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Arthritis (Expert Forum)
Spinal stenosis; SI joint
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions and support regarding arthritis issues such as: Arthritis, Autoimmune Disease, Bursitis, Fibromyalgia, Gout, Juvenile Rheumatoid Arthritis, Lupus, Myositis, Neuralgia, Osteoarthritis, Polymyalgia Rheumatica, Rheumatoid Arthritis, Sciatica, Tendinitis, Vasculitis.
Spinal stenosis; SI joint
by FaithfulMom, Oct 13, 2005 12:00AM
I’ve been struggling with low back pain and sciatica for almost two years. I've missed a considerable amount of time at work because driving and sitting hurt like crazy. There was some mention of spondylolisthesis (L4-5) on an MRI, but primarily degenerative disk disease and arthritic findings. I drive 2 hours a day and work at a computer-oriented job. Sitting causes much pain. I took 2 months off and underwent a serious physical therapy program. Got marginally better, mostly in the ability to manage the pain. Walking and activity usually lessened the pain. Two days after return to work, the pain was back full force. About a month ago, we were threatened with a Category 4 hurricane and my husband was out of town. I spent hours moving things upstairs and loading other things into the car (up and down the stairs for hours). We were spared the wrath of the storm, but a few days later, my back, buttock and leg pain sky-rocketed. Walking is now excruciating. Sitting and prone is best. I’m 52 and don’t know how I will manage the rest of my life with this pain. My mom also has DDD (with spinal stenosis) and has had cervical and lumbar laminectomies. She did fairly well after both. From all of my reading, I know that spinal stenosis is likely and that surgery is probably my best option at this time. I REALLY don't want a fusion, though. My questions, if a laminectomy would help, how unstable does the spine become because of the removal of that bone? Could the SI joint also be a primary issue in my pain? Anatomically, that’s where it hurt the most prior to this latest development. If so, is there ANYTHING that one can do to strengthen or “fix” problems there (SI joint)? Also, I am becoming more and more “flexible”…i.e., my hypermobility usually causes my doctors to think that I have a great range of motion ( I can flex forward and touch the floor)…and thus they don’t take me too seriously. Could there be something hormonally that is causing lax ligaments?
I want to be pro-active with this. I don’t want to be old…so young! And...between hot flashes and excruciating back/butt/leg pain...I am about ready to call it quits. I'd appreciate any words of advice or direction.
I want to be pro-active with this. I don’t want to be old…so young! And...between hot flashes and excruciating back/butt/leg pain...I am about ready to call it quits. I'd appreciate any words of advice or direction.
Doctor's Answer
by Kevin Pho, MD, Oct 17, 2005 12:00AM
, Oct 17, 2005 12:00AM
To answer your questions:
1) It is possible that the SI joint may be the cause of the pain. If this has been determined to be the case, you can consider a referral to a pain clinic for SI joint injections. Steroids would be injected to decrease the inflammation.
2) I am not aware of a hormonal cause that would increase joint flexibility.
3) If spinal stenosis is a concern, a pain clinic or visit to an anesthesiologist can be made to determine if epidural injections would be helpful in pain relief.
If this is not feasible, then a referral to a neurosurgeon can be considered to discuss surgical options.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
http://www.straightfromthedoc.com
1) It is possible that the SI joint may be the cause of the pain. If this has been determined to be the case, you can consider a referral to a pain clinic for SI joint injections. Steroids would be injected to decrease the inflammation.
2) I am not aware of a hormonal cause that would increase joint flexibility.
3) If spinal stenosis is a concern, a pain clinic or visit to an anesthesiologist can be made to determine if epidural injections would be helpful in pain relief.
If this is not feasible, then a referral to a neurosurgeon can be considered to discuss surgical options.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
http://www.straightfromthedoc.com
Thanks, Brenda
For years I've been making do with muscle relaxers and Darvocet. My GP finally gave me Percocet and that helps more than anything. In addition to the arthritis, I also have fibromyalgia, and when both are in flare, I just want to give up. But then I have good days and know that's not an option. Just know you're not alone out there. We are many.
Ann