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  • Rburgess
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    Post count: 3

    Hi Dr. Corenman
    In your experience is is possible for paraspinal muscle spasm to occur in the absence of pain? I have had tight paraspinals for 20 years after an episode of LBP that lasted for about 6 months. Initially the tension was localized to the lower right but now extends to the thoracic R&L and the R paraspinals are hypertrophied vs the L. My MRI shows a 40% loss of disc height at L4/L5 and broad central disk bulge with a small R side protrusion and moderate loss of foraminal height. I experience paresthesia in the 1st 2 toes and sole of the right foot with any weight bearing but no pain. More debilitating is the muscle spasm that occurs after standing or sitting for as little as 10 minutes. I think all the multifidus strengthening that was prescribed was not beneficial.I can sit for long periods if I slouch and keep the lumbar spine flexed. A soft bed will also trigger the spasm unless I elevate my lower back. All the reports of neurogenic muscle spasm that I have read relate to the extremities. I also have a central disk bulge at C5/C6 that is borderline stenosis but no myelopathy symptoms. Is it possible that posterior compression of the spinal nerve within the foramina by the superior articular process could impact the dorsal rami? Would an interspinous spacer potentially provide any benefit?
    Thank you in advance.
    Ron

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    I would assume that the “muscle spasm” sensation that you note is probably discomforting but you don’t interpret this sensation as pain. Muscle spasm can be reactive due to pain or instability or protective to prevent motion that could be painful. With loss of disk height and bone spur formation at L4-5 along with “moderate loss of foraminal height”, this sounds like foraminal collapse. See https://neckandback.com/conditions/foraminal-collapse-lumbar-spine/.

    The foramen changes shape (volume) with flexion and extension. Flexion (bending forward or “slouching”) will “open” the canal and conversely, extension (standing/walking) will narrow this canal. This seems to fit with your symptoms even though there is “no pain”.

    It is highly unlikely that the cervical spine is affecting the lumbar symptoms.

    I am not a fan of interspinous spaces. The cause a forced flexion of the vertebra to “artificially” open the foramen by causing a flexion deformity (kyphosis) of this segment. Increased flexion will increase the stress of the levels above and below. In addition, these deforming devices are “wedged” between the spinous processes and I have seen many erode into the bone which returns the alignment back to normal which then allows the foramen to be recompressed.

    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.
    Rburgess
    Participant
    Post count: 3

    Hi Dr Corenman
    Thank you for your quick and informative reply.
    The spasm can be quite painful when it lingers.
    My impression over the years is that the muscles seem to have a few chronically active fibers, the tension of which extends from the sacrum to the skull. Stretching produces a burning sensation along the muscle and they are thermally warm in specific areas. What I am wondering is if lumbar foraminal stenosis can result in chronic low level paraspinal muscle activation by compression of the portion of the exiting nerve that becomes the dorsal rami rather than pain avoidance. Probably a moot point but lumbar and cervical disc herniations seem to co-occur rather frequently. I am hesitant to undergo surgery for a bit o sciatica, but if the muscle spasms can be eliminated I would a sign the waiver tomorrow.
    Thank you for the wonderful website.
    Ron

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    There are muscle diseases (polymyalgia rheumatica or muscular dystrophy) and muscle injury disorders (most famous being “tennis elbow”) so muscles can generate pain but typically, the muscles are the respondents of the disorder. The pain from the muscle may be nerve generated or muscle tightness from protection or activation by nerve compression.

    The best way to determine if the nerve is the cause of the muscle spasm is with a SNRB (selective nerve root block). Aggravate the muscle spasm and then get the injection. If the nerve is the cause of the muscle spasm, the muscle spasm “pain” should be relieved temporarily with the injection (see pain diary).

    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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