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butt & leg pain Siatica

  : : I've been in pain since 4/23/98
  : : I have had 3 epidurals, 1 facet block, all did nothing to help with the pain.
  : : Here are some of the procedures my doctor has done to find the problem;
  : : MRI: results 5/19/98
  : : L3-4 mild diffuse disc bulge/with ligamenum flavum/mild side to side lateral canal stenosis.
  : : L4-5 mild diffuse disc bulge/with ligamenum flavum/mild lateral canal stenosis.
  : : L4-S1 5 m. focal central disc protusion/mild impression on the ventral aspect of the thecal sac. Central canal & intervertebal foramina appear normal.
  : : Lumbar Myelogram results: 9/8/98
  : : L3-4 mild ventral impression and at L4-5, slightly greater at L3-4.
  : : L1-2 normal
  : : L2-3 Normal
  : : L3-4 mild focal roght paramedian disc protrusion with disc extending 6 mm, beyond the vertebral body margin midly indenting the vental subarachnold space bot not extending into the foramen.
  : : L4-5 Mild diffuse ventral impression extending apporx. 4 mm. posterior to the vertebral body margin.
  : : L5-S1 There is a central fairly focal protrusion which indents the central aspect of the sac but is mostly involving the epidural fat.
  : : My question is this, I've been through P/T since late April for pain management and am now using a TENs unit, which only helps a little. Since the last test of the myelogram my doctor says that he feels my pain is caused by soft tissue. What I want to know is how this is possable, I can feel as though a nerve is being pinched some how. I still have great pain in my left butt and leg, going all the way down to my foot. At times, my foot feels as if it is on fire. I can only walk for a short period before the pain get so intense that I must lay down, and standing for more than 15 minutes is even worse. COULD THIS DOCTOR HAVE MISSED SOMETHING!!!!!!!
  : : If I have all these disc protrusions and mild stenosis, how then could it be only soft tissue causing all my pain. Your opion is greatly needed. ASAP
  : : I do not know where to go from here at this point.
  : : Thank you
  : : Irene W.
  : ===========================================================================
  : Thanks for your question.  The symptoms described in your message are
  : fairly typical of "spinal claudication".  Although the exact mechanism
  : of action is still not well established, spinal claudication is described
  : as a positional dependent pain/discomfort in the lower-back/gluteal region
  : that may or may not propagate further down the legs.  Many times, the simple
  : act of standing up (without moving/walking around) triggers the symptoms.
  : Therefore, patients often complain about not being able to stand up for
  : a prolonged period of time - sometimes even brushing the teeth in front
  : of the basin is enough to trigger the pain.  Spinal claudication most
  : often is associated with stenosis of the spinal canal (such as your case).
  : You did not mention an Electromyography (EMG) in your posting.  It is a
  : test that would help evaluate objectively any degree of nerve damage
  : either intra-canal, or as the nerves exit the vertebral column.
  : If you would like a second opinion, I suggest a consultation/referral to
  : a neurologist specialized in peripheral nervous system or neuromuscular
  : disease.
  : If you live in the Cleveland area, the Department of Neurology at the Cleveland
  : Clinic has a group of neurologists specialized in such area (Drs. Levin,
  : Mitsumoto, Pioro, and Shields).
  : If you wish an appointment at the Department of Neurology at the Cleveland
  : Clinic, please call 1-800-CCF-CARE, or 1-216-444-5559.
  : I hope this information is helpful.  Best of luck.
  : This information is provided for general medical education purposes only.
  : Please consult your doctor regarding diagnostic and treatment options.
  Yes, there was an EMG done and it showed everything to be normal. No nerve root damage thath they could find throught this test.
It is reassuring that the EMG/NCS was normal. That suggests there is no actual damage to nerves passing to the parts of the leg. As the other doctor discussed, the problem appears to lie in the structures within the spine.
It is my experience that many patients with fairly severe symptoms which would point to nerve root involvement have in fact little or no damage per se, but a whole lot of discomfort.
That observation influences treatment. For example, if there is nothing structural to be "fixed," then a surgical procedure wouldn't make a lot of sense. Treatment can be focused on pain management.
Physical therapy often works very nicely. Sometimes local injection ssuch as those you described will work. If you have passed beyond this point, I would recommend a second opinion with either a neurologist or a pain management specialist.
If you are interested in Cleveland Clinic, you are welcome to call 800 223-2273 and ask for neurology appointments at 4-5559. The doctors in the Spine Center may be an appropriate place to start, or one of the general staff neurologists.
I hope this helps. CCF MD mdf.

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