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Partial sacralization of L5 on S1 generally does not cause pain. Tenderness of a spot on the lower back is also not diagnostic of a spinal disorder in general. A connective tissue disorder (like rheumatoid arthritis or fibromyalgia) might very well cause some or most of your pain.
You need a good spine physician to give you a once over to figure out what causes 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.in reply to: sacralization of L5 #7142Even though I have seen three case of painful transverse-alar articulation pain, the vast majority of these articulations are not painful. Suprapubic pain generally is not related to the spine. Some individuals can have hip impingement syndromes which can induce these type of symptoms. A visit to a hip specialist and MRI and an intraarticular injection that yields temporary relief can diagnose this disorder.
L5-S1 injections that help the sacral pain could indicate radiculopathy, degenerative disc disease or even facet syndrome. The injections have to be specifically placed to diagnose which disorder is causing the sacral pain.
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.in reply to: c7 Weakness #7141Generally, I recommend a decompression surgery for significant motor weakness of an important motor group. For the neck, there might be some room to wait as the cervical nerves seem to be “more forgiving” of delayed decompression than the lumbar nerves. C7 is one of the more forgiving nerves. If the patient chooses, I typically will wait three months for recovery of patients that have triceps motor weakness. Most individuals want to have surgery more quickly than that to have a better chance to recover the motor strength.
In my opinion, if the strength has not returned after five months, I generally recommend surgery to give the nerve the best chance to recover. There still is a chance that the nerve can recover on its own but the chances are much less than a surgical decompression can allow.
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.in reply to: Disc Herniation plus other things #7140You have three symptoms that might be independent of each other. The numbness of your left two fingers fits with the EMG report of ulnar nerve compression (cubital tunnel syndrome). The nerve is somewhat compressed in your elbow and bending the elbow stretches the nerve, causing numbness of the outside of your hand. For this disorder, you can try a splint that causes your elbow to remain straight when sleeping. There are hand surgeons that can inject a steroid to reduce inflammation and finally, you an have the nerve surgically decompressed.
Pain in the left shoulder blade could be from cervical nerve root compression but the MRI does not confirm this. The EMG test can fail to diagnose this. The EMG depends upon motor nerve compression to diagnose compression. If the motor nerve is functioning well but the sensory and pain nerves are compressed (a common scenario), the EMG will be negative but the pain will still be excruciating. Other disorders that can cause left shoulder pain are rotator cuff problems and instability (common with martial arts).
The right arm weakness could be from the herniation of the C6-7 level. This nerve supplies the triceps muscle, the wrist flexor muscle (it pushes your wrist to the palm side down) and the MCP extensors (I won’t bother you with that description). Normally, the EMG will indicate problems here but the EMG test is operator dependent and subtle findings can occasionally be missed. You can test the triceps muscle with a weight machine. Can you do as many reps with as much weight on the left as you can do on the right?
You need a skilled spine surgeon and a shoulder surgeon to ferret out these complaints.
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.in reply to: L5-S1 DISC HERNIATION, TWO BACK SURGERIES. #7139Your level of surgery matches your weakness (L5-S1 causing S1 nerve root weakness). I cannot tell you why you have herniated two and possibly three times. There are some discs that have a “cottage cheese” nucleus and that type of nucleus tends to herniate more frequently.
Any disc that herniates will appear “dehydrated” (the nucleus turns black on MRI).
If this were my back, the next surgery I would choose if the disc has reherniated a third time is a TLIF fusion (see website for details).
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.in reply to: L5-S1 DISC HERNIATION, TWO BACK SURGERIES. #7135The test you performed that noted weakness of heel raising is concerning. Weakness of the calf muscle originates from the S1 nerve root on your right side. Did you have a previous microdiscectomy on the right at L5-S1? If so, there are two possibilities for this weakness.
The first is that you have continuing compression of the S1 nerve. If that is the case, you need surgery sooner than later. The motor nerves do not tolerate compression well and may not recover.
The second possibility is that you have an injury to the nerve that was caused by one of the first two herniations and time is not of the essence for further surgery (other than pain). This possibility is frankly impossible to determine unless you have another MRI to determine if that level has reherniated.
If, of course, the surgery level was at L4-5, this does not explain your motor weakness as the L5 nerve would be affected in that case and this nerve does not go to the calf muscles.
It seems that your next step is to obtain a new MRI with gadolinium.
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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