[Diulin]

#20452

In short, my question is about where I would be feeling the pain if I have an L5-S1 annular tear as one doctor has suggested. But here are the details…..

I have had pain for a year from no identifiable incident, centered usually in the buttocks but sometimes higher, with additional pain radiating down the upper leg. Sometimes there is calf pain, but that may be cramping in response to the pain above. It is entirely in the left side and has come and gone over the year such that for short periods I can’t dress myself and for other periods I can hike 4-5 miles in the woods.

I have two physicians, one of whom says L5-S1 disc tear and recommends an epidural steroid, and the other of whom says its facet problem and recommends branch blocks leading, presumably, to a rhizotomy. I want to try the more likely option first, so I did some research. One thing that I read said that a tearin the L5-S1 disc would refer pain largely or even exclusively to the feet, which is something I have never experienced. I can’t find anything online to refute or corroborate that assertion.

If you can tell me your experience with pain sensations associated wither an L5-S1 tear, or offer any other suggestions, I would be most grateful.

Thank you,

Don Ulin

[Donald Corenman, MD, DC]

#20453

Annular tears can be quite painful or cause no pain whatsoever. It really depends upon the “wiring” of the disc. Simple annular tears can be so painful, the patient cannot stand up (called a “low back attack”).

It would be rare for leg pain to occur with these tears (unless they are associated with a lumbar herniated disc). Facet pain is less common in the lower back but can occur. The history and examination can lead to a differential diagnosis with one of the two diagnosis much more suspected than the other diagnosis.

Pain radiating down the upper leg is not typically associated with facet disorders so I would consider the epidural steroid injection first. If you receive no temporary relief (see pain diary), then the facet block would be the next injection to consider.

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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