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Spine and Back Health

Herniated discs/annular tears/leg pain

04/09/2008

Question:

I hope that you can help me. I do already have an appt made for a second opinion. I am in so much pain. I injured my low back 17 months ago. It is getting worse as time goes by. I have had 2 MRI`s, CT scans, aquatic and 2 different types of additional physical therapy, TENS unit, 2 cortisone injections (gone bad, meaning they made the pain worse), different pain medications, a discogram as well as a two level anesthetic discogram. After all that testing, I have learned: #1. My L3-4 disc is herniated with a large left posterior annular tear and has moderate left L3 nerve root displacement as it exits its foramen. #2. My L4-5 disc is also herniated with a large posterior annular tear and has a mild displacement of L4 nerve root going into the spinal canal as well as having (DDD). #3. My L5-S1 has a tiny left herniation and a tiny annular tear (according to the CT scan done right after the discogram with the dye still in my discs). This however, is only stated in one of the Dr. reports so I don`t know if it is a true statement. All of the other reports state that my L5-S1 and L2-3 are anatomically normal discs. I will find out which is the true statement while getting a second opinion on March 20th. My symptoms are, I can not sit for an extended period of time, both of my feet tingle (while laying flat and sitting), I have severe pain in both buttocks and my right leg acts like a "noodle". It either hyper-extends backwards at the knee while walking or the knee gives out on me forwardly. Sometimes the right leg symptoms are not as bad when I first get up in the morning. It get worse throughout the day. At bedtime, the first 2 hours I have to get up at least 5-6 times to urinate, then every 1 to 2 hours through out the night. My concern is that I can not urinate, even with a full bladder. Once I am able to that`s great. It is very frustrating. I can not lay on my sides for very long if at all because of the back pain. I have found that I do get some comfort/relief by laying on a hand towel partially filled with rice. I heat it up in the microwave at night to help me fall asleep and through out the day. Icing doesn`t do much for me. I have pain medication that hardly touches the pain. This is how I can describe my back/buttock pain. It feels like someone is holding screw drivers one in each hand at my L3-4 disc level and tightening them. My low back pain feels like I have a -50* below 0 rubber mallot stuck in my low back. It is a deep dull pain that never goes away. My right leg almost feels like (RLS) restless leg syndrome. One hour after I had the anesthetic discogram done at L3-4 and L4-5 I had 100% NO PAIN! After the anesthetic discogram my surgeon commented that this is what it would feel like after fusing my discs. My surgeon is recommending 2 level disc fusion at L3-4 and L4-5 only because my insurance will not cover 2 total disc replacements. My questions are: #1. Is the lack of my urination problem, have anything to do with my back injury? I never had this problem prior to the injury. #2. Have you heard of anyone having problems with their legs like I have discribed to you? #3. Do you feel my injury needs to be corrected surgically because I have tried everything else? #4. From everything that I have told you, do you feel this is a very serious matter or not? I am totally disabled at this point and know that I can not live the rest of my life like this.

Sorry that this has turned out to be a novel. I can`t wait to get your response. Thank you in advance for your time! This is a very informative site.

Answer:

Thank you for your question. On this site, we try to answer general questions about health but cannot diagnose or recommend treatment. You appear to have some very, very specific questions about your condition, which can only be answered properly by a physician who is familiar with your history, physical exam, and test results.

You did not mention whether you are a man or a woman, or your age. If you are a middle-aged (or older) man, your urinary symptoms may be due to problems with the prostate gland, and you should get that checked by your regular doctor. Other than this, your questions should only be answered by a physician who has performed a full history and physical examination. Definitely follow up with your scheduled second opinion and insist that they answer these questions in a way that you are able to understand before consenting to any treatment. Good luck. 

For more information:

Go to the Spine and Back Health health topic, where you can:

Response by:

David J Hart, MD David J Hart, MD
Associate Professor of Neurosurgery
School of Medicine
Case Western Reserve University