[debbiearseneault]

#6367

hi dr here is what my cat scan says. degen chngs at l5/s1 chronic ossified covered by posterior osteophytes moderate to large central r posterolat herniation of l5/s1 disc. an element of central stenosis is noted at the l5/s1 level and there is bilat foraminal narrowing due to marginal osteophytes. mild bulging of annulus of l4/l5 disc with small r foraminal component but located below actual level of exit of the r l4 nerve root. i was in pain for 4 months, and extreme pain for 3 weeks. when i went to emergency in an ambulance the pain on my left buttock thigh etc stopped and my leg went numb. 8 days later the numbness has improved 40%. emerg dr says i need to see a neuro surgeon. what do you think i am 55 year old female. thanks for your advice

[Donald Corenman, MD, DC]

#6373

Please see the section under “Conditions”- “How to describe symptoms” to give a more complete history.

Do you have an MRI or only a CT scan as the CT scan yields good but often incomplete information?

Your left buttocks pain could be from the left foraminal stenosis (see website for further information). You might need some diagnostic blocks to prove what level is causing pain (see selective nerve root block- SNRB and pain diary for more information).

If you have no motor weakness, you might be able to treat this without surgery (see section on when to have lower back surgery).

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.

[debbiearseneault]

#6375

thanks dr; i’ve only had the cat scan, am now waiting for referral to neuro surgeon. the pain initially was left buttock down leg,sometimes as far as the mid calf. pain started in feb and i was almost at 70% healed able to walk for at least 45 min without stabbing throbbing leg pain. then i got on a plane, since may 14 the pain increased dramatically and i went by ambulance to the er. when the pain increased it was more back pain then leg pain, i would say 60 back 40 leg. i was unable to move and after being jostled around the ambulance that’s when my leg went numb. the numbness now is small toe back to heel, backside of calf and halfway up the thigh. i cannot bend over and i can feel the old pain (sciatic type) in my buttock and leg when i sit for a longer time on a harder surface ie chair, carseat. i do not have any loss of motor but some weakness and the numbness. my concern mostly is the narrowing of the spinal canal at the s1 . again thanks for your help, we appreciate it.

[Donald Corenman, MD, DC]

#6379

I assume your pain is still in the left leg. You should note that the CT reports a large right herniation. Numbness and pain into your ankle and foot indicates either the L5 or the S1 nerve involved. Hopefully soon you can obtain that referral to a neurosurgeon or a spine surgeon.

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.

[debbiearseneault]

#6996

hi dr; i had my mri and it was t1/t2 weighted. report as follows;
t10/11 t11/12 slight disc bulges w/o sign mass effect
at l3/4 slight disc bulge w/o sign mass effect
at l4/5 annular tear present posteriorly associated with slight bulge but there is no focal protrusion
at l5/s1 moderate sized left paramedian disc protrustion deforming and slightly displacing the lest s1 nerve root sleeve posteriorly. the disc margin contacts the right s1 nerve root sleeve as well but does not overtly displace it. facet joints normal. conus is normally positioned and demonstrates normal signal as well. conclusion; left paramedian disc protrustion at l5/s1 w/o extrusion but there is some evidence of impingement on the s1 nerve root sleeve.

my symptoms now are generally pain free from the radicular pain i had in my left buttock and leg. i do however still have contant low back ache, numbness in the left foot/heel and back of left thigh behind the knee. the neuro surgeon i saw said surgery would not fix my symptoms and to continue with exercise, pt and to be very cautious of my back as it would like herniate again. your thoughts and opinion is most appreciated.

[Donald Corenman, MD, DC]

#7001

Your left leg symptoms (numbness) most likely originate from this left L5-S1 disc hernation. You have lower back ache. Is this pain centered in the lower back or does the pain lateralize into the left sacroiliac joint or buttocks? If it does lateralize, the “lower back pain” could also result from the herniation.

If the pain is central (middle of the back) and does not lateralize, the pain more likely originates from the disc itself. The reason this is important is that lateralizing pain can generally be helped by a decompression of the nerve root (simple microsurgery) and central pain does not respond as well to a microdisectomy.

A selective nerve root block (SNRB- see website) can sometimes help to distinguish between nerve compression causing pain and the disc causing 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.
 
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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