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  • luckystar68
    Member
    Post count: 4

    Hi Dr. Corenman,
    I am re-posting under a new category to make sure I’m seen.I originally posted behind someone with 9 pages!
    Thank you for taking the time out of your busy day to help us poor souls with spinal issues.

    Hi Dr. Corenman:)
    I’m a nurse(LVN) of 14yrs.and on 6/21/12,when repositioning a hospice pt upward,I was pulling the large pt(about 150-200#)upward in an electric bed on wheels.The pt was coughing/having trouble breathing and had slid downward towards the foot of the bed and i was pulling pt up to the top of bed so i could then elevate the HOB and help her breathe easier. I do repostion all my pts primarily on my own while families sleep during night hours, every 2-3hrs x 13hrs. This was 4am.
    The bed rolled over the carpeted floor abruptly as I tugged my pt upward the bed pinned me between it and the wall at the waist level. Apparently when I had pulled the pt up- the bed was unlocked so it rolled. Then my back started to pain, but not unbearably just pangs in my lower back. later that day after my “nap” at home,I could not get up out of bed because my back hurt in the worst way, my husband had to help me out of bed. I took tylenol and it helped with the pain but on my next night’s assignment i kept having nerve pain in both sides of my lower back that radiated down my legs that would come and go. I had dull achy nerve pain also seated in my car on the drive home and when I bent to pick up my son’s toothbrush at home, I had a shooting pain at the bottom of my back . I called company nurse and I’ve been on disabilty since then and have nerve pain every day.
    The work comp Dr.diagnosed it a lumbar sprain.
    I went to 3 weeks of therapy to strengthen my core, the pain worsened with a machine that would slide upward with your pushing against gravity with your legs and body weight.I hurt worse after each therapy. On my last week of therapy, 3rd [email protected] 3X a week I had the constant nerve pain at my back and after that the therapist tried to straighten and push on my scoliosis I had sharp knife like stabbing pain at the center of back after.Also, On the drive to therapy I started having leg pain in right leg from behind the knee to my great toe and across the top of my foot. I immediatly told the work comp Dr. of my s/s and he ordered an MRI(i was taken off the weight machine that day, but did core exercises).
    Finally on 8/26/12 my MRI was done and showed the following:
    (I bet you get these a lot):)
    At least a left L5-S1 spondylolysis, possibly bilateral spondylolysis, with minimal spondylolisthesis.
    Broad based disc protrusion noted without attenuation of thecal sac or neural impingement.
    At T12-L1, a broad based right posterior central disc protrusion mildly attenuates the right half of the thecal sac.
    Upper sacrum in near horizontal plane and exaggerated lumbar lordosis contribute to unusal mechanical stresses and low back pain.
    I also have L3-4 bulging,L4-5 bulging and intraosseous hemangioma within T12 on the right.
    I am currently having pain levels (while Typing) at level 5 on 1-10 scale but that is not every day some days i have nerve pain at a level 2-3 pain level,several times a day.The pain has improved since the injury and comes and goes. I take Mobic, flexeril, and tylenol prn. My Dr. ordered me to return to work with no restrictions yesterday with the frequent nerve and lower back pain.He also ordered a referral to see a specialist of my choice for continued back pain.I am brave and need to work. I have ordered a lumbar back support. should I go for it and get back to work using a brace, turning and lifting heavy patients for 13 hour shifts, or should I insist on seeing a specialist first( This is third specialist the 1st two didnt bother reading my MRI & didnt care how much pain I was in. Once I start working at my job they close my case until I am re-injured, or hurting badly again. Is it safe for me to go back to work lifting and repositioning my pts with this condition?
    With Much respect,
    -luckystar68

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    You have a recently diagnosed L5 spondylolysis. Is there a slip of L5 on S1? This may not be identified on an MRI (you are lying down when the test is performed) but should be identified on standing X-rays, especially with flexion and extension views.

    More likely than not, this spondylolysis was present for years before the aggravating work comp event and this lift of the patient was in just the right angle, force and direction to tear the pannus (see description of “spondylolisthesis” and “pars fractures” on the website for pannus description).

    The treatment hope is that the tear of the pannus (the scar tissue that holds this fracture together) can re-heal and you can become pain free again. If the pannus tear is causing the pain, healing of this tear in my experience takes about 8 to 12 weeks.

    A back brace is helpful but should only be used for lifting and heavy activities.

    You do have degenerative tears of the discs at L3-4 and L4-5 and the significance of these is unknown.

    In Colorado, going back to work full time does not mean the case is closed unless the treating doctor closes the case. How else to test the patient but by going back to work full time to determine if the patient can tolerate the stress of work?

    Dr. Corenman

    luckystar68
    Member
    Post count: 4

    Hi Dr Corenman,
    I have been working my same job 1-2 nights a week on weekends. Usually my back hurts after I come home from work from a 6-8 level on a 10 scale. I then deal with the pain for a few days until it subsides to a very comfortable level of 3-4 and pain meds are usually effective.

    So I just have a few new symptoms that are alarming me.

    1.New Years Day (Happy New Year!)I had worked Sat, Sun and Monday then,extreme pain in the lower back, buttocks and thighs after waking up, so much I couldn’t move my legs to walk . I had to call for my hubby’s help to get to the bathroom. My buttocks legs and thighs were clenched very tight and the pain was excruciating. I was afraid to walk without hubby’s help. The pain subsided after about 20-30 minutes and I took my muscle relaxer and pain med. I havent had that type of
    pain since then.

    2. My back is staying swollen from the mid section, (where I’ve had scoliosis for years) to the sacrum. Bulges are seen visibly on each side of the spine at the middle but more on one side than the other. I noticed this on Sunday after working all night Saturday with a heavy pt over 200# in wt.
    Also my lower back has a very visible hole (indention only-skin is intact)in it! about the size of my fist, where the spine goes inward, and I cant feel the spine here it just goes in and is very swollen. My back has never looked or felt this way before. I have had swelling and pain ,just never seen this hole in my back.
    Do I need to be concerned? Has my listhesis worsened or slipped from stage I to stage 2?i never officially got my listhesis “staged” it was just termed mild slippage on my MRI in August 2012.
    I had x-rays done of my lower back while bending foward, then straight at lower back, then hyper extending the back. I was never told what stage the listhesis is. My doctor whom looked at the x-rays said it doesn’t look like I need surgery but he does see the bilateral spondylolysis on the xray, but didn’t mention anything about the slippage.This was in October 2012 that he looked at the xrays.

    The doctor I’ ve been seeing now is only a pain mgmt doctor and after i reported problem#1, his nurse called me back cancelled my appt and referred me to a spinal rehab clinic. He stated he has done everything he can.
    I have the appt with Dallas Spinal Rehab on Tuesday.

    What do you think this is the best course of action for these symptoms? I will at least go to the appt for an eval. but I really didn’t want Physical therapy. I tried that for 6 weeks back in August 2012 it only made my back hurt more.
    They did find hyperlordosis on my MRI consistent with the listhesis.
    Any words of advice would be helpful, thanks so much for your valuable time.
    I am getting tired of the increasing and constant pain.
    I also have some constipation but have a bm once every week or so, & bladder functions are normal.
    Severe cramping in right leg at times sometimes while driving.
    It seems like I’ve been riding the merry go round of Drs trying to treat these issues with my back, and because of the workers comp? I’ m not sure I’m receiving the correct treatment for my diagnosis. The pain is just becoming intolerable and unlivable most of the time and I don’t want to become a drug addict.
    Thanks for any advice.
    MK(aka worrywart)

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    These symptoms are pretty significant. 6-8 level pain after a day of work is pretty high. Some occasions of inability to get out of bed and having to “crawl” up your legs with your hands to stand upright (gower’s maneuver) are both signs of significant spine dysfunction. It may be time to consider a surgical consultation. Bring all your films to the consultation and ask all these questions to the surgeon. You should have all these questions answered satisfactorily to understand what your options are.

    You can still try epidural injections and pars blocks and these might relieve your pain enough to function without a surgical consultation. If your slip has progressed or is a grade II or greater, you probably will be happier with a surgical stabilization.

    Dr. Corenman

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