[CHRONICPAIN2000]

#6528

I have been suffering with chronic pain from neck pain since mid 1990’s, and had a cervical fusion in 2000, and just recently had another cervical fusion in January. During the workup for the neck, a Lumbar MRI was done and revealed”

a very large broad based central disc protrusion, entered slightly to the left of the midline. This reaults in no significant canal stenosis, but fairly severe lateral recess and moderate foraminal encroachment on the left side. There is minimal lateral recess narrowing to the right of the midline as well, and at L5-S1, there is minimal facet hypertrophy, but the spinal canal and neual foramina are well preserved”

Above is the MRI reading interpretation by the radiologist. I experience pain in my left hip when bending, and low back pain with activity. My concern right now is I am having bladder issues in which I have been told I have a neurogenic bladder. I am having to do in and out caths at intervals. Just this morning, I tried for over 20 minutes to void, but could not and required a cath . This was at 3:30 am and had the urge to urinate but could not. I had my Ortho look at the MRI and he does not feel that an ESI would help. His recommendation is surgery by a neurosurgeon and am scheduled to see a neurosurgeon appt aug.8th. I understand that you cannot diagnose but based on that MRI report, what exactly is encroachment of the foramina indicate. I do wake up at night with left leg pain, occasional numbness,but the hip and leg pain seems the worst. What is your opinion on this MRI report and correlating symptoms, and also could any of this be causing my tailbone pain. I have been having this pain for many years and is worse after sitting. I would just appreciate what you think of this post, and why would an ESI not possibly help. That is what my Ortho told me, and he is very conservative and will do an injection if needed, but just told me he did not think that was the proper way to go . Thanks. CHRONICPAIN2000

[Donald Corenman, MD, DC]

#6531

You can look at your symptoms two ways; what can cause bladder problems and what symptoms the pathology the MRI revealed can cause.

Bladder incontinence or hesitation can be caused from the spine but normally from a compression of the spinal cord or of the cauda equina (the nerve that live in the lower back). Spinal cord compression causes many more symptoms than you are experiencing (see myelopathy under conditions) and cauda equina syndrome (normally caused by a massive disc herniation which you don’t have) would cause more symptoms than you describe.

Pain can cause bladder dysfunction, especially in women who have delivered babies as a cystocele can have formed (stretching of the pelvic diaphragm). That needs to be diagnosed by a urologist or an OB/GYN.

The herniation you have at L5-S1 is causing “fairly severe lateral recess and moderate foraminal encroachment on the left side” according to the radiologist. This compresses the L5 or S1 nerve on that side and can cause buttocks pain that radiates down to the foot associated with paresthesias (pins and needles) possibly increased with sitting or bending forward.

If you have no weakness in your leg and the leg pain is mild or tolerable, an injection might help to break the pain cycle. According to the radiologist, there is no significant canal stenosis which means you do not have cauda equina syndrome. See section on “when to have lower back surgery” for more information.

Ask your primary care physician if you can get a referral to a urologist. Also, a second opinion from an interventional PM&R doctor or a spine surgeon might be helpful. You can also wait and get the opinion from the neurosurgeon.

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.

[CHRONICPAIN2000]

#6545

The herniation per the MRI report is actually at L4-L5 and encroachment of the moderate fomamina, nad fairly lateral recess. My Orthopedic told me when he reviewed the MRI scan told me he did not think an injection would really help. Since the original post, I have had problems with my bladder in which I could not initiate a void and had to cath mylself. I have already been seen by a urologist and the cath was the treatment as they feel I have a neurogenic bladder. My question is what can suddenly caused me t have a neurogenic bladder. I have noticed low back pain while sitting, and pain while stretching out my left knee at times. It normally wakes me up at night but not every night. I have the hip pain when bending or stooping, and after activity I have pain sometimes in ambulation. My Ortho and PCP told me I have some clinical presentations of fibromyalgia which if I do have that, my symptoms are worse with physical activity especially the next am. Can you define what is meant by a large broad based central disc protrusion— what is a central disc protrusion and what is meant by encroachment of foramin(moderate), and what is moderate lateral recess compromise?

[Donald Corenman, MD, DC]

#6546

Sorry- I understand your herniation is at L4-5. This would cause compression of the L4 or L5 nerves.Again, this herniation does not fill up your canal which is the normal cause of neurogenic bladder problems.

Is most of your pain on the left side? If so, the pain in the hip, thigh and calf can be caused by this herniation. An injection would also be diagnostic and give you an answer as to the origin of some of your pain. The injection anesthetizes the nerve for 2-3 hours. If you gain relief during that time and the injection is performed properly, you will have good reason to believe that your pain is from this herniation.

The bladder problem could be from pain but don’t depend upon that possibility. More likely, there is something else that is causing your bladder dysfunction. The foramen and lateral recess are explained on the website under conditions.

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.

[CHRONICPAIN2000]

#6551

Thanks, just wondering if surgery could be in my distant future…. Thanks for helping me clear up these questions.

[CHRONICPAIN2000]

#6584

You had asked me if my symptoms are on my left site. My pain is noticeable in my left hip especially with activity. I have leg pain in my right let down the front to the side of my right leg, which I dont understand. It wakes me up several times during the night and I just cant get relief for it, it is almost like restless leg symdrome. I have pain in my left and right hip. Could this nerve be pressing on the sciatiata on both sides since the MRI. The pain is worse when lying down and not much relieves it. I not have incontinence any more, but I do have frequesncy of urination hourly, but no symptoms of an UTI present. I feel like my back pain in in my low back, hip, legs, and sometimes it seems to radiate to my throacic spine at times. what are your thoughts on that?

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