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Transitional Lumbosacral Vertebrae
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Transitional Lumbosacral Vertebrae

Hi,
I have been diagnosed with Transitional Lumbosacral Vertebrae.  Unfortunately I never got the chance to see those x-ray results and those were done in 2003.  I had another x-ray done a year ago which showed rotoscoliosis and a Schmorl's node at L-1.
My symptoms have been increasing pain since 2001.  The pain at that time was in my right hip but my doctor advised an x-ray of the low back which showed the TLS.  I always have pain in my low back, radiating into my right hip and at times the pain radiates down my entire right leg as far as my ankle.  Depending on what I'm doing this pain will be through both hips and legs.  I can't sit for any length of time without feeling pain through that hip and I'm often awakened through the night.  
My chiropractor insists this is all muscular but it doesn't feel like it, it feels more like nerve pain.
I have been referred for an MRI and I hope the appointment will be soon.  
I want to know if there is anything that can be done for the TLS either surgically or non-surgically and what the pain I'm experiencing could be caused from.
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Avatar_n_tn
Hi,
How are you feeling?
Your pain symptomatology suggests that your pain is indeed is radicular pain, the one which radiates down.
I can understand how concerned you are for your hip pain and its radiation down to ankle.
Where is your pain exactly if you have to point out with your index finger?
This is we are trying to differentiate between nociceptive pain from your hip and radicular lower back pain.
What is the quality of your pain (e.g., shooting, electric, dull, aching, etc.)?
Since how long back are you having this pain?
Do any positions aggravate or relieve your symptoms? Have you tried anything to help your pain?
Have you experienced any recent night sweats, weight loss, hematuria, urinary retention, frequency, hesitancy, or cough? Do you have a history of cancer, overseas travel, recent surgery, fever, or increased pain at rest?
Does your pain ever wake you from sleep?
Have you had any recent change in bowel or bladder habits? Do you have any altered sensation in your groin, buttocks, or inner thighs?
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Avatar_f_tn
Thank you, I'll do my best to answer your questions.  As for how I'm feeling, well, today has been better than the last few days.  It seems the weather front that moved past here yesterday took its toll as it felt like I was carrying around an invisible weight.  Right now the pain is a dull ache.
The exact location where my pain is the most is not quite 2 inches to the right of spine before the pelvis would rise into the iliac crest.  That's where the pain always is whether it's a dull ache or the shooting pain of spasms.  But I do have pain into the hip which causes me to limp--full weight when walking sends this pain in reverse. I believe the pain that I have in the left side is mostly from compensation and it rarely gets worse than an ache.
I had some minor back pain in the 1990's but it wasn't until after I delivered my daughter in 1998 that this all began.  In 2001, I was doing in-home nursing care and it started getting worse.  I thought it was from lifting, pushing a wheelchair, etc so I changed jobs and began teaching (2002)and it has gradually worsened since then.  2002-2006 the pain remained mostly in the low back and hip, still causing me to limp and varied in quality depending on a number of variants.  It has been since the summer that the pain has now started radiating down my legs(it does radiate down both legs though the pain in the left hip doesn't typically worsen).  This can be due to weather changes or it can be due to me sitting too long.  It almost feels like the muscle in my right thigh starts to shrink.
I have also been finding, since September, that sitting greatly aggravates the symptoms almost making it impossible for me to bear any weight on the right hip upon standing up and that's when I experience shooting pain from the hip into the low back.  
The greatest relief for me is lying down either on my back with a pillow under my knees as I can't lie flat on my back with both legs extended or pain shoots through low back or on either side with a pillow between my legs.  This is usually how I sleep at night. I have had the pain wake me from sleep--these are usually spasms through that spot on my low back into my hip and more recently it was a pain at the bottom of my foot near the heel that spasmed when it felt like sending the pain into my ankle.
No changes in bowel or bladder habits and no altered sensations through groin, buttockes or inner thighs.
No recent night sweats or weight loss, no bladder issues at all and no cough.  I don't have a history of cancer I have never been overseas.  Once in a while over the last 2 weeks I've been feeling flushed like a low-grade fever but I also work in a family practice with patients coughing all over me so it's hard to tell.
I've recently had blood work done for rheumatoid which was negative.  
I take 2 Robaxacet at bedtime, I will take 1 during the day if it's really bad, or I will take 400mg ibuprofen.  Tylenol doesn't work for this pain anymore, the Robaxacet is starting to lose it's effectiveness and due to an Aspirin sensitivity when I was 8 I try to only take ibuprofen when I really need it.  I do use Tylenol 1's when I have a bad headache but the codeine does nothing to relieve the pain in my back at all which is odd, I know, but it gets rid of the headache but doesn't take the edge off the back pain.  I have been given stretches that I do every night and have been since 2002.  I can tell the difference in the morning when I've skipped them so I do my best to do them every night.  I spend 20 minutes on the heating pad when I go to bed with a pillow under/between my knees depending on my position.  I have used ice, but it doesn't seem to make much of a difference (except make me cold and tighten my muscles) and my chiropractic visits are q2wks and have been since 2002 and that usually lets me get a good night's sleep the night of but then I'm back to where I was prior to the adjustment.  
I hope this information is a help to you and thank you for your time.
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Avatar_n_tn
Hi,
Radicular pain is sharp, shooting, and electric. Nociceptive pain (axial low back and hip pain) and referred pain are not sharp, shooting, or electric.
So your pain is dull ache starting from lower back just before pelvis. Also that your pain radiates down the hip and vice-versa.
Your problem started before pregnancy and then aggravated after your delivery.
All the above history suggests that you are indeed having lower back pathology with nerve compression pain radiating down your legs. This suggests that your injury or pathology is progressing and any in spite of intervention it has not resolved.
Your symptoms of aggravation of pain while sitting and releif when you are lying down suggest nerve compression pathology exists due to spinal disc. There is increase in the intra-discal space upon lying down hence relief in the pain symptoms.
Have been to any orthopaedician or neurologist so far?
Is there any imaging done for your lower back?
What does the chiropractor has to say about your pain?
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Avatar_f_tn
Hi,
I haven't been to any specialist yet.  And x-ray in 2003 showed the Transitional Lumbosacral Vertebrae but I don't have those results to say what else it showed.  A follow-up x-ray done January 2007 showed a Schmorl's node at L1 vetebral body and mild upper lumbar rotoscoliosis concavity to the right.
The requisition has been sent for me to go for an MRI to see what is really going on in there but that was only faxed Thursday morning but I hope to be hearing from them soon with an appointment.
The chiropractor continues to tell me my pain is muscular but can't really offer why or what the true, underlying cause may be.  It will be interesting (at the least)to see what the MRI shows.
Would the transitional lumbosacral vertebrae cause nerve compression alone?  or is there indication that there's more problems? Are there any surgical interventions available for this?


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Avatar_n_tn
Hi,
Transitional lumbosacral vertebrae means the last lumbar vertebrae or first sacral vertebrae is poorly formed as if it is deciding which type of vertebrae to form. It is present since the time of birth. It can cause pain due to anatomical variation and also due to nerve compression.
Treatment option includes physical therapy and/or steroid therapy.
In very rare cases surgery can be attempted to correct the problem.
Hope this helps you.
Bye.
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Avatar_f_tn
I've had my MRI and just received the results and here is what it shows:
Lumbar Spine (Sagittal & axial T1W & T2W images)
Six lumbar-type vertebrae are noted, with the lower most lumbar vertebra labelled L6 on our study.  The lumbar spine is of good alignment.  The tip of the conus is at the level of the upper L2 vertebral body, which is within normal limits.
At the L1-L2 level, mild degenerative changes are noted, associated with mild disc space narrowing, small Schmorl's node, and tiny anterior osteophytes.
The L2-L3 level, L3-L4 level and L4-L5 level appear normal.
At the L5-L6 level, mild degenerative changes are noted, associated with mild disc space narrowing, decreased signal intensity and a disc bulge.
At the L6-S1 level, a rudimentary disc is present.
INTERPRETATION
Six lumbar-type vertebrae are noted.  At the L1-L2, and L5-L6 levels, mild degenerative changes are noted.  A mild disc bulge is noted at the L5-L6 level.  No lumbar disc herniation or foraminal stenosis can be demonstrated.

I also had both hips done but they did that in 2 visits so I only have the Rt Hip at this time and It states the following:
The right femoral head and acetaqbular roof appear unremarkable.  A small amount of fluid is noted in the right hip joint, and this is within normal limits.  Minimal increased T2W signal intensities may also be present just lateral and adjacent to the greater trochanter.  The possibility of minimal greater trochanteric bursitis is raised, but clinical correlation is suggested.  The surrounding soft tissue appears otherwise unremarkable.
INTERPRETATION
No significant abnormality can be demonstrated.  There may be minimal fluid adjacent and lateral to the greater trochanter, and the possibility of minimal greater trochanteric bursitis is raised.  Clinical correlation is strongly suggested.

Does this help shed any further light on my condition and what, if anything, can be done?  Once the Left Hip MRI results come in, I will be seeing about a referral to ortho.

Thank you,
Pam
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