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in reply to: chronic low back pain, what next? #4963
Axial lower back pain for 15 years, visual analog scale pain of 2 increasing to 5 with exercise is annoying and problematic but not disabling. It appears you have tried many treatments without success. The key to managing lower back pain is core strength and ergonomics (how to move, lift etc..) Core strength will stabilize the back to allow lumbar motion with less stress on the discs. Pilates treatment through a skilled physical therapist would be the next step.
You can try epidural injections as these can be effective for a period of time. Non-steroidal anti-inflammatories can also be effective. Testicular pain can occasionally originate by referral pain from the discs of L4-5 and L5-S1.
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.you have not mentioned your neck pain in this discussion. Let’s leave that for another thread.
The surgeon might be correct regarding a recurrence of the herniation with new onset pain five years after the first onset. You are correct that an annular tear with leakage of nuclear contents can cause nerve irritation. An intact annulus would not allow chemical irritation of the nerve.
To determine a recurrent herniation without a previous MRI is generally speculation except in certain specific circumstances. Remember that the disc has no blood circulation so healing does not occur.
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: back pain since 2months #4959Most of your pain is lower back in origin. You have very little leg pain and no weakness or bowel/bladder involvement. It sounds like that if your lower back pain improves, your overall picture will improve.
X-rays being reported as “normal” in the lumbar spine are obviously incorrect as you have a previously reported large herniation of the L4-5 disc. The x-ray probably has subtle signs of changes (narrowing of the L4-5 disc) and X-rays will not identify a herniation.
Sitting pain that improves with standing is the most common identifying symptom factor in most disc herniations. However, most pain generated from a lumbar herniation is extremity or leg pain as the nerve root compression is the most painful problem. Your problem with majority lower back pain from a disc herniation is not typical. None the less, epidural injections along with a good physical therapy program is the initial treatment recommendation. If you fail that program, a surgical discussion would be called for.
The fact that most pain is lower back and not leg pain makes a surgical decision somewhat more difficult. Most patients with majority lower back pain that have failed conservative measures should be worked up to look for a fusion possibility. However, according to your report, you have a massive disc herniation filling the spinal canal. Based upon your complaints and the large disc herniation, a simple microdiscectomy has a greater than 50% chance of relieving a reasonable portion of your back pain. If you do fail a simple decompression, a fusion discussion can still be on the table.
You do not need to look for a surgical discussion if you have no inclination for surgery as it sound like you have pain but no neurological compromise.
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: A Very Long Story #4952At the age of 16, you developed a sequestered disc herniation. After medication treatment, the symptoms resolved. I imagine that this herniation was diagnosed with an MRI.
You did well for 6 months and redeveloped pain in your back as well as right leg pain and numbness of your foot. Your doctor prescribed KKT treatments- a type of ultrasound treatment which would not be the treatment of choice.
This “gland” that has been with you your entire life is most likely not causing your symptoms. You need a diagnosis through a new MRI. Most likely you have a recurrent disc herniation at your old herniation site.
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: Define disc and spine issues #4950You report neck pain for many years that has increased in intensity. You then report an injury fall after your “left side went numb and I fell”. Your report significant pain and paresthesias (pins and needles) in your left arm and you cannot bend your head backwards or to the left.
You have an older MRI that notes cervical kyphosis at C4-6 with degenerative disc disease at those levels. You have “minimal” foraminal stenosis at C4-5 bilaterally and a broad based bulge at C5-6 with minimal right and no left foraminal stenosis.
To let you know, kyphosis normally goes hand in hand with degenerative changes. Your symptoms can be generated by your neck. Some individuals have very sensitive pain component nervous systems and these tears in the disc wall can cause local neck pain. The left arm symptoms are harder to understand as the old MRI report does not note significant nerve compression (foraminal compression) but if the arm symptoms are of more recent vintage, a new MRI might reveal newer anatomic changes. I am also reluctant to read an MRI report and accept the conclusions at face value.
The fall from left sided numbness does not fit well with a neck origin unless the numbness was only in your arm and your arm gave out when you grabbed something to prevent the fall. Numbness in your leg would not fit with your neck disorder.
You need a good spine specialist to look you over and figure this out.
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.Let us separate these issues as the lower back symptoms are not related to the neck. The “sore neck” may not be related to your hand numbness. The numbness in your pinky and one half the ring finger is the sensory distribution of the ulnar nerve. The ulnar nerve is formed in the brachial plexus- this formation occurs in the shoulder and not in the spine. You could have a C8 nerve involvement but that would be somewhat rare.
The ulnar nerve normally becomes irritated in both thoracic outlet syndrome and cubital tunnel syndrome. Thoracic outlet syndrome occurs when the nerves of the shoulder (brachial plexus) get caught in some of the tunnels between bone and muscle insertion. Cubital tunnel syndrome occurs in the elbow where the ulnar nerve becomes trapped in a bony tunnel (the “funny bone”). There also is a tunnel in the wrist that the ulnar nerve traverses that can also pinch the nerve (tunnel of Guyon).
If your hand becomes numb when you extend your head (bend it backwards) and improves with flexion (bend your head forward), then the origin of the nerve irritation may be in your neck. However, if your head is bent forward, you raise your arm over your head and your hand goes numb, the origin may be from the shoulder or elbow.
The prior surgery at L5-S1 with arachnoiditis (nerve clumping) is not related to your neck. That is a different issue and one that needs to be assessed by an experienced spine surgeon.
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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