Lumbar spine and right ankle

///Lumbar spine and right ankle
Lumbar spine and right ankle

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  • Avatarseasunshin
    Participant
    Post count: 1

    Last year I suffered from a prolapsed disc, causing severe leg pain. Conservative treatment addressed the pain and I was then fine.
    I recently fell into a ditch and as well as the resulting ankle pain the leg pain from my prolapsed disc has returned.
    The MRI shows:
    Lumbar Spine
    L4/5: Large right paracentral to foraminal protrusion postero-medially displacing the descending right L5 nerve root within the subarticular recess. No foraminal stenosis. Mild endplate odema.
    L5/S1: mild disc bulging. No neural compromise. Moderate left facet arthropathy.

    No suspicious focal bone lesion or paravertebral abnormality.
    The distal spinal cord and conus appear unremarkable.

    Right ankle
    Ankle and Subtalar Joints:
    Moderate posterior facet joint effusion decompressing posteriorly.
    Subtalar joint cartilage preserved.
    No osteochondral injury talar dome.

    Ankle and Subtaler Ligaments:
    Lateral collateral ligament complex. Slightly attenuated fibres ATFL suggestive of partial thickness injury. High-grade to full-thickness disruption calcenaofibular ligament and slight redundancy of the capsule in the expected location of this structure. Posterior talofibular ligament appears grossly intact but with adjacent synovitis.
    Poorly defined fibre interosseous talocalcaneal ligament suggestive of previous injury.

    Tendons:
    Minor fluid tibialis posterior distally
    Trace fluid FHL and FDL and peroneal tendons

    Mid Foot:
    Type II Os navicular but without surrounding marrow oedema.

    COMMENT:
    1. Right paracentral to foraminal protrusion at L4/5 likely compromising the descending L5 nerve root.
    2. Previous high-grade to full-thickness injury calcaneofibular ligament and partial thickness tear of ATFL. Probably partial thickness injury of the intraosseus talocalcaneal ligament.
    3. Moderate posterior facet subtaler joint effusion decompressing posteriorly with synovitis
    4. Tibialis posterior tenosynovitis.

    The doctor has prescribed diclofenac and gabapentin for the pain.
    The spine specialist/surgeon is on holiday for the next four weeks.

    QUESTIONS
    Should I be expecting surgery?
    What should I do about my ankle in the meantime?
    Which gets fixed first – the ankle or the L4/5 prolapse?
    Any other advice you can give on what I should be doing or what I should be asking the doctor?

    Thank you in advance for your help.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 6907

    Surgery might depend upon the differential of your symptoms. Obviously, your ankle will hurt with the injury changes that have occurred in your ankle. The question is how much pain is generated by the disc herniation?

    The best way to differentiate the differences in pain origin is with a nerve block of your right L4-5 HNP. See https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic/ and https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections/ to understand how to use the information from this injection.

    For the first three hours after the block, the pain reduction would represent the amount of pain generated by the nerve root compression. Also, you have compression of the L5 nerve root that can cause motor weakness. Do you have any weakness of the muscles supplied by that root? See https://neckandback.com/conditions/home-testing-for-leg-weakness/

    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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