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Old 04-07-2012, 05:04 AM   #1
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L4-L5 Compression & sciatica

Does anyone with L4/L5 compression have the following similar symptoms?
(My MRI is fine, except it shows an extra small disc in the lumbar area which could affect my problem). My physical therapist has been working with me for years, and she and I both notice the compression, but nothing shows up on the x-ray - they say it's all muscle spasms. Medications do not help. I also have a history of sciatica.

SYMPTOMS:
left leg & left foot weakness at times, awful strange cramping on side of ankle at times and also feet and legs, hamstring tightness, foot pains at times, strange feelings in feet - almost like it's asleep and bladder problems get worse from it. When it gets bad it's very hard to walk. I've had this for 20 years, and now it's a bit worse as I get older (age 57). No one knows what to do with me! One dr. suggested a "sitting MRI" which might show the compression more.

 
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Old 04-07-2012, 01:06 PM   #2
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Re: L4-L5 Compression & sciatica

Do you find the pain issues you describe worse when standing and/or walking? What makes the pain come on or makes it worse? What activity or position makes it better?

It definitely sounds like you have some nerve compression or irritation going on...

Do you mean you have a small disc or is the central canal smaller than normal? A disc could lose its height, which results in the two vertebrae rubbing together, but I don't know if that's what you mean by "small."

Have you had a flexion/extension x-ray to check for spondylolisthesis? This is a condition where the vertebra slips over the top of the adjacent vertebra. This can (but does not always) cause instability. Sometimes when there is a small amount of instability, it can account for symptoms that come and go, or change seemingly without rhyme or reason....my pain used to switch legs...but for the most part was in one leg. This can be detected on MRI usually, but sometimes is missed (mine was).

 
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Old 04-07-2012, 02:27 PM   #3
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Re: L4-L5 Compression & sciatica

Thanks for writing. I've had MRI's and various types of x-rays, but I don't think I had a flexion/ext. x-ray - what's that - where you bend forward and back?

I was born with an extra vertebrae - I think about 30% of the pop is but normally it does not bother people - unless they later get back problems.

Mine discomfort can come on anytime - just happens - sitting does compress it more - but anything can set it off - it's been going on 20 years and seems to get worse. The worst part is the intense cramping I get in my feet and lower legs and sides of ankle. Neurological is ruled out.

Thanks

 
Old 04-07-2012, 07:58 PM   #4
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Re: L4-L5 Compression & sciatica

I get INTENSE cramping in my lower left leg and foot/ankle pain! I've had this pain for the past 4 years. I have spinal stenosis at L3/L4,mild disc protrusion at this level, and extensive-severe facet arthritis in my entire lumbar spine but oddly more pronoucned on the left side of my spine (along with degenerative scolosis and a disc issue at L5/S1). Mine left side pain is supposedly nerve related. The calf pain and ankle pain has been INSANE! I just had an ESI a week ago. That has helped with the calf pain/cramping...but for some odd reason I've developed more rib-cage pain and stabbing pains down the back of my left thigh.

At any rate... I just wanted to jump in here b/c I can totally relate to the lower leg/foot-ankle pain. It's crazy. (I was recently told that a laminectomy was in my near future. I have a 2nd opinion set up for May 1st. My current spine OS is highly recommended but I still have my concerns about it).

Your MRI doesn't show any sort of spinal stenosis, or disc protrusion, or facet arthritis? Do you have any knee issues? I ask that ( I've had both of my knees replaced) because sometimes the nerves can be compressed at the knee level. How recent is your MRI? You said that you and your PT have been working together a long time and that nothing shows up on the x-rays. X-rays won't show nerve compression (you probably know that). Have you had any nerve conduction tests done? Have you ruled out compartment syndrome?

I just find it odd that for you...neurological is ruled out (for your lower leg symptoms) and for me, after 4 years (and 8 surgeries later) my lower leg issues are due to nerve compression. That seems odd to me......

 
Old 04-07-2012, 09:41 PM   #5
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Re: L4-L5 Compression & sciatica

[B]Neurological is ruled out.
[/B]

What do you mean by this? If you have sciatica, you have neurological pain...so I am confused. Can you clarify what you mean?

 
Old 04-08-2012, 04:36 AM   #6
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Re: L4-L5 Compression & sciatica

Oh, I meant 9 it's not MS, ALS, or any neuropathy that shows on an EMG, no major neurological disease.

 
Old 04-08-2012, 07:21 AM   #7
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Re: L4-L5 Compression & sciatica

Where else do you have pain? Where is the 'extra' vertebra, and what does it look like?

The extra vertebra is called a transitional vertebra usually, meaning it should have been one type, but is actually another. Another term that has been used for this is Bertolotti's Syndrome. In my case, it's a sacral vertebra that developed as a lumbar vertebra . . . sort of. It's half lumbar, half sacral and the sacral half is unfused. I have 6 lumbar vertebra and 4 sacral instead of the usual 5 and 5.

Research that I have seen on these is showing that in many cases, if it fully developed as one type, it's less of a problem and usually doesn't cause problems. There are many variations of the Transitional vertebra . . . with the lumbar-sacral ones, either a lumbar vertebra becomes a sacral vertebra and fuses to the sacrum. They can also fuse only on one side. If a lumbar vertebra becomes sacral, there will be a bit less flex to the lower spine.

If a sacral vertebra becomes a lumbar, you will a bit more flex that intended, which can put additional strain on the lower back. This type of transitional vertebra can also be half and half, and either fuse to the sacrum or can develop like my transitional vertebra.

I have many of the symptoms of both sciatica and of SI joint dysfunction, which are also similar to other low back problems. I also have facet arthritis. The first three years of this was wasted with doctors that couldn't look past the disc degeneration and the fact that my MRI shows no obvious issues. I have finally gotten some docs that have looked beyond the obvious, and am getting some answers and some treatment.

 
Old 04-08-2012, 09:03 AM   #8
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Re: L4-L5 Compression & sciatica

Thanks very much for writing. I'm not sure what they meant by my extra lumbar vetebrae - it does sort of sound like what you are speaking of because I recall them talking about it not being fully formed or something.
I also have a fused sacrum (I guess I was born that way).

All I know is the the physical therapists and osteopaths seem to understand it much better than orthopedics - the orthopedics I have seen are great doctors, but seem to have little soft-tissue knowledge.

 
Old 04-08-2012, 11:32 AM   #9
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Re: L4-L5 Compression & sciatica

[QUOTE=anotherpatty;4957796]Thanks very much for writing. I'm not sure what they meant by my extra lumbar vetebrae - it does sort of sound like what you are speaking of because I recall them talking about it not being fully formed or something.
I also have a fused sacrum (I guess I was born that way).

All I know is the the physical therapists and osteopaths seem to understand it much better than orthopedics - the orthopedics I have seen are great doctors, but seem to have little soft-tissue knowledge.[/QUOTE]

The sacrum is fused on everyone. It could be that your transitional vertebra is one of the lumbar vertebra that became a sacral vertebra, or that it is a sacral vertebra that fused on one side only, making it a partial lumbar vertebra.

 
Old 04-08-2012, 03:43 PM   #10
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Re: L4-L5 Compression & sciatica

yEA - NOT SURE. My orthopedic and PT had told me not everyone's sacrum is fused - perhaps they meant something else -whatever it was it sounded like it was not how it was supposed to be.

Backs sure are tricky!!!! I also have Tarlov cysts - so I guess the whole thing together creates a lot of problems.

I wish you the best and thanks very much for sharing your journey.

 
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