[Cindy121]

#22883

Thank you for your time, doctor. This finding concerned me based upon my own internet research. My PCP is just treating me with steroids and if that helps the pain, the inflammation shouldn’t appear on next image. I am more concerned about knowing what caused this irritation in the first place. What diagnostic process would you follow? I have thought through my symptoms and timeframe and would like to ask if my theory is possible. I started having left leg and hip and thigh pain a year ago after I was taking 3-4 mile walks a few times a week. When it continued and I had clear x rays, lumbar MRI, ultrasound and bone scan through the fall into winter when it became too cold for outdoor walking, In retrospect, I remembered having a very painful trauma to my hip in the middle of the night the previous June when I got a new adjustable bed. I had the head raised and in the “bend” of the bed I was not yet accustomed to my hip falling in that area or to the fact that it is a hybrid with alternating coils, and I remembered that half-asleep injury. My pain increased into the spring and I was unable to take walks at all. I could only walk around in the kitchen 10 minutes without sharp pain in my left side of calf, left side of abdomen, hip/thigh area, lower back. I went to physical therapy for a month and flunked out due to lack of feeling any better. Next I went to a physiatrist who gave me a cortisone shot after evaluating me and diagnosing me with bursitis in my hip. OK, but the pain got worse, sitting on a hard surface, backs of thighs sometimes, not even able to move in the morning at first. (Not pain in all areas mentioned at same time or of same severity), That brought me to last week’s MRI. I also had a finding of a narrowing of the left root exit, Could I have more than one thing going on? Is it possible that the nerves near the damaged bursa also caused enough nerve damage to inflame the cauda equina nerves? Do those nerves calm down, go back to normal or do I have permanent damage that means I have or will have the syndrome? Any thoughts you could provide would be greatly appreciated particularly how to figure out what caused it, how would you recommend I proceed? I appreciate this SO much. (my MRI did not show anything “mechanical” going on like compression, etc. Just mild age-related degeneration) Cindy121

[Donald Corenman, MD, DC]

#22889

I am somewhat confused as you convey in your writing that there has been previous communication. Was there a previous thread that is now disconnected from this one that has more information? I will try to help you based upon this single communication.

You note Hip and thigh pain along with leg pain on the left. Your pain seems to be associated with walking and I will assume that sitting or bending forward will reduce your pain. You have a diagnosis of “bursitis” but your pain is much more diffuse than bursitis will cause. You don’t note the full findings on your MRI but do note there is “a finding of a narrowing of the left root exit” but don’t note the level of this finding.

By sifting through your thread, I come up with the possibility of foraminal stenosis or foraminal collapse. This is a condition where the exit hole from the spine is significantly narrowed. Standing and walking will further narrow this hole and “pinch” the exiting nerve thereby increasing leg pain with standing and walking. See these two sections on this website.

Nerve compression symptoms commonly refer to the hip bursa which can lead to the incorrect diagnosis of a greater trochanteric bursitis.

I hope you also had X-rays which can indicate vertebral unleveling leading to this diagnosis (with a good history and physical examination along with the MRI findings).

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.

[Cindy121]

#22892

I apologize, doctor. I am thrilled to have heard back from you so promptly, then immediately realize the more obvious confusion I caused. My only “previous communication” is the title of my question about the finding of diffuse enhancement of the cauda equina on my MRI. I’m feeling like it’s necessary to know what CAUSED that irritation, not just seeing if steroids will calm it down. I guess I was “grasping” at straws to suggest that, in our complex system of nerves, it could possibly be traced back to a hip trauma. I also thought that my other leg pain was referred from the hip. I looked through many previous Q & As in the forum that mention the cauda equina. (I did see that some people practically sent you the entire MRI report) I cannot copy that from my patient portal and do not have a paper copy yet. Perhaps if I try to restate my main concern? What could be causing the finding of ” diffuse enhancement of the cauda equina of intermediate etiology”? I have read autoimmune disease, infection, polyneuropathy, cancer, etc., which are all scary differential diagnoses to me. Further:: “mild discogenic edema at L5-S1……broad based posterior disc bulge with mild central canal narrowing at L4-L5 and ….left foraminal disc protrusion with moderate left foraminal narrowing, crowding of the exiting of the left L5 nerve roots…no evidence of pathological compression fracture or cord compression…”. I have read your responses to many patients asking about cauda equina, but they weren’t reporting a problem there as already being seen in imaging. It seems unrelated to exit nerve narrowing, which I do understand could be referring pain to my left leg. (Is there a treatment for that?) Does that mean that seeing a diffuse enhancement of the cauda equina is a separate finding entirely and attributable to one of the causes above? Is it reversible? I realize I do not have the syndrome itself or it would be causing much more severe symptoms, but is that where it’s headed. I feel like I need to know the cause. Are there blood tests? Test spinal fluid?

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