What is the treatment for lower back pain, and leg pain inspite of an accident?

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Posted on Tue, 1 Apr 2014 in Brain and Spine
Question: XXXXXXX male 38 yrs old - motorcycle accident - flipped end over end - could not move right after injury - took 2 weeks before could walk without assistance - had MRI 8/31/2012 - this is the report summary: There are bilateral pars interarticularis defects of L5. There is significant 8 MM anterolisthesis of L5 relative to S1 and 5 MM anterior subluxation of L5 relative of L4. The bilateral pars interarticularis defects to preclude centeral canal stenosis. A. At l4-5, there is a moderate-sized posterior central and left paracentral disc extrusion, which migrates inferiorly behind the upper half of the L5 vertebral body, imping the left L5 nerve root in the left lateral recess, that, my opinion, has a significant likelihood of being clinically relevant. Part of the extruded disc fragment contains high water signal and can be seen for instance on axial T2 sequence Image #12 B. At L5-S1, there is uncovered extruded disc material extending just slightly superiorly behind the inferior endplate of L5, attenuating fat in the anterior epidural space, abutting tyhe traversing S1 nerve root in the lateral recesses. However, more significantly, extruded disc material extends intraforaminally, bilaterally, right greater than left, up toward the infrapedicualr axillae, with potential impingement on either exiting L5 nerve root. - he than fell out of a tree while trying to work - landed on his feet - pain - got xray on 6/30/2013 following report; A single view of pelvis was performed. AP and lateral views of the lumbar spine were performed as well as spot view of lumbosacral junction. Examination demonstrates a spina bifida occulta. There appears to be a pars defect aat L5 with spondylolisthesis similar to that seen on prior MRI exam. No new fractures are seen. Mild narowwing is seen at L5-S1. Facet disease is seen at L5. Had seen Dr at pain mgmt after accident - gave him Lortabs did nothing to help except cost a lot of money for office visits. unable to work without some type of pain meds. I am his mother and I am trying to get him help - need understanding of his injuries. He is an addict the was on Methodone - got him changed over to subutone for one week and then changing to subutex for nex 9 to 12 mos to overcome this problem. But I am concerned about his back injury and his ability to do physical labor. Please advise. XXXXXXX
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Answered by Dr. Sudhir Kumar 8 hours later
Brief Answer: There is significant nerve compression in back. Detailed Answer: Hi, Thank you for posting your query. I have noted your son's complaints, medical history as well as the mRI reports. As per the reports, there is significant compression of the nerves in the lower back region at two places. This could result in low back pain, and leg pain (which may radiate from back to thigh, calf and toes). This pain may increase on standing and walking. Initial treatment would consist of neuropathic pain medications such as pregabalin or gabapentin capsules. Physical therapy would also help. If pain does not improve, then, epidural injections would help. The last resort (if all above does not help), would be surgery, where the nerve pressure can be released to make him pain-free. I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information. Wishing you good health, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, India Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar My BLOG: http://bestneurodoctor.blogspot.in
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sudhir Kumar 12 hours later
Are their any limitations on his doing physical labor - such as lifting, moving furniture or having to bend and squat to do work, landscaping work, production line work - lots of standing in place?
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Answered by Dr. Sudhir Kumar 38 minutes later
Brief Answer: There are certain limitations. Detailed Answer: Thank you for getting back. Yes, he should avoid lifting heavy weights and bending forwards. Other activities are fine. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Sudhir Kumar

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Practicing since :1994

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