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Dr. Andrew Rynne

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Treated for compression fracture on spine. Pain and weakness in leg. Any advice?

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Dr. Visvanathan K

Neurologist, Surgical

Practicing since :1997

Answered : 96 Questions

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Posted on Fri, 15 Feb 2013 in Brain and Spine
Question: Hi, 12 years ago I was involved in a head on RTA. I suffered a compression fracture to my spine (L2). I had bed rest followed by physiothgerapy, and was given Tramadol and Diclofenac to take (i have been taking Tramadol for 12 years now and Diclofenac for 11 years. Had to stop them due to adverse side effects). Have been seen by an Orthopaedic Surgeon who said all he could do was offer me spinal fusion.
My last MRI scan was three years ago (which I had to pay for myself) and showed the compression fracture, slight scoliosis, bulging disc at L5/S1 and a schmorls node.
My physiotherapist had said that a Neurosurgeon might be able to do a procedure called a Partial Lamanectomy (this was seven years ago) which could help, was minimally invasive and would only mean one day in hospital. I have never been referred to a neurosurgeon even when I mentioned it to my GP, and I now feel that my condition is deteriorating. I keep falling and the pain has increased, and I also cannot walk far because of weakness in my legs.
Since my accident I have been doing daily exercise (physiotherapist said no surgeon would operate unless I could show them that I was willing to put in the hard work to get as fit as possible and that I could show them this by getting my fitness level back). Unfortunately I think this has been my downfall, as the Orthopaedic surgeon I saw thought I was only there to get a report because I wanted to get on disability welfare. He said I could walk and I should be grateful for that, and I was only in his office for 10 minutes before being ushered out again. This is not the case, I have always been a sporty person who was extremely active. I had just passed my exams to be a personal fitness trainer and had started a gym instructors course when this accident happened. I just want my life back, but my GP no longer listens to me and I just don't know what to do.
Any advice you can ghive me would be greatly appreciated
doctor
Answered by Dr. Visvanathan K 9 hours later
Hi,

Thanks for the query here.

It would be useful to have some representative pictures of your MRI/CT/X-rays. Also, please describe the pain you have, whether it radiates down your legs and what medication you are on currently.

However, the general opinion is that, if you continue to suffer from Low back Pain, it is unlikely to be directly from the Compression fracture especially after 12 years of injury. The disc problem that your MRI has shown could be responsible. If there is any narrowing of your spinal canal from the fracture, instability or deformity though as a result of the fracture, then that could warrant spinal fixation or fusion procedures.

A laminectomy can be done, but it must be done with due care, because there is a chance of creating more instability and therefore worsening the pain if there is loss of the bony support from the back.

A good option to consider is insertion of an intrathecal pump with morphine or other painkillers going directly to the spine. This can give symptomatic relief in well selected patients.

Hope this gave you some information. Looking forward to looking at your reports.

Regards
Above answer was peer-reviewed by : Dr. Mohammed Kappan
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Follow up: Dr. Visvanathan K 12 hours later
Thank you for your reply. The actual MRI report is detailed below

There is mild anterior wedging of the second lumbar intervertebral body in keeping with the known compression fracture in this location.
There is some degenerative end plate change at the upper body of L1
There is diminished T2 signal in the T12-L1, L1-L2, L2-L3 and L5-S1 discs in keeping with degenerative dessication.
There is mild broad based bulging of the L4-L5 disc with moderately severe broad based bulging of the L5-S1 intervertebral disc with a superimposed small central protrusion.

My condition has deteriorated in the last year or so, as I can now only walk a couple of hundred yards without stopping, and I cannot manage a flight of stairs in one go. This is due to numbness and weakness in my legs. I cannot stand or sit in the same position for any length of time either, and I sometimes only just make it to the toilet without wetting myself (I do pelvic floor exercises).
I have kept up with my physiotherapy regime over the last twelve years and have included stretching exercises for the whole of my body (basically pilates). Although I have to keep stopping I still take regular walks, and use the stairs instead of lifts.
I suffer pain in the the whole lower half of my body from the waist down, and weakness in my legs. I also lose the feeling in my legs if I sit on a hard surface for any length of time, and I frequently fall over. I cannot wear shoes with heels, only flats or trainers due to the pain I feel in my back. I have trouble keeping my balance and keep knocking into things. Have had a neurological assessment for this and it was fine.
I take 300mg of Tramadol a day, and used to take diclofenac also, but after 11 years they were leaving me feeling nauseous, giving me headaches and severe dizzy spells so I came off them.
Spoke to someone recently with a similar problem who underwent a microdiscectomy which appears to have solved the problem for them, but wonder if it would help me. Would really like to be able to take long walks like I used to (approx 8 - 10 miles), but would gladly settle for anything to be pain free and to be able to stop taking medication. Appreciate any advice you can give me
doctor
Answered by Dr. Visvanathan K 7 hours later
Hi,

Thank you for your detailed reply.

As per the MRI report, the anterior wedge compression fracture is mild which means it is most likely a stable old injury.

Your spine has wear and tear changes at many levels and any one of this could be responsible for the Low back pain itself.

There is evidence of moderate slipped disc at the L5/S1 level which could be the cause of some of your symptoms. We usually try and match your symptoms and findings on clinical examination with the MRI findings. If they match, then we can predict that a microdiscectomy could be beneficial.

The worry is that the MRI scan has been done about 3 years ago and your condition has worsened over the last 1 year. Your symptoms do sound like coming from your back and could be neurogenic claudication symptoms. Therefore, in my opinion it would be very useful to repeat the MRI in order to see if things have progressed from the scan 3 years ago. The reason is, the mild and moderate disc bulges seen in the scan earlier could have regressed by itself because the disc usually dries out and shrinks. Or else,there could be a more significant prolapse at one or more levels compressing the nerves.

Once we have clarity on this, your Neurosurgeon could give you appropriate advice on the best course forward. As I have mentioned previously, if the scan comes out pretty normal, or after a spinal procedure there is still sever pain options like the morphine pump also exist.

Hope this has helped answer your query. If there are no clarifications I'd appreciate if you could close this question and rate it.

Many thanks
Above answer was peer-reviewed by : Dr. Aparna Kohli
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