[ColoradoPT]

#34741

I have been dealing with spinal issues for the past 30 years. At 25 I underwent L5S1 discectomy and another L5S1 discectomy at 30. I had no problems for years. At 45, I had a C5C6 fusion due to compression and developing motor weakness. At 50, I had interlaminar spacers placed at L3L4 and L4L5. At 51, I had a 4 level C/S fusion (C34, C45, C56, C67). All of these surgeries were 100% successful, but–no surprise–I’m developing lumbar symptoms suggestive of L2 and/or L1 nerve root compression.

As you know, soft tissue hypermobility is on a continuum of Ehlor’s Donlos Syndrome to the opposite end of extreme stiffness. I am definitely near the hypermobile end as I developed a painful right shoulder from years of swimming and the pain was only corrected at the age of 23 with a capsular shift. At 52, I underwent surgery to correct what was diagnosed as Basal Joint OA in my left thumb but one look at the X-ray would show you the extent of dislocation that was present at the trapezium-MC joint. Plus, per the above, I’ve had four spinal surgeries in the last 25 years.

I learned from you that spinal discs lose blood flow circulation when we are very young and clearly, muscle strength alone is not enough to keep our spine from collapsing/deteriorating. (I work in the healthcare field and I have an in-depth understanding of muscles and how they work.) Since I am on the hyperflexible, most likely breakable, collagen spectrum, I tell people my spinal issues are genetic. Would you agree?

Immediately after my lumbar surgery in 2017, I had numbness on my right thigh in the distribution of the lateral femoral cutaneous nerve. No big deal, it was just numbness. One year ago, 2021, I developed symptoms that strongly correlated with meralgia peresthetica (on the right side), and the neurosurgeon I consulted agreed. During the last three months or so, this numb area has gradually become VERY painful to any pressure. It’s numb to light touch but if I lean against a table or rest the lateral side of my thigh against the arm of a chair–forget it–it’s sharp and very painful and often eliciting an involuntary “Ouch.” I have increasing severity of aching pain in the groin and deep anterior hip and recently the buttocks; hip extension with gait is becoming increasingly more painful, lying supine with legs extended for about 5 minutes results in aggravation of the deep nerve symptoms. All symptoms are right-sided.

Looking back, I think my meralgia peresthtica was related to irritation of the L2 nerve root. yes?

I see my neurosurgeon this week. Any thoughts from you? Any advice for imaging? What might be options for treatment? If surgery, what are options considering I have interlaminer spacers, which, according to my neurosurgeon are intact and look good.

[Donald Corenman, MD, DC]

#34745

“I tell people my spinal issues are genetic. Would you agree”? Absolutely.

Generally, allodynia (pain with light touch) is associated with root injury and not with a sensory root compression (meralgia paresthetica) although I can’t see why that can’t happen. Deep pain in the hip region is not associated with meralgia paresthetica. It can be a hip disorder however this would not cause allodynia. I think your idea of an L1 or L2 disorder makes more sense. A standard lumbar MRI would reveal this disorder. If a root is compressed, a direct decompression would be in order.

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.

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