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#4830 In reply to: middle back pain |
Let me summarize your history and complaints. 5 months ago you were lifting boxes and felt and heard a click or pop type sound from your midback (I assume the area in between the bottom of your shoulder blades). This pain disappeared and three weeks later the same pain reappeared with lifting again. Pain also occurred in both arms and legs.
You rested for two months without improvement and then saw a chiropractor. He or she treated you without relief and obtained an MRI that noted a small herniated disc at T7-8 that slightly compresses the cord or at least distorts the cord pathway.
Your arm symptoms improved but your leg symptoms are just as significant as at onset of initial pain. You have no weakness. Your thoracic pain is a 7-8 on a VAS scale and the pain does not radiate around the ribs. I imagine you have no bowel or bladder symptoms and have no imbalance. The leg pain is less than your thoracic pain and is bilateral with left leg more intense.
First off- if the thoracic disc herniation is causing your thoracic pain and is not causing cord compression (you report no myelopathy- see web site), continue non-surgical treatment. Surgically treating thoracic disc herniations is difficult and can cause symptoms that were not present previously. Epidural injections can be helpful and occasionally, the facets can cause local pain. Facet blocks and rhizotomies (see web site) can be helpful.
Your leg pain is most likely not originating from the thoracic spine. You indicate that you have no lower back pain but there are circumstances that nerve compression may not be associated with back pain. If you underwent a thorough physical examination, was there any evidence of nerve root pathology?
It would be unusual to have onset of a thoracic disc herniation and onset of a lumbar disc herniation at the same time, especially a lumbar herniation that caused compression of both sides but stranger things have happened. You could have a systemic neurological problem and a neurological consult may be in order.
Another set of eyes may be helpful to determine what disorder is causing your symptoms.
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.#4828Topic: middle back pain in forum BACK PAIN |-hello Dr. Coreman. thank you for your great forum and valuable feedback.
-I am 33 y/o. about 5 months ago early one morning after wakening up, i was moving around some boxes at my apartment, and suddenly i heard a click sound in middle back accompained by sharp pain that lasted about 2 hours. within a few days my pain got better and within two weeks pain was completely gone.
-then within three weeks while getting ready to move out to a new apartment , i was moving around some furniture the pain suddenly started. pain was sharp and intense at the same area in mid back, however this time i started to feel sharp pain in my arms and legs and within a few days the pain got worse and started to expand further in my arms and hand and legs (( both left and right arms and legs))
-I have not had any back pain history ( before this incidence) and generally in good health.
-so, for a couple of months now i tried to not do much hoping that it will get better. but so far i felt very mild improvement .
-then i started to see a chiropractic doctor. after discussing the history of my back pain the doctor ordered a MRI of the T-spine.
-the finding of the MRI by the radiologist were:
-There is small slightly right paracentral disc protrusion at T7-T8. this disc protrusion indents the cord along the right lateral aspect anteriorly (( there is no spinal stenosis or abnormal signal in the cord))
-There is mild disc space narrowing at T10-T11 disc level. minimal diffuse disc bulge is identified . there is mild flattening of the thecal sac. there is no spinal stenosis.
-1.5 cm hemangioma present at T3
-there is no spinal stenosis throughout.-after reviewing and discussing the findings with the chiropractic doctor, he recommended some therapy at his office along with use of OTC meds which i followed with very closely for a couple of months so far.
-5 months later, i am still having pain in mide pain (( I think at T-7-T8)) accompained with sharp pain in my legs (right and left -front and back and sides -but more on left leg) the the sharp pain in my arm and hands got better but I still feel it every now and then.
-I am able to walk around, i feel no weakness in my arms or legs but i feel the sharp pain in my legs and some times in in my arm and in middle of my back (( general pain index in my middle back is 7-8 constant. sciatica pain in my legs 4-6 pain index . no bowl or bladder problem.
and i have no pain in the side or front of my rib cage. pain mostly in my middle back and sharp pain in my legs ( right and left ( front and back and sides) -more so on the left leg. some sharp pain in left and right arm– i have no lower back pain and from what i heard and read sciatica pain is involve with issues with lower back.
-It has been five months and the pain and sciatica still active.
-i have read that surgery is the last resort for thoracic spine problem.
-will the disc problem between T-7 T-8 affect other thoracic disc with time and cause more disc problem with time.
-my life has completely come to sudden stop because of it. I have not been working for the past 5 months because i did not want it to get worse (( my job require and bending and side to side movement all the time))
-if there is a disc bulge at T7-8 is it going to get better with time or it will not change or possibly get worse.
-if I wait another several months will it heal up.
-i tried pasting some of the images of the mri but could not do it. i looked at the image in your website of the thoracic spine disc herniation and it looks very very similiar.
-any feedback will be greatly appreciated. thank you for taking the time to help.
#4826 In reply to: Disc Prolapse C4/C5 |You have more neck than shoulder pain. The pain increases with neutral head position and further increases with extension (bending the head backwards). You do not mention shoulder (deltoid) weakness so I will assume there is no upper extremity weakness. You also do not mention imbalance, problems with your hands involving fine motor skills, lightening type sensations down the spine and extremities and bowel/bladder symptoms so I will assume there is no spinal cord compression.
The steroid injection is not a pain killer. The steroid reduces inflammation and strengthens the nerve membrane so it is therapeutic. This injection can change the nerve environment and can give long lasting relief. The steroid injection will do nothing for motor weakness however.
Rest by itself for 6-8 weeks would not be recommend as your neck muscles can become deconditioned. You do need to avoid the positions of your neck that cause pain so wearing a soft collar may help you. Physical therapy can be helpful and is recommended.
The swallowing difficulty should be worked up by a specialist such as an ear-nose-throat doctor (ENT).
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.#4824Topic: back pain since 2months in forum BACK PAIN |HELLO DOCTOR ,I M FACING SEVER BACK PROBLEMS FROM ALMOST 30-35DAYS N THE PAIN GOES DONE TO MY LEGS,ESPECIALLY MY LEFT LEG,I VISITED DOCTORS WHO HAVE TOLD ME TO REST AND GIVEN SUM PAIN KILLERS ,I GOT MY MRI DONE THE STUDY REVELS THE FOLLOWING:
1)BROAD BASED POSTERIOR DISC BULGE WITH POSTEROCENTRAL DISC EXTRUSION IS SEEN AT L4-L5 level causing severe lumbar canal stenosis with indentation upon the bilateral budding L5 nerve roots.
2)The T11-T12 INTERVERTEBRAL DISC IS REDUCED IN HEIGHT AND EXHIBITS DIFFUSE POSTERIOR BULGE WITH LEFT POSTERO LATERAL DISC HERNIATION WITHOUT ANY NERVE ROOT COMPRESSION.
3)MILD POSTERIOR DISC BULGE IS SENN AT L1-L2 LEVEL WITHOU ANY NERVE ROOT COMPARESSION.
4)MILD OLD WEDGING OF T11&T12 VERTEBRAL BODIES IS SEEN…PLEASE EXPLAIN ME EACH POINTS ABOVE…AND SLOUTION FOR THE SAME…
DOCTOR I m 28yrs old FROM LAST 2MONTHS MY CAREER IS ON FULL STOP,,,MY Back PAIN IS LESS AS DOCTOR TOLD ME THE INTENSITY OF THE PAIN IS LESS N NERVES R FUNCTIONING FINE but pain is coming n goin,,HE SHOWED ME THT L4-L5 DISC IS BECOME FULL BLACK N PRESSIN THE NERVE,,HE HAS GIVEN ME PAIN KILLER MEDICINES,,how can I make my spine more strong,,,I WANT YOUR HELP AND ADVICE HOW I CN BE FIT N FINE,,WHT PRECAUTIONS SHOULD I TAKE,,HOW CAN I FIGHT WITH THIS PROBLEM N GET INTO MY NORMAL ROUTINE,,NOW M TAKIN MEDICINES SUCH AS PAIN KILLER N HIGH ON CALCIUM MEDICINE..LAST 3-4 DAYS EVEN MY NECK N SHOULDERS R ALSO PAININ WHICH WAS NOT THER BEFORE…WHAT MEASURES SHOULD I TAKE AS I HVE GR8 SUPPORT FROM MY FAMILY,SO PLEASE LET ME KNOW I WIL BE VERY THANK FULL TO YOU..DOCTOR I ASLO WANT TO KNOW HOW TO AVOID THE BULGING OF OTHER DISC….AWAITING FOR YOUR REPLY…THANK YOU…………
#4823 In reply to: Disc Prolapse C4/C5 |Hi Doctor
Thanks for the reply
The pain is 70/30 neck / shoulder and more on the right shoulder.
There is no tingling sensation but as informed by you pain is more intense when head is in neutral (looking straight) or bent backward.Should I go to a specialist for the swallowing issue.
Regarding the steroid injection how does this work ie., is it a pain reliever or it treats the cause.
Further I hear that the long rest of 6 to 8 weeks would make me better is this true ?
Regards
#4822 In reply to: Disc Prolapse C4/C5 |Your MRI findings are not your diagnosis but the physical disposition of your neck. You note acute pain in your neck and shoulders. How would you differentiate your neck versus shoulder pain? Is it 50% neck and 50% shoulder pain or more in the neck or shoulder? 60/40, 80/20, 30/70 neck versus shoulder. The percentage of pain from right to left can be helpful.
Do you have any tingling (paresthesias) in your arms or hands? Does the neck pain or shoulder pain become more intense when you bring your head up to neutral versus keeping it bent forward?
The MRI report notes a “bulge” at C5-6 “indenting” the thecal sac. Does this also compress the spinal cord? I would assume not but I don’t necessarily always believe what the radiological report states. You do have C5 nerve root compression according to the report. This would cause pain to radiate into the top of the right shoulder and possibly cause deltoid weakness (weakness with lifting up the arm at the shoulder). Bending your head backwards would cause further compression of this nerve root and more pain. In contrast, keeping your head bent forward will relieve some root pressure and consequently, there will be less pain.
Difficulty swallowing food is normally not associated with neck disorders unless you have developed a bone spur so large that it presses on your esophagus (very rare- I have seen only one case in my career).
Depending upon the correct diagnosis- if you really suffered from C5 nerve compression and had no significant deltoid muscle weakness, you could consider an epidural steroid injection or selective nerve root block (see website for discussion of these) along with some physical therapy. If that was not effective, an ACDF (anterior cervical decompression and fusion) would be the next step.
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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