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Old 12-29-2003, 01:27 PM   #1
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Badlands HB User
L2 Disk Causing Sciatica?

I have a tiny herniation at L5 but it doesn't touch the nerves.

L2-L3 is bigger.

Does or has anyone had full sciatica to the foot from an L2 disk?

 
Old 12-29-2003, 01:44 PM   #2
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Re: L2 Disk Causing Sciatica?

[QUOTE=Badlands]I have a tiny herniation at L5 but it doesn't touch the nerves.

L2-L3 is bigger.

Does or has anyone had full sciatica to the foot from an L2 disk?[/QUOTE]
Yes, I do. My is touching nerveroot at L2-L3 to the left and it is pain all the way down my legs. I cannot stand for a long period of time. I was suppose to have an operation on Dec 13th but kind of chickened out. I didnt want to go thru the discogram that I have to have before the operation. But now I am sorry that I did not do it as it is really bad pain. good luck.

 
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Old 12-29-2003, 01:50 PM   #3
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Badlands HB User
Re: L2 Disk Causing Sciatica?

[QUOTE=jchernyb]Yes, I do. My is touching nerveroot at L2-L3 to the left and it is pain all the way down my legs. I cannot stand for a long period of time. I was suppose to have an operation on Dec 13th but kind of chickened out. I didnt want to go thru the discogram that I have to have before the operation. But now I am sorry that I did not do it as it is really bad pain. good luck.[/QUOTE]

Yours goes down BOTH legs?

Mine is only in the left leg, worse with standing and of course with walking. I too am reluctant to have surgery.

 
Old 12-29-2003, 04:44 PM   #4
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Re: L2 Disk Causing Sciatica?

[QUOTE=Badlands]Yours goes down BOTH legs?

Mine is only in the left leg, worse with standing and of course with walking. I too am reluctant to have surgery.[/QUOTE]
Yes, unfortunately, mine goes down both legs, however, the right leg seems to be worse and give me more pain than the left at the present. Boy, if I could bottle up my good days and keep it and then when I have bad days, let some out of the bottle, that would be great! Ice packs on my back have helped tremendously. Good luck!

 
Old 12-29-2003, 05:11 PM   #5
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Re: L2 Disk Causing Sciatica?

I think full sciatica (all the way to foot) is relatively unusual with L2/3, which is where my own main bulge is. More typically, it's the femoral nerve (not the sciatic) nerve that is affected, causing _upper_ leg, hip, groin pain, that rarely goes below the knee. It could be that the combination of disks is responsible for your situation, although I do think full sciatica _can_ happen with L 2/3.

More than likely, you'd have to have a discogram to be sure.

jchernyb--I'm a bit surprised; you seemed so positive about the procedure and your surgeon. Do you think you'll reschedule? Good luck with whatever the course!

Standingman

 
Old 12-30-2003, 05:11 AM   #6
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Re: L2 Disk Causing Sciatica?

Your L5 herniation doesn't have to touch the nerves to cause sciatica. The substens leaking out of your disc can cause chemical irritation of the area, there could be inflammation of your nerves due to that. This is often not seen on x-ray, MRI e t c. What does you doctor think?
I'm not to confident on the dermatome map but I isn't it generally lower discs that give pain in the feet, like L5-S1..?

/Kris L.

 
Old 12-30-2003, 05:42 AM   #7
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Re: L2 Disk Causing Sciatica?

Kris L. makes good points, I think. I'm also a bit "agnostic" about dermatome map, but, as I understand it also, it is relatively rare for pain below the knee/upper calf to be caused by L 1/2 or L 2/3. On other hand, I have seen articles that talk about "isolated sciatica" from those disks. Not certain what that means--I _think_ occasional sciatica.

Short of a discogram, a selective nerve block can sometimes be useful to determine which nerve has the pain generator along it (but it won't tell you precisely why, whether disk is impinging, leaking, or something else going on that affects that nerve). It's also possible that both disks are "red herrings" and that the real cause is something like piriformis syndrome, which has symptoms essentially the same as sciatica.

Standingman

Last edited by standingman; 12-30-2003 at 05:46 AM.

 
Old 12-30-2003, 06:57 AM   #8
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Re: L2 Disk Causing Sciatica?

I have had pain below the knees before, however, the majority of my pain is coming from the right groin area and right hip area, down to my knees. Now, MRI shows L2-L3 herniation with nerveroot hitting at L3 to the left, slight herniation at L3-L4 and L5-S1 had decompression. I still have full confidence in my doctor standingman and I still do plan on having the operation----I am just so scared of the discogram!!! I guess I must not be hurting enough yet!!! Joke joke!! I had about 1 month when I was pain free from Thanksgiving to Christmas---now tell me, why is that? Now it is slowly creeping back again. But, if my right hip did not give me such pain when I tried to get out of a chair, it could be tolerable. Also, when I walk any distance, I can feel both of my legs getting weaker and weaker. Thanks for all the advise.

 
Old 12-30-2003, 07:20 AM   #9
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Re: L2 Disk Causing Sciatica?

[QUOTE=jchernyb]I have had pain below the knees before, however, the majority of my pain is coming from the right groin area and right hip area, down to my knees. Now, MRI shows L2-L3 herniation with nerveroot hitting at L3 to the left, slight herniation at L3-L4 and L5-S1 had decompression. I still have full confidence in my doctor standingman and I still do plan on having the operation----I am just so scared of the discogram!!! I guess I must not be hurting enough yet!!! Joke joke!! I had about 1 month when I was pain free from Thanksgiving to Christmas---now tell me, why is that? Now it is slowly creeping back again. But, if my right hip did not give me such pain when I tried to get out of a chair, it could be tolerable. Also, when I walk any distance, I can feel both of my legs getting weaker and weaker. Thanks for all the advise.[/QUOTE]


Hi again, jchernyb-Well, you're right--lots to puzzle about from what you describe. Your hip/groin pain _sounds like_ L3, but you say the impingement is to the left, not the right which is where you experience your pain. So there's one mystery to be solved.

Being pain free for a month may be another. Were you _totally_ without symptoms during that time. Meaning, no weakness in walking, no pain, absolutely back to baseline? I've also had surprising interludes of improvement, but rarely longer than a day or so, and never _entirely_ back to what was normal.

Personally, the weakness with walking would be more of concern to me than pain per se, but that's partly because that's more how my own problem shows itself (although not with walking) and also because weakness, with or without pain, is more suggestive of potential nerve damage. Have you had an emg? Are your reflexes equally responsive on both sides?

I've also avoided the disco, mostly because I haven't wanted to "upset the applecart" as long as things were improving and surgery was still "iffy." However, if I was sure to "pretty sure" I'd be having surgery, I would do the disco too. Whatever discomfort of the test would certainly be better than the possibility of having surgery but "fixing" the wrong thing! That would be a quintuple whammy relative to the discogram.

Hope that's of some use. As for so many of us, these can be very tough decisions. As I've said on another thread, I sometimes envy my friend who had a recent laminectomy/diskectomy. He absolutely couldn't get off the floor with pain/weakness. Unless he wanted to live on the floor, it wasn't a tough call what to do.

Standingman

 
Old 12-30-2003, 12:43 PM   #10
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Re: L2 Disk Causing Sciatica?

[QUOTE=standingman]Hi again, jchernyb-Well, you're right--lots to puzzle about from what you describe. Your hip/groin pain _sounds like_ L3, but you say the impingement is to the left, not the right which is where you experience your pain. So there's one mystery to be solved.

Being pain free for a month may be another. Were you _totally_ without symptoms during that time. Meaning, no weakness in walking, no pain, absolutely back to baseline? I've also had surprising interludes of improvement, but rarely longer than a day or so, and never _entirely_ back to what was normal.

Personally, the weakness with walking would be more of concern to me than pain per se, but that's partly because that's more how my own problem shows itself (although not with walking) and also because weakness, with or without pain, is more suggestive of potential nerve damage. Have you had an emg? Are your reflexes equally responsive on both sides?

I've also avoided the disco, mostly because I haven't wanted to "upset the applecart" as long as things were improving and surgery was still "iffy." However, if I was sure to "pretty sure" I'd be having surgery, I would do the disco too. Whatever discomfort of the test would certainly be better than the possibility of having surgery but "fixing" the wrong thing! That would be a quintuple whammy relative to the discogram.

Hope that's of some use. As for so many of us, these can be very tough decisions. As I've said on another thread, I sometimes envy my friend who had a recent laminectomy/diskectomy. He absolutely couldn't get off the floor with pain/weakness. Unless he wanted to live on the floor, it wasn't a tough call what to do.

Standingman[/QUOTE]
Ok, I was probably 90% without pain. I have never had an emg study on the right leg. They did one on the left leg and didnt find anything but that was about 3 years ago. Maybe it is time to do it again. I am with you about not wanting to upset the applecart. I have heard such horror stories about people who have had the back surgery and then they were worse off than before the surgery and the pain came back worse. Man, that would be horrible and I dont think I would know what to do if that happened. I am just going to have to do some serious sole searching. When I describe my pain I am afraid that there is no xray that will find where the problem is stemming from. Someone said that it could possibly be the SI joints all along. Now, that is another story in itself!! What to do----what to do!!

 
Old 12-31-2003, 01:32 PM   #11
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Badlands HB User
Re: L2 Disk Causing Sciatica?

[QUOTE=standingman]I think full sciatica (all the way to foot) is relatively unusual with L2/3, which is where my own main bulge is. More typically, it's the femoral nerve (not the sciatic) nerve that is affected, causing _upper_ leg, hip, groin pain, that rarely goes below the knee. It could be that the combination of disks is responsible for your situation, although I do think full sciatica _can_ happen with L 2/3.

More than likely, you'd have to have a discogram to be sure.

Standingman[/QUOTE]

The discogram is a bit invasive. My pain is not so bad. Nothing along the femoral nerve which surprises me. As I said the L2-L3 disc is herniated with root compression. L5-S1 is a tiny herniation without root compression.

The problem is that I work out regularly. I have had to cut out squats, but I did some heavy leg presses (6 plates each side), this weekend and it aggravated the sciatica. The bottom of my left foot is numb and the left calf burns.
I also get the pain in the left gluteal region (butt).

Deep massage helps and of course taking it easy from lifting. At 45 I have been dealing with this for over 20 years. Today is not so bad after resting (not working out) for 3 days.

There are no guarantees with surgery and at least I know the "devil I live with now" as opposed to how bad it could get with a failed procedure. It helps to read the boards and appreciate how bad things could be.

There is hope for all of us! Happy New Year!

 
Old 12-31-2003, 01:59 PM   #12
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Badlands HB User
Re: L2 Disk Causing Sciatica?

[QUOTE=KrisL]Your L5 herniation doesn't have to touch the nerves to cause sciatica. The substens leaking out of your disc can cause chemical irritation of the area, there could be inflammation of your nerves due to that. This is often not seen on x-ray, MRI e t c. What does you doctor think?
I'm not to confident on the dermatome map but I isn't it generally lower discs that give pain in the feet, like L5-S1..?

/Kris L.[/QUOTE]

You bring up a good point about the "substances" in the disc causing inflammation without mechanical pressure of the disc itself against the nerve root itself.

Contemporary research is looking more into that concept. I was reading a paper online under the search topic of "failed back surgeries" that theorized that the disc proteins are sealed inside and kept from contact with the immune sytem until a herniation occurs. With a herniation the disc proteins are recognized as "foreign" by the immune system and are thus attacked. The resulting inflammation is thereby related to the nerve root irritation.

Historically disc surgeries attempt to remove actual disc pressure from the nerve, but if it's an autoimmune response, and without actual disc pressure on the nerve roots, perhaps some herniated discs are better treated pharmacologically.

This is also the issue I have with discograms. If a needle punctures a disc in the process of injecting dye, isn't more disc protein exposed to the immune system?

 
Old 01-01-2004, 03:17 AM   #13
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Re: L2 Disk Causing Sciatica?

[QUOTE=Badlands]You bring up a good point about the "substances" in the disc causing inflammation without mechanical pressure of the disc itself against the nerve root itself.

Contemporary research is looking more into that concept. I was reading a paper online under the search topic of "failed back surgeries" that theorized that the disc proteins are sealed inside and kept from contact with the immune sytem until a herniation occurs. With a herniation the disc proteins are recognized as "foreign" by the immune system and are thus attacked. The resulting inflammation is thereby related to the nerve root irritation.

Historically disc surgeries attempt to remove actual disc pressure from the nerve, but if it's an autoimmune response, and without actual disc pressure on the nerve roots, perhaps some herniated discs are better treated pharmacologically.

This is also the issue I have with discograms. If a needle punctures a disc in the process of injecting dye, isn't more disc protein exposed to the immune system?[/QUOTE]

I've been thinking about that too Badlands. It really doesn't sound so good to put a needle in the disc. There has been research about possible sideffects of discograms and they have found nothing - but one can wonder how long follow-up they've had on patients? And maybe they didn't know/recognize this effect of nucleus during this sideffect research?
However I should think that the puncture is very small and that the nucleus (beeing the consistence of toothpaste in normal cases) just never gets pushed through the hole.
But then your disc probably isn't healthy if you undergo discogram, so maybe you have nucleus already pushed close to the annulus - and a needle coming in there is just the trick to let the proteins out?
My mind is sure spinning now since I'm about to have a discogram

About pharmatreatment of leaking nucleus, they are trying that Enbrel injection (antiinflammatory), there has been a lot written about it here.
But in order for the Enbrel to have effect, the nucleus substance must have leaked OUT of the disc as I understand it? For those with contained leaks (IDD) that just goes fron the center of the disc to the annulus this medication is useless?? Since the disc has poor supply of nutrients the Enbrel will never get into the disc (?).

So people with IDD (chronic) really only face the choice of fusion or ADR surgery? Cause what else could be done..

/Kris L.

 
Old 01-01-2004, 09:37 AM   #14
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Re: L2 Disk Causing Sciatica?

Kris and Badlands--You are all making good points. For what it's worth, I think a discogram can detect whether there is an actual leak of nucleus, while an MRI, etc., cannot. Whether it can actually _cause_ such a leak is a good question! Most people here seem to report the procedure itself being quite painful, and that can last for several days, but they usually get back to wherever they were before--although it may be a number of days later. Do leaks "seal themselves" eventually, or is it a question of their emptying out?

Badlands--if you are working out as you describe, you're doing well! Likewise, if the leg pain you get subsides after a few days of rest or of altering your routine. That's often the kind of symptoms (or "devil") that people do, indeed, are advised to live with, rather than going in and "rearranging" everything.

Take care,

Standingman

 
Old 01-02-2004, 06:21 AM   #15
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Re: L2 Disk Causing Sciatica?

I have heard about the discogram but could you all explain it a little better? It has been mentioned in the past that I will have to have one and I have heard that it is severe pain. Please let me know.

 
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