manage31MemberSeptember 6, 2011 at 6:10 pmPost count: 2
I am new to this message board but I am enjoying all the information. My problem according to the MRI is:
There is a left paracentral disc extrusion measuring 10mm with severe narrowing of the left lateral recess and impingement of the left S1 nerve root in the lateral recess. Exiting L5 nerve root is spared. no central canal stenosis or right neural foraminal is identified. Right lateral recess is normal.
I am 37 male, 5’10” 210 and I have been experiencing terrible back pain for about a year. I have an 8 month old which doesn’t help, but to make a long story short. I have had 2 epidurals (no relief at all), months of nsaids (mostly celebrex) and I’ve done physical therapy. My Doctor who comes with a very good reputation says “no need for surgery because there is no neurological symptoms and you have no leg pain”
Thank you so much for your time.Donald Corenman, MD, DCModeratorSeptember 6, 2011 at 9:24 pmPost count: 8459
You note a rather large herniation at L5-S1 left causing left lateral recess stenosis and impingment of the left S1 nerve. You have had what sounds to be good rehabilitation care and have failed that care. The fact that you have no leg pain and no neurological symptoms is generally reason not to perform a microdiscectomy but there are some exceptions and you need to supply some missing information.
You note that you had no relief with epidural steroid injections. Was that long term relief only? Many times, patients who undergo epidural injections are not asked to keep a pain diary or pain log for the first three hours. This period is crucial for diagnostic information. The injection contains both a corticosteroid and an anesthetic like Novocain. The injected anesthetic temporarily “numbs” the structures in the canal and if you noted relief for only three hours, that piece of information would be important to know.
You don’t specifically describe your back pain. Is the pain in the center of your back or does the pain radiate to your buttocks or sacroiliac joint on one side? If it is central back pain, what makes the pain worse? Sitting vs standing vs lifting vs????
If your pain is central back pain, the disc herniation may still be causing your pain as it could be tenting the annular fibers which could cause the symptoms (see website). The pain could also be coming from the disc itself and the herniation is a red herring. You may be a candidate for discograms (see website).
Some surgeons do not consider surgery for lower back pain and if there are no neurological signs or symptoms and no leg pain, you would not be a surgical candidate in their eyes. Other surgeons do have surgical solutions for lower back pain. You may need another set of eyes to help you.
Dr. Corenmanmanage31MemberSeptember 7, 2011 at 12:24 pmPost count: 2
Thank you Dr. Corenman,
I don’t think I received any pain relief from the shot. I don’t recall pain immediately after the epidurals but it was back within a few hours. That could have been soreness, but I really think it was just the same back pain I had been getting. I wish they had asked me to keep a journal. Darn.
As far as pain. Hip pain is just as terrible as the back pain. The actual hip bone. It does travel to the buttocks at times but not all the time. Sometimes I get a feeling in my left leg that reminds me of what I have heard when people describe restless leg syndrome. I don’t know that I would describe it the way I would explain the almost toothache like pain in my central back and hips.
Thanks againDonald Corenman, MD, DCModeratorSeptember 7, 2011 at 9:05 pmPost count: 8459
When you note “hip” pain- where exactly is this hip pain. Is it where your back pocket would be when wearing jeans, where a holster would hang if you wore a gunbelt or in the groin area in front of the thigh? There are occasions that hip disorders can refer pain into these regions. Did you also have a hip work-up?
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