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  • SarahMay
    Participant
    Post count: 19

    Dear Dr Corenman,
    I posted here a month ago about a searing pain in my lower lumbar spine which is aggravated by vibration. You suggested that it may be IDR.I have since had an MRI.
    L4-L5 Shows mild disc degeneration with an annular bulging and tear.Not compressing L5 nerve root. Mild to moderate bilateral foraminal stenosis with partial effacement of the epidural fat around L4 nerve roots but no compression.
    At L5/S1 meoderate disc degeneration and endplate changes. Broad based central disc protrusion without mass effect on thecal sac or S1 roots. Lateral small disc osteophyte complexes causing moderately severe bilateral exit foraminal stenosis with near complete effacement of epidural fat around the L5 roots.

    Still having PT. Back sore when sitting. Also standing or walking for a long time. It seems to tighten up. Feel like my stride is shorter when walking. Have annoying pain around sacroiliac joints and can go into top of thighs.Nerve pain into inner thigh at front on right.Get darts of nerve pain when bend to either side and having trouble squatting down.Sciatica going to ankle on and off in left hip. Pain in pubic bone also. Have scheuremans and vertebrae at cervico thoracic junction frequently flares up.
    Where to next?. Three months of PT and trying to keep active and not feeling great.Persist with this?.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    Most likely, you do have IDR of L5-S1 (“At L5/S1 moderate disc degeneration and endplate changes”). I have just written IDR as a new topic. Look at the website for lumbar IDR to more fully understand this disorder.

    Hopefully, your physician has also discussed medications (NSAIDs and membrane stabilizers). An epidural steroid injection can sometimes be very helpful.

    Finally, if nothing is helping and your impairment is not acceptable, a work-up to determine if you are a surgical candidate 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.
    SarahMay
    Participant
    Post count: 19

    Dear Dr Corenman,
    Many thanks for your reply. I read the IDR topic and found it very informative. It certainly strikes a chord with me. I have mostly been walking-an hour a day and stationary biking every second day. I have been doing water aerobic classes and have noticed my pain intensifies after these. I went to bed about four hours after the class and the pain in my hips just ignited and I had two hours of it before I could sleep. I tend to flare my sciatica too.
    I am trying to stay active but is this doing more harm than good?.
    Also from what I read about foraminal stenosis people get this age 50-60 years, I’m 35 and wondering if this is just going to get worse or can it settle?.
    Should I see a specialist about this and if so should it be orthopaedics or neurosurgery?.
    I don’t have any medications sorted yet.
    I sincerely appreciate your advice.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    Based upon your complaints of lower back pain, this sounds like IDR. Foraminal stenosis causes buttocks and leg pain generally with standing and walking that is relieved with sitting and forward flexion. IDR is treated with a fusion.

    If you need a fusion, either a spine surgeon (an orthopedist with a fellowship in spine surgery) or a neurosurgeon should do. Just make sure you do your research and read up on this individual. All surgeons are not the same.

    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.
    SarahMay
    Participant
    Post count: 19

    Hi Dr Corenman,
    I went to see a neurosurgeon this week. I’m not a surgical candidate. Just said I had wear and tear-an expression I despise as it seems to belittle the fact that it is painful. I did have different sensation on the left side compared to the right. I was just told I was lucky not to be a surgical candidate and to lose weight and excercise both of which I have been doing in earnest.And that was it. Zero help to me and I’m still in pain.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    You might consider a second opinion from a spine surgeon-not a neurosurgeon. There are some neurosurgeons, especially “old school” types that do not consider significant back pain or severe degenerative disc disorders as surgically appropriate.

    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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