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Vakul Aren
Vakul Aren, Doctor
Category: Medical
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Experience:  MBBS,DTM&H,30 years of experience
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This is an ortho spinal pain question.

Resolved Question:

This is an ortho spinal pain question, for someone experienced in spines.

I hurt my back and had lumbar disctectomy last Feb. I am fit and normal weight and exercise almost daily. My problem was a herniated disc at L4/L5 that caused left foot drop. I still have a residual 5mm posterior disc bulge and also some scar tissue compressing l5 nerve root to the left. Also severe spinal arthrosis at l4/l5 and S1.

My problem is although my back should be strong from all the exercise, my sacrum area is very painful when pressure is applied like sitting back onto a car seat or sofa cushion pressing on it, or even pressure from touch. It is now even triggered from laying the bathtub because the bathtub surface is hard. I get a deep ache in sacrum andit radiates into my thigh. A very deep ache
from some pressure put onto sacrum from very normal and gentle activity? What can it be from??

Thank you for your help.
Submitted: 1 year ago.
Category: Medical
Expert:  Vakul Aren replied 1 year ago.
Have you had a MRI scan done lately?Was there a increase in the problem after surgery?Any thyroid problems or diabetes?Please give me more information.Thank you.
Customer: replied 1 year ago.
My last MRI was in Nov 2011. The MRi states that there is a residual 5mm posterior disc bulge mildly abutting thecal sac. Also a round scar tissue compressing left L5 nerve root which is focally thickened, and of course severe l4-s1 facet arthrosis. That's all. I am also hyperthyroid.
Expert:  Vakul Aren replied 1 year ago.

Thank you for the information.Studies have indicated that almost 50% of patients will have bulging of interveretebral discs in the lumbosacral spine by the age of 40-60 years out of which only half will be symptomatic. Evidently in your case there are severe symptoms,also perhaps a check up of the sacral spinal root nerves/pudendal nerves may show compression of these nerve roots causing the symptoms of the sacral area.Inflammatory joint disease like in Rheumatoid Arthritis and Spondylosis of the lumbosacral spine ,sacroiliac joint dysfunction due to trauma or stretching or compressive forces of the ligaments and SI joints may cause tenderness in the sacral area.Disc prolapse and spinal nerve root compression in the lumbar and sacral area may also cause tenderness of the coccyx. Coccydynia may occur due to injury/fall on the sacrum or damage of the coccyx. This can result in tenderness and pain.Osteoporosis and sacral insufficiency fractures have been known to occur in females without any history of trauma.The bones may become too weak to handle weight bearing in the area due to severe osteoporosis,a DEXA scan will reveal the severe osteoporosis.Hyperparathyroidism may need to be ruled out . L5-S1 disc compression and thecal bulging has been known to produce pain in the hips,buttocks and thighs.Numbness,tingling and other sensory changes are known to occur with the L5-S1 disc problems and facet problems in the area.The opinion of a Neurosurgeon and a good Orthopaedic surgeon may help in managing this problem.

Customer: replied 1 year ago.

Ok may I please ask what is the treatment for sacral spinal nerve root compression?


 


Also what imaging can be done will a CT scan be ok??

Expert:  Vakul Aren replied 1 year ago.
Depending on the severity of the problem,you can treat spinal nerve root compression by surgical decompression and non-surgical means. Non-surgical management will include the use of bed rest, pain management with drugs, and physiotherapy.The physiotherapy modalities may include intermitent traction and local SWD,interferential therapy and other means of pain relief.Surgical decompression is usually more effective but may involve greater risks.
Imaging can be done by a CT scan and a MRI scan.the MRI scan s preferred as it brings out greater details.
Vakul Aren, Doctor
Category: Medical
Satisfied Customers: 3373
Experience: MBBS,DTM&H,30 years of experience
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