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    Old 09-24-2015, 09:49 AM   #1
    renee0087
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    Severe Siatic Pain down Right Leg

    Hi I'm new here! I have had chronic back pain for years, but for the last year I have had severe sciatic nerve pain down my right leg. So bad that i can hardly walk/get up off sofa, bed, chair etc. I have had many MRIs and I keep getting told that my bulging discs are mild or slight. But why am I in so much pain? I have had radifrequency nerve ablation 3 times on my facet joints and multiple L5-S1 steriod injections, sometimes with relief and sometimes no relief. Can one of you help me interpret my MRIs and x-ray. The doctors have me on Tramadol 50mg 2-3 times a day (mostly take at night since I still try to work), 5mg Flexaril 3-4 times a day (mostely at night again to work), just started me on gabapentin 400mg (titrating me up to 900mg).

    My last MRI was 9/12/2014 and here are the results:

    Lumbar: The conus medulans terminates at upper L1 and appears normal; the cauda equina appears normal, no intraspinal masses or inflammatory processes are present.
    L1-L2: Unremarkable intervertebral disc, facet and foramina. No change from previous. Thecal sac: 1.5cm (ap midline); L2-L3 unremarkable intervertebral disc, facet and foramina. No change from previous. Thecal sac: 1.4cm (ap midline); L3-L4: unremarkable intervertebral disc, facet and foramina. No change from previous. Thecal sac: 1.3cm (ap midline); L4-L5: Mild annular disc bulge greatest laterally with slight mass effect on the thecal sac and mild facet arthroplathy. Mild ligamentous hypertrophy. No significant neural foraminal stenosis. Thecal sac 1.3 cm (ap midline). L5-S1: Slight loss of disc height poesteriorly with small central posterior disc bulge slight mass effect on the thecal sac with minimal progression from previous. Mild difuse anular disc bulge seen without significant neural foraminal encroachment. Mild facet athropathy and ligamentous hypertrophy noted. Thecal sac 1.2cm (ap midline).

    Thoracic: Vertebral bodies are normal in height. Mild curvature of the thoracic spine to the right. A vetebral body hemangioma is noted at T11. Degenerative changes are in the mid to lower thoracic spince with small vertebral body osteophytes and degenerative changes. There is a loss of height of the T6-T7, T7-T8, T8-T9, T9-T10 and T10-T11 intevertebral discs with mild discogenic marrow changes of the verterbral body endplates. The spinal cord is normal in size. A small central thoracic cord syrinx is present which begins at the T5 level and extends to the T9 level and measures less than 2mm in diameter.
    T6-7: Mild disc-osteophyte complex with a very small central disc protrusion. The AP diameter of the thecal sac is 1.5cm. T7-8, T8-9: minimal disc osteophyte complex. The AP diameter of the thecal sac is 1.5cm. T9-10: No significant disc bulging or protrusion. AP diameter of the thecal sac is 1.5cm. T10-11: Mild disc osteophyte complex with a small and broad-based lef paracentral disc protrusion. AP diameter of the thecal sac is 1.3cm. T11-12: No significant disc bulging or prtrusion. AP diameter is 1.6cm
    Impression: Small throacic cord syrinx extending from T5-T9. Degenerative changes in mid to lower thoracis spine with vertebral body osteophyts, degenerative disc changes and minimal to mild disc-osteophyte complexes. Concurrent small and broad-based left paracentral disc protrusion at T10-11. Small central disc protrusion at T6-7. Mild curvature of thoracic spine to the right.
    Sacrum and Coccyx Radiographs (12/30/2009):
    No acute fracture. Acute angulation of the coccyx is identified. Ther eis no evidence of abnormal presacral soft tissue swelling. Mild degerneative changes of the sacroiliac joints are identified. The sacral arcades remain intact. Mild degenerative disc disease L5-S1. Impression: Mild bilateral sacroiliac joint osteoarthrosis and mild bilateral L5-S1 degernative joint disease.

     
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    Old 09-25-2015, 06:42 AM   #2
    teteri66
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    Re: Severe Siatic Pain down Right Leg

    Welcome to the board. I will get back to you soon to try to help you better understand the MRI findings. But first I have a couple questions for you. Is the leg pain only in the right leg, never the left leg?

    Have you seen a spine specialist? This would be either a fellowship-trained orthopedic spine surgeon or a neurosurgeon whose practice is limited to the neck and back?

    Has anyone evaluated you for sacroiliac joint dysfunction?

    My back issues began with sciatic pain too so I feel I will be able to give you some information after I hear back from you.

     
    Old 09-25-2015, 11:25 AM   #3
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    Re: Severe Siatic Pain down Right Leg

    Hi Teteri, I have also suffered from sciatic nerve pain and back pain. It doesn't matter what the MRI is showing, the bottom line is that a the sciatic nerve is being pinched by the bulging disc and all doctors are going to do is pile you with lot of medications, which we all know is not good for your health in the long run.

    What I do is research natural supplements that can also relieve pain and what I have found that helps me are: Omega-3, vitamin C, Curcumin, and Replenex. These are all natural and cannot harm your body any further. Research on these supplements and try them. Hope you feel better soon.

     
    Old 09-25-2015, 11:29 AM   #4
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    Re: Severe Siatic Pain down Right Leg

    Hi Teteri, I have also suffered from sciatic nerve pain and back pain. It doesn't matter what the MRI is showing, the bottom line is that a the sciatic nerve is being pinched by the bulging disc and all doctors are going to do is pile you with lot of medications, which we all know is not good for your health in the long run.

    What I do is research natural supplements that can also relieve pain and what I have found that helps me are: Omega-3, vitamin C, Curcumin, and Replenex. These are all natural and cannot harm your body any further. Research on these supplements and try them. Hope you feel better soon.

     
    Old 09-28-2015, 09:06 AM   #5
    renee0087
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    Re: Severe Siatic Pain down Right Leg

    teteri66 - Pain is only down right leg never left. I saw a neurosurgeon last year and he told me there was nothing surgically he could do. Hel felt the bulging discs were small and couldn't be causing all the pain. He never looked at my MRI showing the sacroiliac joint osteoarthrosis.

    The pain is severe and contant however, when I try to get up or sit down I get a jolting pain (kinda like you hit your funny bone). I also get the feeling like my foot is asleep with the tingling feeling.

    My new primary care doctor is sending me to KU Pain Center here in Kansas City. I told him I didn't want to see yet another pain doctor but he swears these people are better and different. My goal is to get them to refer me to the head of their neurosurgery because he is the best out here.

     
    Old 09-28-2015, 05:39 PM   #6
    teteri66
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    Re: Severe Siatic Pain down Right Leg

    Personally I would suggest you see a fellowship trained orthopedic spine surgeon. Their training is similar to the neurosurgery specialty but they often have a slightly different approach to issues.

    Also, I would not go through any more ablations or ESIs. There is some nerve compression that is impinging a nerve on the right side. There is nothing to indicate an issue with facet joints. You probably need a new MRI that includes the sacral area and SI joints.

     
    Old 09-29-2015, 08:59 AM   #7
    renee0087
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    Re: Severe Siatic Pain down Right Leg

    teteri66 - Thanks for the advice. Can you explain any of my MRI to me at this point. I have called and asked to have a new one done.

    Thanks!

     
    Old 09-30-2015, 07:56 AM   #8
    teteri66
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    Re: Severe Siatic Pain down Right Leg

    True sciatica comes from nerve compression of one or more of the lower lumbar spinal nerves. This can happen primarily in one of two areas: the central canal and the foramina, which is an opening located at each vertebral segment that allows the individual spinal nerve to exit the spine and go out to innervate a particular part of the body. As you can imagine, this is a small opening that can easily become narrowed or clogged up when something that doesn't belong there is in the way...things like a bulging disc, an enlarged facet joint, growth of little bone spurs, etc. This results in an irritation or compression of a spinal nerve which can cause pain and symptoms at the source of the compression or anywhere along the path of the nerve. If there is bad compression it can result in tingling or numbness.

    Another issue that can contribute to this narrowing, which is called stenosis, is a thickening of the ligamentum flavum. This is a band of ligaments that connect the vertebrae and provide stability for posture. As a part of degenerative disc disease and as we age this ligament tends to harden and lose its elasticity. It can contribute to the stenosis of the central canal, as it is doing here at L4-5 and L5-S1.

    There is a small amount of disc bulging at these two levels as well as some facet arthropathy. The facet joints are paired at each spinal segment and, along with the discs, are what allows the spine to bend and twist. Arthropathy refers to change in the joint that are of an arthritic, degenerative nature.

    I would have to agree that there is little here that would indicate a reason for severe sciatic pain.

     
    Old 09-30-2015, 09:26 AM   #9
    teteri66
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    Re: Severe Siatic Pain down Right Leg

    The middle part of the spine shows some curvature off to the right. Degenerative disc changes begin about half way down the thoracic spine, causing some small disc bulging, some signs of facet joint arthritis, some formation of small osteophytes(bone spurs). There is a loss of disc height from T6 on down...which is the beginning of degenerative disc disease. But all findings are not that significant, or were not at the time of the MRI.

    There is a small syrinx, which is a fluid-filled sac that has formed inside the spinal cord. It is filled with cerebrospinal fluid (CSF) which is normally surrounding the spinal cord. The formation of a syrinx is called "Syringomyelia." If you enjoy doing research, before you see the doctor, you may want to read up on this. It is possible that this could be causing some of your pain. It can also be a cause for curvature/scoliosis.

    I don't know enough about this topic to tell you much more...but I would definitely talk to your doctor about it, and I would want that doctor to be either a fellowship-trained orthopedic spine surgeon or a neurosurgeon. A GP may just shrug his shoulders and tell you it isn't that significant. He might be right, but I would want to be told that by a spine specialist!!

    Since you indicate you have been in lots of pain and have sciatic pain, and since the usually cause of sciatica is not apparent from your MRI, you will need to insist that the doctors investigate further. I would check out the syrinx or something with the SI joints if I were in your position.

    You could probably rule in or out the SI Joints as a source of pain by having a diagnostic nerve block. Doctors used to believe that sciatic pain was only produced by nerve compression of the L5 so S1 nerve. However, when this nerve compression is not apparent on MRI, there are cases where sciatic pain is caused by sacroiliac joint dysfunction. You might just be one of those people!

    I have quite a bit of experience with sciatic pain that was not easily diagnosed. I had a fusion at L4-5 which had no effect on it. Then because the MRI didn't show any nerve compression, I was told there was nothing that could be done. I spent the next two years going from specialist to specialist looking for answers. I did eventually find someone who could help me, but it was an arduous process.

    You may have to keep looking too.

    One more thing....I would ask the spine specialist what "acute angulation of the coccyx" means to you. In my case, my spine made an acute angle at about S1. When I was on my feet, gravity pushed down and the nerves were compressed right at that angle. When I lay down, the nerves decompressed and the pain eased. I don't know if the same thing could be happening with the coccyx, but it is worth investigating.

     
    Old 10-01-2015, 05:12 AM   #10
    renee0087
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    Re: Severe Siatic Pain down Right Leg

    teteri66 - I won't give up on this quest to get relief. I went to my PC doctor yesterday, he said he had to see me before ordering an MRI. So he checked me out and told me that I have diminished reflexes in my right ankle which indicates a pinched nerve duh. He would only order an MRI on my lumbar area I guess it's better than nothing. I will keep you all posted.

    Thanks!

     
    Old 10-01-2015, 05:48 AM   #11
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    Re: Severe Siatic Pain down Right Leg

    When you go in for the MRI, before they start tell the technician that you would like them to include the coccyx/sacrum area. Explain that you had a previous x-ray that showed some problems and you'd like to have it included. They may or may not do it, but it is worth asking.

     
    Old 10-01-2015, 07:44 AM   #12
    renee0087
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    Re: Severe Siatic Pain down Right Leg

    Thanks teteri66! I will make sure to ask, hopefully they will do it.

     
    Old 10-13-2015, 10:22 AM   #13
    renee0087
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    Re: Severe Siatic Pain down Right Leg

    teteri66 - I had my new MRI Sunday and here are the results.
    Findings: Minimal retrolisthesis of L5-S1 no cmpression.
    Enhancing focus in the L2 vertebral body measuring 1.2cm; despite atypical imaging features, this likely represents a hemangioma given its unchanged appearance. Other more typical appearing hemangiomas are seen, the largest at T11.

    L1-L2: No significant disc bulge, neuroforaminal narrowing or spinal canal narrowing.
    L1-L2: No significant disc bulge, neuroforaminal narrowing or spinal canal narrowing.
    L2-L3: Circumferential disc bulge without spinal canal narrowing. Mild bilateral neruoforaminal narrowing.
    L3-L4: Circumferential disc bulge without spinal canal narrowing. Mild bilateral neruoforaminal narrowing.
    L4-L5: Circumferential disc bulge with mild spinal canal narrowing. Mild bilateral neruoforaminal narrowing and mild facet arthropathy.
    L5-S1: Central disc protrusion with mild spinal canal narrowing. No neuroforaminal narrowing. Mild facet arthropathy.

    Impression: Multilevel degenerative changes, worst at L4-L5, with mild spinal canal narrowing and mild bilateral neuroforaminal narrowing.

    So now what shoould I do. I have severe sciatica down my right leg into calf and foot. My doctor is referring me to a Neurosurgeon that has a fellowship in spine surgery. What do you think he will say or want to do. I have had 12 ESIs in the last year with some pain relief, did PT with no help, chiropractic care no help, and tried gabapentin but stopped it due to it making me basically loopy and forgetful etc.

    Thanks in advance for helping me on this.

     
    Old 10-20-2015, 12:41 PM   #14
    renee0087
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    Re: Severe Siatic Pain down Right Leg

    Does anyone have any idea with my new MRI results what could be causing my sciatic pain down my right leg? I also have tingling, pins and needle feelings. I noticed late last week that my left foot is getting some tingling too.

    My husband was giving me a back massage last night and I noticed when he pushed down on my thoracic area my pain intinsified down my leg. Don't know if it's related or not. I know I have issues in my T-spine too but dr didn't order my MRI for that. I go see the Neurosurgeon on Monday, I only hope he can figure out my issue and fix it or at least try to.

    I also have an appointment at the pain clinic at KU Med Center tomorrow, not sure if I really want to go. But my husband said to go anyway, they have ortho and neuro surgeons in the clinic and if the pain dr wants to she can have them take a look at my MRI. Then I might get my second opinion and not have to wait til February to see their drs.

     
    Old 10-21-2015, 04:22 PM   #15
    renee0087
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    Re: Severe Siatic Pain down Right Leg

    I saw the pain doctor today and she said she wouldn't give anymore ESIs which was fine I didn't want one. She did order an EMG nerve conduction study to see if my nerve is pinched causing my sciatica. She says she believes I do have one and confirmed that I do have diminished Achilles reflex in my right foot compared to left. She was perplexed that my MRI shows mild stenosis etc. but my pain is more than it should be. She also ordered a new MRI of my thoracic spine to see if something new is going on there. I have a syrinx from T5-T9 and wants to check on it as well.

    Problem is I see neurosurgeon on Monday and these new tests won't be done till end of November! MRI is scheduled for 10/29 but EMG is day before Thanksgiving 😒

    Anybody have thoughts on my situation? My lumbar MRI results are above any takers on what the neurosurgeon might say? Someone please respond anyone!

     
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