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Suffering From Bilateral Facet Joint Arthrosis. Constant Pain, Mobility Problems. On Medication. Best Course Of Action?
I am a 53 yr old female with lower back pain in the L2,3,4,5 & S1 disc area since early December. I could not walk forward or backwards only very tiny steps sideways. I called an ambulance who took me to the hospital I did not ask to go to as they don't deal with a lot of spinal cases. They discharged me 2 days later as I could take very tiny forward steps with a lot of help. I was not satisfied so I went to my GP who ordered an urgent CT scan, with the result being slight bulging of discs in L3,4,5, and compromised nerve exit at L4,5 to both legs. Also lumbar spinal canal stenosis. I have been in constant pain with this and have been having to use crutches to aid my walking as I have balance problems and numbness in my right leg. I have had a recent MRI with the condition worsening. I am on the waiting list for Neurological assessment with the earliest waiting time of 3 years. I have been in & out of hospital for the past 2 months with worsening pain. My GP done another CT scan with the results listed below:
L2/3 Disc Space - Slight annular bulging of the disc distorting the thecal sac. There is bilateral facet joint arthrosis. There is disc osteophytic narrowing seen of the right neural formina which could irritate the exiting right L2 nerve.
L3/4 Disc Space - There is broadbased protrusion attenuating the thecal sac resulting in mild spinal canal stenosis. There is bilateral facet joint arthrosis. Disc bulging to both neural foramina which could irritate the exiting L3 nerve.
L4/5 disc Space - the height of the disc is reduced with a vacuum phenomenon. There is prominent right paracentral disc protrusion which is compromising the right L5 nerve just as it exits from the thecal sac at this level. This is likely to be the cause for the patients symptoms. Bilateral facet arthrosis. There is no compression on the exiting L4 nerve.
L5/S1 Disc Space - No dis protrusion is seen. There is bilateral facet joint arthrosis. No compression seen on the exiting L5 nerves or S1 nerves. there is vacuum phenomena and degeneration both S1 joints. There is a small sacral Tarlov cyst seen at S3.
Given all of that I am still in constant pain & have mobility problems which one ER/ED doctor said was all in my head, women don't have that sort of problem.
My back goes into severe spasms a couple of times a week, which is sheer agony. I have numbness & weakness in my right leg, as well as drop foot.
My GP has prescribed the following medications - Panadol Osteo, Lyrica 150mg & Lyrica 75mg, 15mg Morphine tablets - BD.
What is the best course of action.
L2/3 Disc Space - Slight annular bulging of the disc distorting the thecal sac. There is bilateral facet joint arthrosis. There is disc osteophytic narrowing seen of the right neural formina which could irritate the exiting right L2 nerve.
L3/4 Disc Space - There is broadbased protrusion attenuating the thecal sac resulting in mild spinal canal stenosis. There is bilateral facet joint arthrosis. Disc bulging to both neural foramina which could irritate the exiting L3 nerve.
L4/5 disc Space - the height of the disc is reduced with a vacuum phenomenon. There is prominent right paracentral disc protrusion which is compromising the right L5 nerve just as it exits from the thecal sac at this level. This is likely to be the cause for the patients symptoms. Bilateral facet arthrosis. There is no compression on the exiting L4 nerve.
L5/S1 Disc Space - No dis protrusion is seen. There is bilateral facet joint arthrosis. No compression seen on the exiting L5 nerves or S1 nerves. there is vacuum phenomena and degeneration both S1 joints. There is a small sacral Tarlov cyst seen at S3.
Given all of that I am still in constant pain & have mobility problems which one ER/ED doctor said was all in my head, women don't have that sort of problem.
My back goes into severe spasms a couple of times a week, which is sheer agony. I have numbness & weakness in my right leg, as well as drop foot.
My GP has prescribed the following medications - Panadol Osteo, Lyrica 150mg & Lyrica 75mg, 15mg Morphine tablets - BD.
What is the best course of action.
Fri, 16 Aug 2013
Hi, thanks for writing to HCM.
Based upon the description, You have facet joint arthropathy at almost all levels. The best way to tackle the pain arising out of facet joints is to have facet joint blocks or injections. This may produce substantial amount of pain relief.
As you have weakness in the leg along with foot drop, there is no role for conservative management. You may need to undergo surgical decompression in the form of microlumbar discectomy or endoscopic discectomy.
Consult an orthopedic / spine surgeon for further management.
Hope this information is helpful. Good day
Based upon the description, You have facet joint arthropathy at almost all levels. The best way to tackle the pain arising out of facet joints is to have facet joint blocks or injections. This may produce substantial amount of pain relief.
As you have weakness in the leg along with foot drop, there is no role for conservative management. You may need to undergo surgical decompression in the form of microlumbar discectomy or endoscopic discectomy.
Consult an orthopedic / spine surgeon for further management.
Hope this information is helpful. Good day
I find this answer helpful
Hi,
The symptoms of numbness, weakness and foot drop suggest significant nerve root compression so I suggest you see a spinal surgeon to discuss the possibility of surgical management. I suggest you do this soon as these symptoms may not improve with conservative treatment.
The multiple facet joint changes may be relieved by facet joint injections of local anesthetic and steroid to reduce inflammation. Again, this could be discussed with a spinal surgeon.
Hope this helps you. I wish you a speedy improvement.
Dr K A Pottinger
MBChB FRCA
The symptoms of numbness, weakness and foot drop suggest significant nerve root compression so I suggest you see a spinal surgeon to discuss the possibility of surgical management. I suggest you do this soon as these symptoms may not improve with conservative treatment.
The multiple facet joint changes may be relieved by facet joint injections of local anesthetic and steroid to reduce inflammation. Again, this could be discussed with a spinal surgeon.
Hope this helps you. I wish you a speedy improvement.
Dr K A Pottinger
MBChB FRCA
I find this answer helpful
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