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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes severe pain in the sciatica and lumbar region?

I ve been told I have severe lumbar lordosis, lack of sacral kyphosis, saggital imbalance, posterior pelvic tilt, with crushing of the lower vertebrae (L1-S1), unstable burst T12 was treated with fusion surgery, MRI shows T12-L1 fusion, with a posterior hemi-vertebra & fracture at this level, failure of segmentation of lumbosacral juction, limbus vertebra at L3, schmorls nodes throughout, marked degeneration of the spine. I have as a result chronic musculoskeletal imbalance. To me it feels as though the problem stems from the hip & pelvis, feels as if my pelvis is rolled under me when sitting providing no support for my upper spine and that I m bending from the waist more than at the hip. I have frequent daily cramps of my lower legs, calves, shin, toes and soles of my feet all cramp at times depending on my position at the time, I have severe sciatic pain, and stabbing pain in the lumbar region, a shooting/tearing pain in my upper back (thoracic), bowel and bladder difficulty. I m 37 years old, 5 8 approx 140lbs, female (post--op gender reassignment M-F) Sex is extremely painful to the extreme it s impossible to enjoy, though at this point that s secondary concern to the other problems which are dramatically affecting my mobility and quality of life. My question is, is there anything that could help to address the spine and pelvic problems to alleviate the chronic saggital & subsequent musculoskeletal imbalance. Physiotherapy incl. hyrotherapy, core strengthening, myofascial release (foam rollering) acupuncture have all been tried extensively with no effect, and at the moment the only thing that is being one is pain management through opiate analgesics (MST 60mg b.d., oramorph 2 x 10mg/5ml x3-4/day, paracetmol 500mg 2 x 4/day, naproxen NSAID, diazepam 2 x 5mg (x3/day) which barely controls pain and spasms/cramps. Majority of symptoms all presented shortly after the fusion surgery and pre-dates the gender surgery, but which has also exacerbated the severity of the symptoms, any help or advice would be extremely appreciated.
Wed, 31 Mar 2021
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Orthopaedic Surgeon 's  Response
Hello,

Severe pain in sciatica happens due to nerve root compression. In addition to all the medicines that you are taking, regular physiotherapy and lumbar traction can help in preventing further progression of the problem.

Take care. Hope I have answered your question. Let me know if I can assist you further.

Regards,
Dr. Praveen Tayal, Orthopedic Surgeon
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What causes severe pain in the sciatica and lumbar region?

Hello, Severe pain in sciatica happens due to nerve root compression. In addition to all the medicines that you are taking, regular physiotherapy and lumbar traction can help in preventing further progression of the problem. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Praveen Tayal, Orthopedic Surgeon