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#11643

I am trying to clarify source of lower back pain on right side with radiating pain down right leg. My pain started after a Yoga class (5 months ago) where we did a great deal of hip & lower back stretching. I admit that I overdid it and a day later was in severe pain. After taking the conservative route of X-rays and PT with no relief, I was sent for a MRI. MRI shows following problems on the L4-L5 level: slight disc bulge, synovial cyst & medial bony overgrowth/ligamentous hypertrophy. BUT the radiologist noted a slight impingement and spine surgeon agreed that it looks “slight” and that he would not have made note of it outside of symptoms.

I have had 2 steroid shots both of which provided zero to minimal pain relief. I need to decide whether I should proceed with outpatient surgery or just wait it out longer. I can perform activities of daily living as long a I am on the full OTC dose of Advil each day plus Icy Hot. I cannot exercise other than walking for a maximum of 20 minutes. My symptoms correlate with synovial cyst – feels fine when sitting down. But, given that all this started with a yoga class where I overstretched, I wonder if the overstretching of the nerve is the real culprit. If so, how would I know and will the nerve heal on its own over time? Any insights would be most helpful.
Thank you, Virginia

[Donald Corenman, MD, DC]

#11647

By your findings, it sounds like you might have a degenerative spondylolisthesis of L4-5 (“synovial cyst & medial bony overgrowth/ligamentous hypertrophy”). Have you had any flexion/extension standing X-rays? These X-rays would reveal the presence of this disorder.

A “slight” impingement might be much bigger than it appears. Remember that the MRI is taken with you lying down. If you do have a slip, this slip will “reduce” when lying down and become much bigger when standing.

None-the-less, you might have a stretch radiculopathy and not a compressive radiculopathy. This would be unusual if you did not have a fall but I assume it is still possible.

You note no relief from your “steroid shots”. I’ll bet that you were not told to take note of your symptoms in the first three hours (the diagnostic window) nor were you told to aggravate your symptoms prior to the injection or try to reproduce them in the diagnostic window (three hours). See “pain diary” to understand this concept.

If your symptoms “feel fine” with sitting down and flair up with standing and walking, this is stenotic pain and more likely than not, these are due to lateral recess or foraminal stenosis (see website).
Generally, a stretched nerve will not feel better when you sit down and be aggravated when you stand up.

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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#11655

Thank you – your insights are very helpful!!!

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