[jeffrey_w]

#32747

Thank you so much for providing and monitoring this forum.

In early February of this year I woke up one morning and couldn’t sit up. I felt immense pain in my lower back, and I had to crawl to get to the bathroom. I began physical therapy, but still found that it took a month before I was able to walk normally. Physical therapy did not seem to help much. I occasionally felt sciatic pain down my left leg, but the primary source of pain was the lower back area. We took x-rays, which said the following:

“6 non-rib-bearing vertebrae are present with the lowest non-rib-bearing vertebrae transitional in nature with the transverse processes either ankylosed, or articulating with the sacrum. No acute bone finding. The disc spaces are maintained. Sacroiliac joints appear unremarkable. The pedicles are intact. No abnormal soft tissue calcifications identified.”

I was then referred to a spine surgeon, and his NP ordered an MRI. The results said:

“1. Transitional vertebrae is present at the lowest non-rib-bearing vertebrae. For numbering purposes this vertebrae is termed S1.
2. L5-S1 disc herniation lateralizing mildly toward the left without canal stenosis. The finding does appear to abut the exiting nerve on the left.”

The NP then suggested that I wait and see how my back felt, and if it didn’t improve, to get steroid injections near the herniated disc. I continued to do my physical therapy exercises, but plateaued at a state where I could walk, but could not sit or stand for longer than 30 minutes without feeling pain. Since my injury, I’ve had to stop using either a sitting or standing desk and lie on the floor for most of my day.

I have had lower back pain since I was young. I remember complaining to my parents about lower back pain when I had to lean forward while washing the dishes or mowing the lawn. I often find myself unconsciously leaning to the left side because it feels more “right”. I fear that my herniated disc and history of back pain are driven by Bertolotti’s Syndrome, and that addressing the herniated disc alone will not fix the underlying issue.

I reinjured the area while getting out of bed in mid-June. While standing up I felt a pop in my lower back, and then within 30 seconds the pain began to ramp up. Once more I was reduced to a state of crawling and it took over a week before I was able to walk again, even with a cane. After riding in a car with the seat leaned back for a few hours for an appointment I was unable to walk, experiencing severe (9/10) pain and muscle weakness and collapsing a few steps away. I had to do several minutes of stretching and resting before I could walk again, with difficulty.

Very recently (July 10th), I was doing some stretches that I’ve been doing since beginning physical therapy. While doing the yoga “child’s pose”, I felt a pop in my lower back, left side (near the waistline) and a warm, tingling, almost dripping sensation go down my leg. I felt almost immediate relief, and can walk much better (and I lean to the left a bit less as well), though I am still in a worse state than before my reinjury. We theorize that I had a trapped nerve that finally released. Our research indicates these can be caused by Bertolloti’s and/or a herniated disc.

My questions are:
1) Do you think it’s possible that Bertolotti’s Syndrome is the driving factor behind my lower back pain? The NP did not seem to think that my abnormal transverse processes could cause acute problems, and suggested that the main issue was the disc herniation and it was caused by standard reasons of sitting too long or carrying something heavy. However, I was often using a standing desk, and I rarely if ever lift heavy objects.
2) Do you have any suggestions for what avenues to pursue at this point to get to the bottom of my back pain?

Thank you for your help,
Jeff

[Donald Corenman, MD, DC]

#32754

Your MRI noted; “Transitional vertebrae is present at the lowest non-rib-bearing vertebrae. For numbering purposes this vertebrae is termed S1…L5-S1 disc herniation lateralizing mildly toward the left without canal stenosis. The finding does appear to abut the exiting nerve on the left.”. This means that you have a “sacralization” of S1. Another way of thinking about it is that the first sacral segment which normally fuses fully to the rest of the sacrum, has not fully fused.

Normally, this condition is generally stable as the large transverse-alar process and the rudimentary disc are so stiff that this segment is “protected” and quite stiff. This immobility is generally supported by the fact that the disc herniation occurred at the segment above. Herniations occur in movable segments and not in fixed or stiff segments.

You note; “I fear that my herniated disc and history of back pain are driven by Bertolotti’s Syndrome, and that addressing the herniated disc alone will not fix the underlying issue”. This is probably not accurate.

You then note; “I reinjured the area while getting out of bed in mid-June. While standing up I felt a pop in my lower back, and then within 30 seconds the pain began to ramp up. Once more I was reduced to a state of crawling and it took over a week before I was able to walk again, even with a cane. After riding in a car with the seat leaned back for a few hours for an appointment I was unable to walk, experiencing severe (9/10) pain and muscle weakness and collapsing a few steps away. I had to do several minutes of stretching and resting before I could walk again, with difficulty”. This sounds exactly like a recurrent disc herniation (a new larger herniation at the same spot the previous herniation occurred).

I think you need a new MRI. If the herniation is larger than before, an epidural steroid injection can be diagnostic and therapeutic. If however you have motor weakness due to this herniation, you should consider surgery as the root has the best chance of recovery with surgery sooner than later.

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.

[jeffrey_w]

#32756

Thank you for your response, it’s much appreciated. I’ll do as you’ve suggested.

I have two short follow up questions.
1) Based on the fact that I had lower back pain throughout my teen years (I’m 31 now), would it seem likely that I somehow injured the disc or the area as a child without knowing it? The pain back then was dull and fairly constant, but never enough to impact my life. Now it’s in the same region but significantly worse, obviously.

2) My difficulty standing and walking now feels similar to dislocating my knee while playing basketball back in high school. After that, I found that putting any kind of weight on my knee made it feel as though the joint would buckle and like I didn’t have the strength to keep it from doing so. Is this what you mean by motor weakness?

Thanks for your help, and I hope my questions can be helpful for others who find this forum.
Jeff

[Donald Corenman, MD, DC]

#32771

“Based on the fact that I had lower back pain throughout my teen years (I’m 31 now), would it seem likely that I somehow injured the disc or the area as a child without knowing it?” Probably yes is the answer. Since the lowest segment which we will call S1-2 is “lumbarized” (generally non-movable), the lowest movable segment is L5-S1. That level has the most stress on it when you are young and you either suffered an annular tear or developed a mild degenerative facet which then caused pain.

“putting any kind of weight on my knee made it feel as though the joint would buckle and like I didn’t have the strength to keep it from doing so”. Knee buckling (not related to the mechanics of a deranged knee joint) is due to weakness of the quad muscles. These muscles are connected to the L3 and L4 nerve roots which would not be affected by the L5-S1 levels (L5 or S1 nerves).

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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