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Dr. Thomas, MD
Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 56313
Experience:  Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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Hi, I am a 31 year old female I have been suffering from chronic

Resolved Question:

Hi, I am a 31 year old female
I have been suffering from chronic left low back pain for about 4 years, along with leg pain, upper/mid back pain, neck, headaches and TMJ.
I have been diagnosed with Fibromyalgia but told by the doctor the cause of this most likely is my chronic left low back pain. I have a enlarged left transverse process with "false joints" to the ilium and sacrum. Its basically bone on bone and the whole area is arthritic. I also have an L6 vertebrae. I also have annular tears on the lowest two levels in my lumbar spine. I was always an athletic person but because of my pain I have not been able to do much at all the last couple of years.
I also suffer from chronic pelvic pain and non relaxing pelvic floor.

To get to my questions... I have had an increase in inner thigh, knee and calf pain the last few months. Along with saddle pain and numbness( numbness comes and goes).
This is all along the left side. Every time I have to poop the pain in the leg gets intense , then after I have gone to the bathroom it gets better.
Is this something to worry about?
I talked to my doctor about this and she mentioned possible obtruator nerve damage.
Could this be coming for my lumbar spine or is it more likely to be from a pinched nerve in the pelvis? And what could be done about it??
Thank you for your time!
Submitted: 11 months ago.
Category: Medical
Expert:  Dr. Thomas, MD replied 11 months ago.
Hello from JA
It could be coming from lower spine OR pelvis

What type of doctor are you seeing?
Customer: replied 11 months ago.

I have been seeing a doctor at OBGYN specializing in chronic pelvic pain , an orthopedic surgeon, a chiropractor, and a Rheumatologist specializing in fibromyalgia.


I

Expert:  Dr. Thomas, MD replied 11 months ago.
OK
and have you had an MRI of the lower spine?
Customer: replied 11 months ago.

Yes I had an MRI of my lumbar spine and Pelvis in November 2012.


Showing:


 


The Lumbar MRI said:


 




'The visualized osseous elements are intact with no evidence of fracture or spondylolisthesis. The marrow signals are within normal limits. The normal lordotic curvature of the lumbar spine is well maintained. The conus medullaris and cauda equina are within normal limits. Multilevel dehydration is seen without desiccation and preservation of normal disc space height.


The spinal cord terminates at L1 vertebral body level. On this study the last disk space is labelled as L5-S1.


There is evidence of an enlarged left L5 transverse process which forms joint/arthrosis with ileum as well as sacrum. This represents a lumbosacral transitional vertebra variant and is known to produce Bertolotti's syndrome, a low back pain due to change in the biomechanical properties of the lumbar spine.


Note is made of prominent Schmorl's nodes at T10-T11 and T11-T12 levels which represent endplate microfracture and likely related to prior or repetitive injury/stress. Evaluation of individual levels reveals the following.


At L5-S1 disc bulge indents the ventral thecal sac. There is evidence of mild hypertrophic facet disease. Canal and foramina are patent.


At L4-L5 disc bulge is seen. Foramina are narrowed. Canal is patent. Mild hypertrophic facet disease is noted.


At L3-L4 there is no disc herniation or bulge present. Canal and foramina are patent. Mild hypertrophic facet disease is noted. '


 






IMPRESSION:




 





page2image8392




1. At L5-S1 disc bulge indents the ventral thecal sac. There is evidence of mild hypertrophic facet disease. Canal and foramina are patent.
2. At L4-L5 disc bulge is seen. Foramina are narrowed. Canal is patent. Mild hypertrophic facet disease is noted.


3. Prominent Schmorl's nodes at T10-T11 and T11-T12 levels
4. Enlarged left L5 transverse process which forms joint/arthrosis with ileum as well as sacrum. This represents a lumbosacral transitional vertebra variant and is known to produce Bertolotti's syndrome, a low back pain due to change in the biomechanical properties of the lumbar spine.


 


Pelvis MRI said:


"



COMMENTS:


There is evidence of an enlarged left L5 transverse process which forms joint/arthrosis with ileum as well as sacrum. This represents a lumbosacral transitional vertebra variant and is known to produce Bertolotti's syndrome, a low back pain due to change in the biomechanical properties of the lumbar spine. The bony structures are otherwise within normal limits without evidence of fractures or abnormal bone marrow edema.


The uterus is mildly enlarged measuring 8.5 x 3.5 x 5.5 cm. The endometrial stripe measures up to measures 5 mm. Transitional zone measures up to 7 mm within limits of normal. Several nabothian cysts are present. Both ovaries contain follicles measuring up to 5 mm.


The bladder is physiologically distended. There is no abnormally increased free intraperitoneal fluid. There is no pelvic mass or no enlarged lymph nodes. Small amount of fluid is present in the pelvic cul-de-sac. This may represent ruptured ovarian cyst.


There is no evidence of soft tissue pelvic pathology.


IMPRESSION:
1. Enlarged left L5 transverse process which forms joint/arthrosis with ileum as well as sacrum. This represents a lumbosacral transitional vertebra variant and is known to produce Bertolotti's syndrome, a low back pain due to change in the biomechanical properties of the lumbar spine.
2. Small amount of fluid is present in the pelvic cul-de-sac. This may represent ruptured ovarian cyst. "







 



Expert:  Dr. Thomas, MD replied 11 months ago.
I suggest that you see a physical medicine and rehabilitation MD, a type of specialist in structural and manual medicine.
Yes this is most likely either from spine or pelvis and can be relieved greatly with the correct manual medicine techniques...from physical therapy to the correct traction.

Hands on assessment will also most likely localize the problem.
Please let me know if you have further questions.
Please don’t forget a positive rating.
Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 56313
Experience: Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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