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Good Morning Dr. Corenman. I am a surgical nurse with chronic back pain. I recently had an MRI of the L spine which shows some disturbing impressions:
“Circumferential disc osteophyte complexes with superimposed left foraminal disc protrusion at L2-3 level causing left neural foraminal narrowing. Circumferential disc osteophyte complex, facet degenerative changes, and ligamentum flavum thickening causing bilateral neural foraminal narrowing at L5-S1 low signal intensity lesions are visualized in the L4 and L5 vertebral bodies, which could be related to atypical hemangiomas, however multiple myeloma or metastatic disease cannot be completely excluded. Follow up with Bence Jones proteins and further evaluation with MRI of the lumbar spine with and without IV contrast would be helpful.”

Blood test results showed normal CBC, negative ESR, elevated cholesterol, (don’t we all) and further blood tests have been ordered.

My question is will CRP, LDH, and serum electrophoresis rule out multiple myeloma? And what other tests or treatments would you recommend?

Age 56, 155lbs 5’5, no other real health issues. MVA in 1985 with pelvis fx among other injuries, G4P4, all healthy children, breast CA in mother, living, age 80 living in a nursing home, father age 85 living,very active no CA. 4 siblings alive and well, no sig health issues.

Thank you for this forum. BevRN, Michigan

Hello Dr. Corenman,

First off, thank you for taking the time to respond to all our queries.

History:
Since 2004, on & off, i have had back pains which was treated with Physiotherapy and traction.
In 2006, my left leg fell numb all of a sudden after 2 days of excruciating pain. The doctor’s refused to conduct a surgery. I was on complete bed rest (23 hrs traction & 1 hour physiotherapy) for 29 days. My left leg became better and i was back to work after a month.

Recent History:
On Aug 8, 2012 I had radiating pain on the left leg going downwards. The next day, my left foot (ankle downwards) fell numb and loss of ability to push towards the body. I opted for traditional ayurvedic treatment. The pain went away, but the numbness and Foot drop remained. Its been 3 months, i have no pain (touchwood) but my foot is 50% numb, i am unable to rise the foot towards my body (i can lower it) and my toes dont have the strenght to push up.I have absolutely no pain or radiating pain on any part of my body, only minor strain at the back due to excessive lifting of my 3 year old son.

MRI dated November 14, 2012
– Normal Curvature & Alignment of Lumbo sacral spine
– At L5-S1, there is reduced disc height and signal intensity on T2 suggestive of the desiccation accompanied by type II end plate degenaration. Its disc shows large and broad central subligamntous extension which is touching the theca and moderately pressing bilateral preforaminal S1 nerve roots.
– Normal marrow signal od examined vertebrae
– Vertebral bodies and appendages are normal
– Facet joints appear normal
– Normal appearence of Spinal cord,cauda equina and filum terminale
– Spinal ligaments and para spinal soft tissue is normal

Neurosurgeon’s Observation & Treatment Plan

The doctors advised that due to the numbness on the feet for the past
3 months without any healing a lumbar micro discectomy (on Nov 26) will be performed to chip out the herniated portion of the disc only, which will reduce the pressure on the nerve. Surgery is advised for avoiding permanent damage to the nerve which may further cause loss of bladder and bowel control. She also mentioned that they cannot guarantee the removal of the numbness & foot drop.

After reading the above,
a) Would you advise a MDisectomy
b) If i choose not to go ahead with the surgery, will i lose the ability to withold my bladder/bowel movement
c) Any other suggestions ?

Thanks doc for your time.

God bless.

Cheers,
Ben

I am experiencing very bad back pain so I had an MRI and see a spine specialist soon. I have had back pain since I was about 14 years old so for about 15 years now. It seems to be worse now. Things that have been tried are physical therapy, a steroid injection (this made the pain worse), tens unit, anti inflammatories, and a back brace. My pcp gave me vicodin 5-500 and said take 1 twice a day until I see the specialist. These don’t seem to take the edge off at all. I have also been on ultram which doesn’t do anything at all for it. I have a dip in about the middle of my back and this is where the pain seems to start but moves down to the top of my butt. The pain in the dip feels like someone stabbing a knife through my back and into my stomach then twisting it. I also have some numbness that comes and goes in the bottom of each foot. I am going to post my MRI results in hopes that someone can give me some idea of what it means and what might happen next in the treatment of this. Any information would be much appreciated as I’m in the dark on all of this and kind of freaked out since I’m only 29 and having all these issues. Thank you in advance.

MRI FINDINGS:
Alignment is anatomic. The paraspinous soft tissues are normal. Incidentally noted is chronic, mild ectasia of the distal thecal sac. The distal spinal cord and nerve roots of the cauda equina are normal in appearance. No bone marrow pathology is seen.

No significant abnormality is demonstrated at the T10-T11 through L3-L4 levels. There is no lumbar disc protrusion, spinal stenosis, or foraminal narrowing.

L4-L5: There is a posterior annular tear and a small, broad-based, left foraminal disc protrusion. There is mild left lateral recess narrowing. There is no nerve root displacement. There is no significant facet arthropathy. There is no spinal stenosis or foraminal narrowing.

L5-S1: There is disc degeneration and mild disc bulging. There is mild bilateral facet arthropathy. There is no spinal stenosis or significant foraminal narrowing.

The visualized upper sacrum is unremarkable.

Again thank you in advance to anyone who has any input for me.

I am looking for a doctor within a few hours of grand junction that will do a L5/S1 fusion. I was in a car accident and need one that will do a lein until my lawsuit is settled. I am in excrusiating pain and would like to do this asap. I was diagnosed with grade 2 spondy with spinal instability I have a 17mm slippage with movement on flexation and extension. I was hit by a 10 Wheeler dump truck, never had a back pain ever, now I cant walk. Ive done all the conservative treatments. If anyone knows a doctor willing to help please let me know. God bless