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  • Rkrebs
    Member
    Post count: 3

    I have been dealing with debilitating back pain/radiating leg pain for 7 months now. As many here, I’ve been unable to work, have dropped out of school, and have grown apart from many people close to me. My MRI has shown a 4mm right para central disc protrusion barely abutting the S1 nerve root. I have had one epidural that provided no relief and am scheduled to get my second one in a week. I have also recently been diagnosed with femoral acetabelar impingement and possibly labral tears in my right hip pending an MRI. I have previously had weakness in my calf that has since gone away. However, despite putting in a ton of time doing core stabilization/swimming I cannot shake the pain in my back and butt as well as the dull ache that remains in my leg.

    Questions:

    At this point, even if the epidural works, what are the chances that the disc will actually heal on its own? I have been extremely diligent with my PT and have seen no results as of yet. I was in my first year of dental school before I had to take the year of to take care of my health and don’t want this to be a recurring problem if possible.

    How does the diagnoses of FAI and probable labral tears play into my pain? Is it possible the dull ache in my leg is coming from that?

    I also get occasional tingling and numbness in my right foot. Is this a sign of nerve damage and is it something that may eventually go away?

    I also, since around 4 months ago have broken out in hives and despite any antibiotics I take can not seem to get rid of them. On top of that I wake up some mornings with purple bruises running down both legs, and sometimes little ones on my arm. I have no idea how I get this as they always only show up after I sleep. Do these symptoms maybe fight into some of the puzzle too?

    I’ve seen a good many physicians at this point and am running out of options here as I will have to inform my dental school soon if I will be able to return next year. I appreciate that you take the time to respond to all of these comments and I look forward to hearing back! Thank you!

    -Rob K

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    Disc “healing” is relative. The annulus of the disc (outside of the jelly donut) is avascular (no blood supply) and tears in this wall will not heal. The disc hernation material is the inside jelly (nucleus) and will not “heal”. This material however will shrink down over time and the nerve can adapt to the new compression. This is how an individual “recovers” from a disc herniation.

    Your FAI (femoral acetabular impingement) can occasionally mimic disc hernation pain. The best way to differentially diagnose this pain generation is with a selective nerve root block of the herniation level and then a diagnostic block of the hip joint. The hip pain will not get better if the nerve compression is not causing this hip pain. A hip block will however yield relief if this impingement is causing the pain.

    Hives and purple bruises (purpura) do not relate to the hip or the spine problems. You do need to see your primary care doctor for work-up of these sooner than later however.

    Dr. Corenman

    Rkrebs
    Member
    Post count: 3

    Thanks for the response Dr. Corenman. I will be going for my second epidural injection soon which will hit the s1 nerve root, which is what the disc is impinging upon. Is this the same as the nerve root block you were suggesting?

    I will soon be getting an MRI of my hip and the closer I get to figuring it out I am starting to think that FAI could be the major source of pain for this. If that is the case I will likely see Dr. Phillipon in your clinic when I can make an appointment. Once again, thanks for the reply.

    Rkrebs
    Member
    Post count: 3

    Hello again,

    I have just undergone the nerve root block procedure at s1 which has given me minimal relief. I have no pain at the injection site in the low back, however, the pain in the back and side of my thigh as well as the the very cold feeling in my foot has persisted. I have had this problem for over 8 months now and have not seen much success from PT, and about 25-30% pain relief from the nerve root block. I unfortunately had to decline my return to graduate school as I am still incapable of focusing very well while sitting due to the pain. I understand it’s hard to tell without the MRI, but if I get surgery what are generally the chances of reherniation in the future say 5, 10, or 20 years? It is about a 4mm right paracentral disc protrusion. I am at my wits’ end with this and am ready to move on with my life. Any advice or help would be appreciated. Thanks again.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    The first three hours after the nerve block is the critical time to determine if you gained relief. I will assume that you only improved 25% in that period of time. If that is the case, then a hip block would be the next test. If the temporary improvement in the first three hours would be around 80%, the pain generator is the hip.

    If the hip pain only becomes 25% better, then there is a dilemma in diagnosis as the blocks did not point to the correct diagnosis. The physical examination tests would have to be relied upon to decide which disorder causes more pain. If that series of test does not point to the painful structure, you might have to undergo both surgeries to gain relief.

    Dr. Corenman

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