Sambo

Dr, Thanks for caring and taking the time to give me, and us, you highly valued thoughts. I truly believe this is where my problem is, and before fusion I always said to physio’s, chiro’s and Dr’s, who I only saw when the disc flared up, that wherever the pain is coming from its on the left and always put my finger on that area. Its actually a much larger piece of bone that the other side to the feel and during certain training I do, especially lying leg raises on my back, that area clicks constantly (I now do not do anything in training to promote that). I have had a series of X RAYS done by the chiro many times over the years and on the side where I do have the L5 enlarged transverse process, the hip is a far bit higher. For years the chiro’s have tried to even them out working on that left hip when adjusting, but still remains high. When I used to have a disc flare up, the L5 transverse process was very painful during adjustment on that side. All chiro’s have said reason my L4/5 wore out was due to the fact I have the L5 transverse process – not sure if this is right or not. But if this is true – I feel like a ticking time bomb as it would then be only a matter of time before another disc goes – and with Police K9 duties I reckon I couldnt do another fusion, it would end my career and the reason I get up each day. Just 3 questions please:
1) If the bone was removed would my hip on that side drop down – we have tried everything to get it to even up with no luck
2) If there is no increased uptake to that area on bone scan, but positive on injection (ie, pain relief) and indications on MRI that there is an issue there – would I be a candidate for surgery? I have already had a bone scan with nothing showing up, but great result from injection temporarily.
3) Could a transverse process, coupled with hip being raised on that side, be a reason for discs wearing out.

I am getting a work up as you suggested and let you know how it goes, if I was a betting man, I am sure this is the area causing me the drama.

Thanks, Dave.

Hi Dr, I had ALIF at L4/5 2 years ago with a good result. I am a K9 Police dog handler and returned to full operational duties fairly quickly (3 months). Besides a bit of “bone ache” feeling at L4/5 after running a 3km track with my dog, I can pretty much do what I want. Prior to having ALIF, I always said to my surgeon I felt the origin of my back pain was coming from the left around my sacrum, but clearly on MRI L4/5 was gone, so we addressed that, but the very painfull ache in my lower left is still there. Of note, if I ever had a flare up of my L4/5 disc is was as a result of sleeping on my left side or carrying things on my left. After ALIF, very painfull still lower left side, worse when sitting, actually better when running, I don’t fell it. Aches down into my hip, buttock and quad also. Also painfull if I sleep on that side, some relief sleeping on the other. Been back to my spine surgeon, had a bone scan and it showed no increased uptake. Had an injection in my enlarged transverse process at L5 on the left near the sacral ala and awesome immediate relief. I actually said to the radiograopher when he put the needle in, “yeah thats right on it”. Felt better for a few days, but still now chronically aching. The injection was 18 months ago and I have not been back for another. Saw my spine surgeon last week and he said, he has seen 2 cases where same area has proven to be the area of pain (positive on injection and bone scan) and he has removed the patients small piece of bone through minimally invasive surgery, with a laser I think. He is a fantastic surgeon and I trust him completely. He said for him to be convinced that the enlarged L5 transverse process was causing my the drama, I would need a positive on injection and bone scan. 2 questions, if it is the area causing me the pain, is it possible to not show up on bone scan, as I said great relief with injection, and is it a fairly simple procedure to surgically correct. He said I can be back to Police K9 duties in 6 weeks, but he has to be sure it is the source of pain. Interested on your thoughts re same? Thanks very much.