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  • rick_h
    Member
    Post count: 3

    Hello sir,
    I have chronic back pain and symptoms associated with stenosis, however, my MRIs do not correlate with my symptoms (pain, weakness, tingling, numbness, twitching, burning, and sever pain) within my lower back and basically everything below the belly button. However these symptoms are most prevalent when in the upright position.
    DDD in the L4/L5, L5/L6, and L6/S1 (i have an extra lumbar). DJD noted on the L6/S/1. Mild lordosis noted. All non invasive treatments such as physical therapy, epidural, trigger therapy, and nerve root branch block have not worked.
    After consulting a few clinics, one suggested an upright MRI with contrast, flexion, and extension.
    Do you feel that this kind of imaging would be beneficial for diagnostic purposes?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    Upright MRIs are generally not very good diagnostic tools. You can gain better information from a standard MRI and standing X-rays with flexion/extension views.

    The diagnostic question revolve around what hurts more; the lower back pain or the buttocks/leg symptoms? Does pain depend upon position (standing vs. sitting vs. loading (lifting)?

    Dynamic leg symptoms (symptoms that occur only with standing/walking that disappear with sitting or leaning forward) are certainly stenotic symptoms but can be caused by more than canal narrowing. Have you had a vascular workup to look for vascular deficiency? Have you had a workup for peripheral neuropathy?

    Dr. Corenman

    rick_h
    Member
    Post count: 3

    The pain varies day to day, I know it gets worse when the weather changes.
    Location also varies, some times more in the back, others in the lower extremities, but on average, I would say 60% back, 40% lower.
    Being upright from sitting is painful, but is worsened when walking, lifting almost brings an automatic pins and needles in the legs.
    I forgot to mention the frequent clicking and popping in the lower back, and the facet atrophy on lower vertebrae.
    The only 2 things that relieve the symptoms is, supporting my upper body be leaning on a counter or hoisting my self up (can cause a clicking in lower back), or by laying down.
    My vascular system per my physician is good. No luck for neuropathy diagnosis. Should I ask for a EMG?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    The next step could be an EMG to determine why you have leg pain if there is no potential compression of your nerve roots. You could have dynamic compression (only noted with position and therefore standing X-rays are needed to help diagnose this disorder.

    Your back pain could be related to your degenerative disc disease. See the section under “Conditions”: “Causes of lower back pain” to understand why lower back pain occurs.

    Dr. Corenman

    rick_h
    Member
    Post count: 3

    Will do, and thank you for your time sir. I shall keep you up dated.

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