosis fits with your current symptoms. You should consider a selective nerve root block to diagnose and possibly treat this pain. See https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic/ and https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections/.

    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.
    If this forum has helped you, please let Dr. Corenman know!

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