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Neurology (Expert Forum)
back pain / muscle spasms
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back pain / muscle spasms
by emerald28, Jul 11, 2003 12:00AM
I was injured on Jan 4,2003 when a patient attempted to bite me. I jumped back/twisted away from him. About 20 min later my lower back started to kill. Later that night my upper back went into spasms. I continued having upper back spasms and lower back pain for months. Dr's said upper back was compensating for lower back problem. Cervical MRI showed C5-6 annular disk bulge with mild central canal stenosis. Lumbar mri showed l5 s1 protrusion. In the end of March I began to have urinary problems (ie retention, incontinence after urinating, and loss of flow control). I went to a urologist, he said it was my back. My orthopedic disagreed and said there was nothing further he could do for me. After begging, I was reffered to a spine specialist. I discussed it with him and he said that he couldn't see where the Mri indicated bladder issues. He thought it was the pain/spasm medicine. He did order a new mri that showed prodominant L5-S1 Right paramedial herniation causing spinal stenosis and Right foraminal encroachment. The next morning i had a microdiscectomy. I was great for about 2 weeks and then tripped and now everything is back(not as bad as before). Bladder hasn't recovered yet. My question is could a prodominant R parimedial herniation cause cauda equina syndrome? My INNER THIGHS on both legs are sore and painful along a path down my knee from groin area(I can't find any info about that kind of radiculopathy). What could that be? I now have new tingling in perineal area. Dr said it was inflammation but steroids didn't totally take it away. Thankyou for your thoughts
Doctor's Answer
by CCF-Neuro-M.D.-CS, Jul 13, 2003 12:00AM
The spinal cord actually ends at approximately the L1 level in most individuals. All of the nerves leaving the spine for lower segments (L5, S1) leave the spinal cord and travel the remainder of the way outside the cord. The collection of these nerves is referred to as the cauda equina (named after a horses tail). Cauda equina syndrome occurrs when something compresses these structures. It is possible with cauda equina syndrome to spare the nerves serving motor function in the leg , and only injure the nerves going to your bowel, bladder, and sensation in the perineal region. Since you had a fall with recurrence of symptoms, a MRI may be needed to ensure that there has been no new injury. You should discuss this with your surgeon, and if you are not satisfied then a second opinion with a spine surgeon, or a consult with a Neurologist would be appropriate. If you are in the Cleveland Clinic area we have excellent surgeons and neurologists available for consultations. If at any point you loss complete bladder or bowel function this is an emergency, which should be addressed immediately. I hope this helps. Goodluck
Georgie