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  • RWGonzales47
    Member
    Post count: 6

    Doctor,
    I have a 5mm subluxation of the L5 that has now become an 8mm since last October. I also have ischemic pain from a popliteal bypass (4 operations, 3 baloons and drips). My back pain now is more than was the leg pain. PT works temporarily. Any ideas?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8436

    I assume you are in the 40-60 age range. The subluxation you have at L5 is most likely an isthmic spondylolysthesis (broken pars- see website). There is the possibility that you have a degenerative spondylolysthesis. The fact that it is increasing in amount of slip is concerning as that means the stability of the slip is compromised. If you have increasing back pain, that would fit with increased instability.

    If you have gone through physical therapy and continue to have back pain (and even leg pain if it is caused by nerve compression and not vascular compromise), a surgeon might consider you a candidate for a decompression and fusion surgery. The vascular disease you have complicates the matter as spine surgery in the face of vascular disease has more potential risks.

    None-the-less, I think it might be time to consult a spine surgeon for a surgical opinion.

    Dr. Corenman

    RWGonzales47
    Member
    Post count: 6

    Doctor,
    I am 47 years old. The left leg was injured in a car accident 25 years ago and the bypasses and procedures were to re-establish blood flow. I did notice last October that my pain meds (hydrocodone) were not as effective and began experiencing the lower back pain. X-Rays showed the L5 pushed forward as well as arthritis. I think the blood flow has probably been relatively good and the pain was complicated by the back. I am told there is a regular ischemic pain as from the accident and then nueral ischemic pain from the back; both have same symptoms. Anyway, Thank You very much for the information. It is greatly appreciated. Any more suggestions you can make with the added info are welcome.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8436

    Ischemic pain (pain from lack of blood flow) and nerve compression pain can seem similar but there are substantial differences.Ischemic pain normally causes cramping and starts distally and progresses proximally (starts in the calf and ascends up the leg). This type of pain is made worse with activity and the position of the back does not affect the pain. That is- if you walked enough to develop pain, just the act of stopping walking will give relief without having to bend forward. In addition, there will always be a consistant distance that you can walk until the onset of pain.

    Nerve pain is only rarely associated with cramping. The distance to walk with pain onset typically varies day to day or week to week. The pain will radiate from the buttocks down the leg instead of calf to buttocks. The pain will be relieved with position of the back- unlike ischemic pain. If you develop leg pain, most likely when you bend over, sit or crouch down, the leg pain will abate. Also, it is unlikely that ischemic symptoms will include back pain where spondylolysthesis will commonly cause back pain.

    The fact that your vascular insufficiency is from a trauma and not developmental from a true vascular disease is in your favor and makes any potential surgery less risky.

    Hope this helps.

    Dr. Corenman

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