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    Old 06-10-2018, 05:29 AM   #1
    61Frank
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    Terrible Sciatic Pain - looking for advice please ...

    I am a 68 year old relatively healthy guy with a family history of " bad backs " and have had on and off back pain for years - probably since my 20s. Occasionally I would also get soreness in my right butt cheek area.

    About 10 days ago I was putting a heavy power washer on a trailer and dont really know it that was the start of my current problem or not. Anyways during the course of that day while I was powerwashing My lower back really felt sore. I took off the next day because I was feeling worse and the pain was getting more prominent in my right butt cheek area and a little lower towards the right knee.

    I saw my regular doctor the next day who prescribed a 6 day dose pack of prednisone and ordered an MRI of lumbar spine. He also gave me a referral to their pain management group once the MRI results came in. The earliest they could do the MRI was 3 days later.

    While waiting for the day of the MRI my butt and leg pain were getting much worse each day to the point where the pain was now extending down below the knee and to the foot both along the right side and top. I could barely walk 20 feet before the severe burning would start and I would have to take all the pressure off my right leg. Walking is almost impossible.

    My MRI results came in this past Friday and here are the results:

    FINDINGS: The lumbar vertebral body heights are preserved. There is
    diffuse intervertebral disc desiccation with sparing of the L1-2 level.
    There is diffuse loss of intervertebral disc height, most prominent at
    L5-S1. The conus terminates normally at the T12-L1 level. There is
    normal alignment. There is no lumbar vertebral compression fracture.
    Prevertebral and paravertebral soft tissues are unremarkable.

    At L1-2, there is no disc herniation. There is no spinal canal or neural
    foraminal stenosis.

    At L2-3, there is a small disc bulge without significant spinal canal or
    neural foraminal stenosis.

    At L3-4, there is bilateral facet arthropathy and ligamentum flavum
    thickening with central annular fissure and small disc bulge. There is no
    significant spinal canal or neural foraminal stenosis.

    At L4-5, there is severe bilateral facet arthropathy, right worse than
    left, with bilateral facet joint effusions, ligamentum flavum thickening
    and disc osteophyte complex. There is a central annular fissure. The
    spinal canal is patent. There is a superimposed right neural foraminal
    disc extrusion, which compresses and displaces the exiting right L4 nerve
    root.

    At L5-S1, there is disc osteophyte complex with left central disc
    extrusion which indents the ventral thecal sac causing mild spinal canal
    stenosis and mildly displaces the left S1 nerve root. Bilateral neural
    foramina are patent.

    I will be contacting pain management tomorrow to see how quickly they can see me.
    I really have not seen any help from the Prednisone pills or the Ibuprofen that I am taking.
    This morning at 5 am I awoke with absolutely excruciating pain in back but concentrated in the right butt cheek area periformas muscle. Dont know if I moved during the night and aggravated something which caused this. If I sit I cannot put any pressure on my right butt cheek due to pain. If I stand on my left foot and let my right leg hang the burning starts almost immediately all the way down to my foot.

    Just wondering if anyone has had anything similar. Could the L4 nerve be the cause of this. What can I expect???

    Thank you for your time...

     
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    Old 06-11-2018, 06:02 AM   #2
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    Re: Terrible Sciatic Pain - looking for advice please...

    I would suggest you make an appointment with a spine specialist. This can be either a fellowship-trained orthopedic spine surgeon or a neurosurgeon whose practice is limited to issues of the neck and back. For the most part, your lumbar spine shows the kind of issues that are common as we age...some spinal arthritis that causes the facet joints to enlarge (facet arthropathy) some drying out of the disc tissue, which causes the disc to lose height (disc dessiccation), loss of elasticity of the ligamentum flavum which is the long ligament that connects the vertebrae. Generally when there is facet arthropathy, the ligament tends to thicken and become less flexible, which often contributes to spinal stenosis.

    It looks like most of your pain is stemming from the injury to the disc at L4-5. You will note there are a couple other small disc bulges that are mentioned in the report. This is not unusual and is not an issue unless they are pushing into a spinal nerve...which is not the case here.

    However at L4-5, the disc is pushing out of the disc space into an opening called the foramen, which is an opening or passageway that allows the spinal nerve to exit the spine as it goes out to the area of the body it innervates. Some disc tissue has moved into this passageway and is putting pressure on the L4 nerve. This can cause pain to be felt in the lower back or anywhere along the path of the part of the body the nerve innervates...in this case, it runs across part of the lower back, buttocks and then kind of wraps around the hip and runs down the thigh, across the knee and then down the inside of the calf.

    There is a smaller disc extrusion that has caused some disc material to push out of the disc space, mainly on the left side, and it is pushing into the spinal canal and the left S1 nerve. This is resulting in mild spinal stenosis.

    I would suggest you visit a spine specialist for an accurate diagnosis and plan for treatment...which will most likely take a conservative approach, consisting of a course of physical therapy, oral medication to treat inflammation and pain, perhaps a series of epidural steroid injections, given for the same purposes, etc. When you have a history of back pain, and now know there are several discs that are bulging or herniated, I think it is a good idea to meet with either an orthopedic spine or neuro surgeon rather than starting out in pain management. This way, if you find yourself in a position where surgery becomes necessary, you will have an established relationship with a spine surgeon and won't have to wait so long for an appointment.

    Also the spine surgeon will be able to look at the MRI and will perform a basic neurological test to see to what extent the bulges are impacting the nerves. This helps to determine whether surgery is required or whether the situation can resolve itself.

    In the meantime avoid any activity where you are bending over or backward, twisting at the waist and do not lift anything over about 10 pounds. Be sure to drink lots of fluids, particularly water. You will be in pain. There really aren't medications that will successfully resolve the pain. While it is very painful, it will not lead to paralysis and it is not an emergency situation.

    Good luck and hopefully you will be feeling better relatively soon.

     
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    Old 06-11-2018, 07:47 AM   #3
    61Frank
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    Re: Terrible Sciatic Pain - looking for advice please...

    Thank you very much for the reply and all the information. I have just requested an appointment to have a consultation with a neurosurgeon.

    In the meanwhile pain management was supposed to call me today to see how quickly they can see me. If they can see me quickly (hopefully) I will have to go in since the pain I am having is the worst I have ever had and absolutely excruciating.... Maybe they can do something to relieve some of this.

    What is strange is that when the pain is severe, I hardly feel any pain in my lower back --- it all seems to be concentrated a few inches to the right in the piriformis muscle - then it goes down to the lower leg and foot. If I lay down with a hard rubber ball under that spot of the piriformis I get a little relief - like a " good hurt ".

    Will hope for the best. Thank you for your time.

    Frank

     
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    Old 06-11-2018, 10:50 AM   #4
    teteri66
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    Re: Terrible Sciatic Pain - looking for advice please...

    I had sciatic pain and lived with it for several years before I finally agreed to surgery. I had almost no back pain during that period...but increasingly I could not walk due to leg and hip pain. Mine was caused from spinal stenosis rather than a disc problem, so the pain was mostly radiating.

    Even though using the ball helps to relieve the pain briefly, the source of the pain is in your lower spine.

    You might also want to make an appointment with an orthopedic spine surgeon so you will have two solid opinions in case surgery is recommended.

    Don't be surprised if the people at pain management want to give you an epidural steroid injection right away. It is pretty standard practice...that and a course of physical therapy. Often the injection is given first so the person can tolerate physical therapy and exercise.

     
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    Old 06-12-2018, 07:47 AM   #5
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    Re: Terrible Sciatic Pain - looking for advice please...

    Frank,

    My answer is simplistic but some times the best answers are simple. My daughter had such severe sciatic pain that she could not walk that took her to the Emergency room. We all thought she needed surgery. The MRI showed problems but her insurance resisted paying for surgery.

    She did change insurance companies, but it turned out to be a good thing that the first insurance company was so uncooperative. She was sent by a surgeon to physical therapy and gradually the pain started going away. She sits all day at work. She got a new chair, better for the back, and a the new adjustable computer stand so she can sit or stand to do her work.

    Surgery is a risk and not always the best solution. You may want to seriously consider other solutions. If you have to have surgery, that is always still an option.
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    Last edited by yayagirl; 06-12-2018 at 07:53 AM.

     
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    Old 06-12-2018, 09:34 AM   #6
    61Frank
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    Re: Terrible Sciatic Pain - looking for advice please...

    Just wondering did your daughter have any MRI results showing any disk herniation affecting any nerve roots which would be the cause of her sciatica ??

    I would never jump in any back surgery - just looking for a professional opinion as to whether my condition could heal itself as discs sometimes do.

    I doubt if I would even ever try an ESI epidural steroid injection. If you want to read something really scary just look into " Arachnoiditis " this condition has been occurring with more frequency lately due to these injections.

    Physical therapy would certainly be preferred.

    Thank you for your advice. Frank

     
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    Old 06-22-2019, 04:55 PM   #7
    ladygirl50
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    Re: Terrible Sciatic Pain - looking for advice please...

    I am 59 years old i have had two back surgery's one in 1999 L5 S1 and my second 2015 L4. My second one I didn't bounce back as quickly. My spinal fluid sac was nicked and I had to lay flat for 3 days. Doctor saud they did clean up a bunch of scare tissues from first surgery. I had a laminectomy for both surgeries and the second they had to add screws.
    Recovery was not as easy I guess I have to chalk that up to age I guesss. Here is my problem. I am having the worst nerve pain down both of my legs. This started two years afterv2nd surgery. Mild at first now its horribke. The pain can leave me paralyzed unable to move. And i am nit exaggerating. I have it worse at night. My husband has heard me cry out at night it is so bad.

    I am scheduled for a bilateral EMG and also an MRI next week.

    I am no novice to nerve pain,but this is the worst . It goes from my back to my butt down both sides of my legs, sometimes my knees and my calf. I have to ask for a disabled placard for long distance. When we go to ballgames I have to stand most of the time,and walk around even when it hurts.

    So any advice or maybe some idea of what it could be? I heard that sciatica pain is a symptom that says there's something else goung on. Thank you kindly

     
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    Old 06-22-2019, 05:29 PM   #8
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    Re: Terrible Sciatic Pain - looking for advice please...

    My husband has similar pain and almost the exact same MRI results. Have you considered going for PT before you do something as drastic as surgery? Spinal surgeries never end with just one..

    My husband has gone for PT off and on for years and he also gets Steriod injections- both help him enough to work (he does physical work in construction) and he manages to live with it with minimal pain. When he cannot get to PT- he does the exercises at home.

    I would look into less invasive possibilities before you contemplate surgery as surgery should really be a last resort.
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    Old 06-22-2019, 06:43 PM   #9
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    Re: Terrible Sciatic Pain - looking for advice please...

    I have the same thing from L1-S1..along with the stenosis. Did 12 sessions of PT, keep up with my exercises at home, changed my workout, stopped jogging and all is great! I did do a Medrol dose pack just to see how much it would help - if at all. It knocked it back a little. But I am now a firm believer in PT. I didn't give it much chance at the start but it has really made my life so much easier...even though I've had to limit some things. I strongly suggest you give it a try.

     
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    Old 06-25-2019, 06:28 PM   #10
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    Re: Terrible Sciatic Pain - looking for advice please...

    Sciatic pain is a sign of a spinal nerve compression. However, it is somewhat unusual to have it in both legs unless there is also some instability going on.

    It may be that you have developed a spondylolisthesis a L5-S1, or, possibly L4-5 if that segment is not fused....

    Let us know the results of the MRI after you have it!

     
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    Old 06-30-2019, 10:06 PM   #11
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    Re: Terrible Sciatic Pain - looking for advice please...

    [QUOTE=teteri66;5495607]Sciatic pain is a sign of a spinal nerve compression. However, it is somewhat unusual to have it in both legs unless there is also some instability going on.

    It may be that you have developed a spondylolisthesis a L5-S1, or, possibly L4-5 if that segment is not fused....

    Let us know the results of the MRI after you have it![/QUOTE]

     
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    Old 06-30-2019, 10:10 PM   #12
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    Re: Terrible Sciatic Pain - looking for advice please ...

    seen posterior to L4-5, L5-S1 level. No focal fluid collection is
    identified. 7 mm T2 hyperintensity is noted in the right kidney
    midportion, likely a cyst.
    On axial images, at T12-L1 level, there is no disc disease.
    At L1-L2 level, there is no disc bulge.
    At L2-L3 level, there is no disc disease.
    At L3-L4 level, there is 4 mm diffuse disc osteophyte complex, mild
    bilateral facet disease. There is mild central canal stenosis with no
    neuroforaminal narrowing. Previously noted synovial cyst is no longer
    seen.
    At L4-L5 level, there is no central canal stenosis. Hardware artifact is
    again noted. There is no definite evidence of neuroforaminal narrowing.
    At L5-S1 level, hardware artifact is again demonstrated which obscures
    neuroforamina. There is no central canal stenosis.


    IMPRESSION:
    1. Redemonstration of fusion at L4-5, L5-S1 level with hardware in place
    2. 4 mm disc osteophyte complex at L3-4 level causing mild central canal
    stenosis without neuroforaminal narrowing.

    Last edited by ladygirl50; 06-30-2019 at 10:12 PM. Reason: Information cut off

     
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    Old 07-10-2019, 05:12 PM   #13
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    Re: Terrible Sciatic Pain - looking for advice please ...

    [QUOTE=ladygirl50;5495676]seen posterior to L4-5, L5-S1 level. No focal fluid collection is
    identified. 7 mm T2 hyperintensity is noted in the right kidney
    midportion, likely a cyst.
    On axial images, at T12-L1 level, there is no disc disease.
    At L1-L2 level, there is no disc bulge.
    At L2-L3 level, there is no disc disease.
    At L3-L4 level, there is 4 mm diffuse disc osteophyte complex, mild
    bilateral facet disease. There is mild central canal stenosis with no
    neuroforaminal narrowing. Previously noted synovial cyst is no longer
    seen.
    At L4-L5 level, there is no central canal stenosis. Hardware artifact is
    again noted. There is no definite evidence of neuroforaminal narrowing.
    At L5-S1 level, hardware artifact is again demonstrated which obscures
    neuroforamina. There is no central canal stenosis.


    IMPRESSION:
    1. Redemonstration of fusion at L4-5, L5-S1 level with hardware in place
    2. 4 mm disc osteophyte complex at L3-4 level causing mild central canal
    stenosis without neuroforaminal narrowing.[/QUOTE]

     
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    Old 07-10-2019, 05:14 PM   #14
    bygrace1
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    Re: Terrible Sciatic Pain - looking for advice please ...

    [QUOTE=ladygirl50;5495676]seen posterior to L4-5, L5-S1 level. No focal fluid collection is
    identified. 7 mm T2 hyperintensity is noted in the right kidney
    midportion, likely a cyst.
    On axial images, at T12-L1 level, there is no disc disease.
    At L1-L2 level, there is no disc bulge.
    At L2-L3 level, there is no disc disease.
    At L3-L4 level, there is 4 mm diffuse disc osteophyte complex, mild
    bilateral facet disease. There is mild central canal stenosis with no
    neuroforaminal narrowing. Previously noted synovial cyst is no longer
    seen.
    At L4-L5 level, there is no central canal stenosis. Hardware artifact is
    again noted. There is no definite evidence of neuroforaminal narrowing.
    At L5-S1 level, hardware artifact is again demonstrated which obscures
    neuroforamina. There is no central canal stenosis.


    IMPRESSION:
    1. Redemonstration of fusion at L4-5, L5-S1 level with hardware in place
    2. 4 mm disc osteophyte complex at L3-4 level causing mild central canal
    stenosis without neuroforaminal narrowing.[/QUOTE]

    How are you doing now?

     
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    Old 07-10-2019, 05:28 PM   #15
    bygrace1
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    Re: Terrible Sciatic Pain - looking for advice please...

    I had large cyst in L4 L5 lumbar spine surgically removed 5 weeks ago and still have pain and lot of swelling at the incision area for last 4 weeks ago ?

     
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