[Jmaj8971]

#21669

when a person cannot void on their own, has intractable pain, and cannot walk, FOLLOWING AN INJURY, and their MRI report states the following, what would YOU think is the problem?
MRI Report:
“There is diffuse degenerative changes with diffuse disc desiccation.
At L4-L5: there is shallow dis bulging with the flavum ligamentum and facet joint hypertrophy without spinal canal stenosis. There is mild narrowing of the left neural foramina.
At the L5-S1 level- there is broad-based left parasagittal disc herniation, indenting the ventral thecal sac with ligamental and facet joint hypertrophy without spinal canal stenosis. There is narrowing of the left lateral recess. There is mild narrowing of the right and moderate narrowing of the left foramina. Increased signal within the L5-S1 disc consistent with an annular tear.
Left parasagittal disc herniation at L5-S1 with increased signal within the discs suggestive of an annular tear. The disc herniation contributes to the narrowing of the left lateral recess and bilateral neural foramina, left greater than right. “

[Donald Corenman, MD, DC]

#21773

Voiding is a combination of the somatic (voluntary or “controllable”) nervous system and the parasympathetic nervous system (not under your conscious control). The only type of condition that can occur in the lower spine that can cause a urination control deficit is “cauda equina syndrome”. This would require a very large compression of the spinal canal in the lumbar spine of which you do not have.

You do not describe your pain so I cannot use your MRI findings to try and correlate to your pain. See the section https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-lower-back-and-leg-pain/ to understand how to describe symptoms.

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.

[Jmaj8971]

#21776

Thanks Dr Corenman-

The patient is my 30yo fiance; she is a Black Belt in karate, in which she started when she was 11 yo. Since 2014, she had severe pain in her lower back, right buttock and burning down her right leg. She saw a Spinal Specialist, and she went thru about 8 fluoro guided epidural, and an injection in her right Piriformis muscle. At that time, she had no symptoms on her left side at all, until her injury during an inside-outside crescent kick, left leg. She got to the top of the kick, felt and heard a “pop” and her legs buckled under her and immediate tears. And this girl does not cry often- she can tolerate quite a bit of pain and still keep fighting. I literally had to carry her from karate class, down stairs and out to our car in the parking lot. Since then, she has severe sharp pain in her lower back, moving across to her left buttock, with numbness, tingling (pins and needles) down her left leg to her foot. She has Anaphylactic reactions to all NSAIDS, and is prescribed an Epipen for these severe allergies. She has been taking Norco, Flexeril, ice/ heat with no improvement. She cannot weight bear on her left side, so she uses a cane on her right and me on her left, to act as a crutch. Do you think her symptoms and MRI warrant surgical intervention? She would like to get back to her normal activity level, including 3 x week karate class, and be able to do her own ADLs, and of course be pain free. Any advice? Thanks in advanced for your time and advice Dr. Corenman! :-)

[Donald Corenman, MD, DC]

#21784

First-a diagnosis is in order. A tear of a disc wall (annular tear) is what the symptoms sound like but with that mechanism, you cannot rule out a labral tear of the hip joint. The fact she cannot bear weight on the left leg makes me again think of the hip joint. A spine problem can do that but much more common for a hip disorder to affect weight bearing.

The MRI reading does note a herniation at L5-S1 on the left; “At the L5-S1 level- there is broad-based left parasagittal disc herniation, indenting the ventral thecal sac with ligamental and facet joint hypertrophy without spinal canal stenosis. There is narrowing of the left lateral recess. There is mild narrowing of the right and moderate narrowing of the left foramina”.

This can cause leg pain with difficulty to load the leg in the acute phase.

If this is the case, then if there is no leg weakness (see https://neckandback.com/conditions/home-testing-for-leg-weakness/), then an epidural injection would be a consideration. A course of oral steroid would be another. A soft lumbar brace would be helpful and gentile PT would be another.

If there is motor weakness present, I think a surgical 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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