Lower Lumbar to knee pains

by Phil
(LA, CA, USA)


Greetings,


I had a 6k lb. Ford Expedition turn over me on my motorcycle 11/2/2015. I sacrificed my L2 to S2 left lower back (2" from spine convex muscle impacted) between the bus size vehicle and my motorcycle to keep from knocking my motorcycle down in morning LA traffic on the expressway. I was lucky and did not crash, but had nerve damage from the latent pain syndrome a few weeks later.

The pain in lower back to knees started a few weeks after, and my lumbar facet joins were locked to the left at about a 15 degree angle trunk rotation for 8 months to 6/26/2016. Then I held my breath, and twisted beyond the 15 degrees and heard "click-click-click." Before this time, I was Chiropractic adjusted about 6 times and relieved of pain by 20 acupuncture txts in L2 to S2 region of back with accompanied knee and extremity points (I am a graduate of Acupuncture in CA.)

From that time to now, I can rotate 90 degrees to the left with still no resistance (!), from hypomobility rotation to extreme hypermobility rotation. My private and VA radiological imaging says they can't see anything wrong except normal arthritis and slight lordosis of the spine.(but the VA may be copying my private Ortho-surgeon's opinion who did nothing except a 3rd party MRI and used their Dx.)

Other than simple cause and effect, I know for a fact few know how to properly sequence with medium injections radiological imaging to show facet joint injuries.

What could possible Dx's be?
1. dislocated facet joints or spine,
2. broken/cracked facet joints or spine,
3. nothing, and turning my trunk 180 degrees is nothing to be alarmed about, or
4. ??

- Left lower back p/l (6-8)/10 constant with unstable feeling,
- Upper leg to knee p/l (6-9)/10 random with movement (agitated arthritis?),
- irregular bladder and rectal function randomly, and
- left 3 small toes are numb (could be: a) nerve glanced on left exterior knee when hit, b) S1 trauma, or c) peripheral neuropathy for a 58 y.o. large man (285 lb. when hit and working out, and now 325 lb. not working out since then.) A1C1 = 5.5

(6-29-16) VA xray Report Below
====================================================
Report: LUMBOSACRAL SPINE: FINDINGS: The vertebral bodies show slightly increased lumbar lordosis.
Disc spaces are preserved but there may be small osteophytes. There are no visible fractures, lytic or blastic lesions. Paraspinous soft tissues are not widened. There are no pars defects visible. Sacroiliac joints are clear but may show mild degeneration. Impression: MILD DEGENERATIVE CHANGES NOTE: If symptoms persist follow up CT Lumbar exam may further the work up. Primary Diagnostic Code:
====================================================
(7-25-16) CT scan Report Below
====================================================
Report: CT lumbar spine without contrast DATE: 07/25/16 11:10:00 COMPARISON: X-ray 6/29/2016 FINDINGS: There is no acute fracture, subluxation, or dislocation. No suspicious lytic or blastic lesion. Bone density is within normal. Soft tissue planes are within normal limits. Small anterior osteophytes are noted at L3-L4. All intervertebral disc spaces are maintained. Assessment for posterior disk disease and spinal canal stenosis is superior with MRI. There is no CT evidence of significant posterior disc disease. There is no CT evidence of significant spinal canal or neural foraminal stenosis. There is mild facet arthritis seen at the L4-L5 and L5-S1 levels. There is mild facet arthritis with vacuum phenomenon within the left L3-L4 facet joint. Mild vascular calcifications are noted. There is mild sacroiliac joint arthritis. Impression: #No CT evidence of acute fracture or malalignment. #Mild degenerative changes as above. No CT evidence of significant spinal canal or neural foraminal stenosis. Primary Diagnostic Code:
=======================================================
(MY SUMMARY)
** Until 6-26-16, I went from LOCKED Facet hypomotility -15 degrees on left rotation to hyper motility -90 degrees and STILL NO RESISTANCE! I feel like I could do a 180 degrees rotation, but my lower aorta may not appreciated that!!!

Hello Phil,
A very concise report; thank you.

What I'm unclear of, is what evasive action did you actually take? What did you do to incur these injuries?

You say the nerve pain only began some weeks later; are you sure it's related to the near miss?

Where exactly is the pain radiating down to your knee? Back, side or front of the thigh? Would you know if the sciatic or femoral nerve stretches increase this pain?

Clearly there was some locking mechanism in your lumbar spine, hence the hypomobility, and somehow you managed to reduce that. I take it the nerve pain in your leg had already started before that.

The scans seem unequivocal; no obvious damage, but CT doesn't show disc material like an MRI.

More important to me is whether forward flexion, extension and lateral flexion have any effect in your back or leg. And whether the sciatic or femoral stretch tests are limited and painful, reproducing the pain.

A man of your size is difficult to adjust unless your chiropractor is a very large and strong man; I'm currently struggling with a man of similar dimensions.

Are you doing any lower back exercises? I recommend every morning before arising; on your bed.

Your weight is obviously a huge problem, and not just for your back, but you know that, so I'm not going to lecture you. Cutting out all the refined high glycemic index carbs is the easiest way.

The lateral foot belong very specifically to the S1 nerve root; is the Slump test for sciatica positive?

The bladder and bowel symptoms are obviously of great concern; has anyone mentioned a cauda equina syndrome?

Mostly likely you have an unseen on CT disc bulge at L5-S1, or yes possible facet syndrome, though that is less likely to produce those symptoms down in your lower leg, and gross deterioration not seen on the CT.

The best course of action is:
1. Get your bike into a crate and ship it to me; I'll gladly pay the delivery charges! Missing my bike terribly but She Who Must Be Obeyed is adamant; I may not go out and purchase another bike; hankering for a Zero actually.

2. Start some disciplined back exercises every day.

3. By hook or by crook get those unwanted pounds off.

4. Stay with your chiro and let me know if the sciatic and femoral stretch tests are positive.

5. Perhaps have an MRI; they were looking for fractures with the CT.

I hope this contributes.

Dr B


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