runner's surgery blog, L4/5, 2008

[treefrog]

Kim, I have L4/5 and L5/6 (or L5/S1, depending on who's talking) disc degeneration. I have had pain that runs from my hip then down the front of my thigh, toward the inside of my knee. I think this pain is from the L5/6 disc. Where exactly is the pain in your thigh and knee?

And I also had much more pain after my discogram, so bad that I could hardly walk. And it got extremely bad in my knee, I felt like a poker was being stabbed into my knee. I also started having some slight numbness and tingling in my lower leg and feet, as well as around my knee, after the discogram. It took about a week before it started to feel slightly better, and that was with taking more pain meds.

When do you go see the doctor about the discogram results? I wouldn't be surprised if you do have problems with L5/S1.

[runner]

Hi Cathy,

I have pain on my right thigh from the back/hip area to mostly the outside of the thigh (the right side is from where the needles were put in). I already have tingling and numbness and sciatica. I guess the pain kind of goes to the inside but it starts from the outside at the hip/back.

I see the pain doc on Friday and if things are the way they are now, i might come limping into the office. My main concern now is getting rid of this pain as I cannot even go for walks.

I have been uncomfortable sleeping, partly because I cannot sleep on my side due to the pain. I am spending most of my time since Sunday, lying down as when I stand up and move around, the pain increases. I do have to get up now and then to take care of my boys.
My thigh feels so tight, that I kneed it trying to get it to relax, but it doesn't work. I am still taking the increased pain meds and they wear off before the next one is due.

It makes me feel better that you have had right thigh pain with problems at L5/S1. This particular (thigh) pain is new to me.
BTW, L5/S1 is the suspect disc.

Thanks for answering my question,

runner

[Justin]

Hey Runner,

Sorry you are still struggling. Just an FYI: most people has increased symptoms / "new" symptoms after a discogram for ~2-3 weeks. Inherently the discogram tries to replicate your pain and in doing so it irritates many elements in your spine. The "new" symptoms sound like L5/S1 to me.

Look at this map of dermatomes:



I hope things start to subside...

[treefrog]

I should say that for a very long time I had pain that went down the front of my thigh, from my hip. But more recently I have pain that goes down the side of my thigh, like you are describing.

That is a great dermatome map Justin. Though I know sometimes people can have symptoms that don't exactly correlate with the dermatome maps.

[Justin]

Originally Posted by treefrog

I should say that for a very long time I had pain that went down the front of my thigh, from my hip. But more recently I have pain that goes down the side of my thigh, like you are describing.

That is a great dermatome map Justin. Though I know sometimes people can have symptoms that don't exactly correlate with the dermatome maps.

Yeah, that is very true. This dermatome map is "most likely" in the general population; however, we have unique anatomy for sure.

Interesting fact: close to 15% of Asian Americans have their piriformis muscle bifurcated by the sciatic nerve. (I'll have to pull that study up some day from my pile of papers).

[runner]

Thank you, Justin and Cathy,

It seems like my nerves are in a major state of being ticked off.
It is like L5/S1 is raising its head and saying, "you didn't pay enough attention to me and so here I am".
I keep telling my kids to stay away from me as them jumping around is like the last thing I need.

I think i am going to have to ask to increase or change the meds because I am in a lot of pain, especially when the meds wear off early. At least until things calm down. I am not functioning too well. I am running the house from the couch.

In 2007 with the disco, my pain did increase for about 10 days or so, and I recovered and then things started slowly sliding downhill.

Justin, I was just wondering if because the doc put a lot of pressure in the L5/S1 disc to produce pain that that inflamed the disc more. In 2007, the pressure was stopped earlier because pain was elicited earlier at low pressures.

[runner]

Just more confusion.
According to my pain doc, my pain was not what he expected during the discogram last week. Also the CT didn't show what we expected.

So my pain doc and my neurosurgeon have decided to go back to the facet joints and do another diagnositic test by numbing the nerves.
I told the pain doc that I had strong pain during the disco but I really don't show pain well, that i don't scream during a procedure, that I didn't do that with the last discogram which was obviously abnormal.

So it seems he did not listen to me, but he doesn't know how I tolerate pain so I can see where they want to make sure it is the discs.
But I am still not happy because I don't think the facet injections will work because my pain goes past my knees. (facet pain usually does not go past the knees).
I told him how I had plantar fascitis pain in both my feet and he said that could be from last time before the surgery and it could come back. But I developed the left foot pain recently, never had it before.

I can see why they have to inject the facets again because they don't want to do surgery on the discs if the facets are the problem.
However, I did tell him about the right leg pain that I still have and he didn't have an answer for why that is a new symptom that developed after the discogram. Other than facet joints can cause pain in the thighs and hips.

I was just in a lot of pain at the appt and they are not dismissing my pain but i don't think they see it. My blood pressure was 153/117 and I told the person that took it that it was because I was in pain.

I spoke to my PT yesterday and he thinks the pain is coming from the disc and wonders why they are going to inject the facets again, when it didn't work last time and agreed with me that my pain goes past my knees.
So that's it. I have got another procedure next week with the facets and then I will see what is up.
This is getting old fast.

I spoke to my PT and he thinks the pain is coming from the disc. He reminded me of the little shocks I get in my toes along with the sciatica.
So next Thursday, i wiil have my sixth procedure since january. Oh fun.

Runner