Question
QUESTION: MRI of lumbar spine show loss of normal disc signal intensity throughout the lumbar spine. There is no significant disc space norrowing or vertebral compression.
STIR and T2 weighted images demonstrate high-signal intensity area in the S2 and L3 vertebral bodies. The areas
are iso to slightly hyperintense to the morrow on T1 weighted images. Appearances is suggestive of hemangiomas.
At L3-4 is a left posterolateral annular tear and small broad-based left far lateral disc bulge. No nerve root compression is seen. There are mild facet joint changes at L5-S1.
Impression:
1.Lumbar spondylosis. Disc bulge at L4-5.
2.Nonspecific lesions at L3 and S2 as above suggestive of hemangioma.
My question: As I understand most of this, the MRI did not answer the question I had which was the reason for the test.
I have lower back pain with sore spots over from the spine on both hips. The pain goes in the hips and down the sides of the thigh to the knee. I have some surface numbness on the outside of both thigh, but when I when I push in at that area, the soreness is very deep and feels like a knife cutting the pain is so bad. I have been to several Dr.s about this and also 2 Chiropractors. No one seems to know what could create this kind of problem. Do you have any ideas about this? Any help would be great. Thanks.

ANSWER: Dear Sue,

Well the hemagiomas are just a benign finding as I am sure you have been told, but the disk bulge and facet joint changes can cause pain in the areas you have described.  I have to agree though that the MRI really doesn't have any significant (severe) findings.  Especially without a finding of nerve root encroachment.

In relation to the pain you are experiencing, I have two probable explanations.  The first is that you may additionally have sacroilliac (SI) joint dysfunction.  These are the bilateral joints in the buttocks formed by the articulations of pelvis and the sacrum.  When these joints become problematic, inflammation will set in. This can be caused by either excessive motion or restricted motion.

Research has found that the pain referral patterns for the SI joints encompass the entire leg, but most frequent pain is into the buttock, posterior and lateral thigh.  Sounds like you huh?  Treatment: manipulation is good when the joint is restricted, but a compression belt is the treatment of choice for when the SI is hypermobile.

Conversely, you have a band of tissue that extends from the top of the pelvis down the lateral thigh all the way to the knee.  This band is divided into two parts:  the top 1/3rd is called the Tensor Fascia Lata, and the bottom 2/3rds is called the Illio-Tibial Band.  When this structure become tight, severe pain can result locally as well as at the lateral aspect of the knee.  This is usually seen in athletes...runners, but it is also found in individuals who are sedentary.  Pressure over this band when tight and inflamed is exquisitely tender, and you may even be able to feel knots in the tissue.  Again, sounds like you, huh?

To complicate things further, it could easily be a combination of the two in addition to inflammation from the disk bulge and the arthritic changes noted at the L5/S1 facet joints.  Frankly Sue, your type of pain is what chiropractors are usually really effective in treating.

I am not sure how you were evaluated, or what type of treatment you have received to this point, but I would encourage you to talk with your doctors about what I have discussed and realize that myo-fascial release and massage techniques in the low back, hips and lateral thighs may be the best treatment for you.  Oh you need to stretch as well.  A tight low back, buttock, and hamstrings can cause quite a bit of dysfunction an pain.  All of this should have been initially addressed by the chiropractors, but I write it in just incase it was not.

Don't throw in the towel just yet Sue.  Let me know what your thoughts are, as well as any new developments/ideas rendered by your medical/chiropractic team.

Respectfully,
Dr. J. Shawn Leatherman

---------- FOLLOW-UP ----------

QUESTION: Dear J. Shawn Leatherman, It has been a while since you responded to my question. Thank you so much. I am sorry I didn't get back to you right away. I have been seeing Doctors to see if they could come close to what you said. It took a while, but I think we finally came up with the right problem. You came closer to knowing what the problem was then anyone else did. The diagnoses is Meralgia paresthetica. This is just for the surface numbness in the thigh that I have been trying to find out about for 20 yrs. The Dr. gave me Lyrica but it made me so dizzy that I had to stop taking it. We decided to try the cortisone injections which I had yesterday. Don't know if it will help, but at least we know what it is. My question to you:
What do you think of this treatment or what would you have recommended. They tell me the nerve is probably scarred and the injection might not even help. Is this something a chiropractor could work with? Thanks again for your help.

Sue

Answer
Dear Sue,

Meralgia paresthetica is nothing more than a simple nerve inflammation.  The specific nerve is called the Lateral Femoral Cutaneous nerve, and it is a cutaneous sensory branch off of the femoral nerve.  The nerve roots in the low back give rise to this nerve supply and a simple adjustment to the L5/S1 vertebral area will usually decrease pain/tingling in a few visits.  this is not a real complicated diagnosis.

A few questions/comments:  the lateral thigh pain is usually described as burning and irritating, but not really sharp.  Placing your hands in your pockets, or carrying keys in them may irritate the area more.  This is usually found in people who have a work history of wearing a restrictive belt or apron of some kind like a policeman, carpenter, chef etc...  Does any of the above description fit your case?

Anyway, drugs for the problem are a waste of time.  If the irritation to the nerve in question is not removed, then the pain will continue.  As far as a cortisone injection is concerned, this may have an effect of lessening pain/problems due to the fact that cortisone is a really good anti-inflammatory, but these should be performed in moderation.  Most doctors I know will only do one or two in any area, and try to limit them because cortico-steroids have a reputation for destroying the cartilage in joint surfaces.  You should use this treatment sparingly.

My office treatment for meralgia paresthetica, initial use of ice for inflammation, low back spinal adjustments, and good nutritional supplements to reduce system wide inflammation.  We get great results with that simple protocol, and like I said before it usually only takes a few visits.  Unfortunately, I believe your problem may be more complicated than that from our previous discussion, and you are likely to have more than just that issue (20 years).

Listen Sue, I can't do a whole lot for you from a computer screen, and I definitely can't diagnose you without a proper examination, but what I can do is help you with getting good nutritional supplements while you approach the problem from other doctors.  I utilize custom nutritional products based on metabolic testing in my practice. The programs are based off of your individual results, are formulated by the #1 nutritional and pharmaceutical formulary in the country (Douglas Labs), and tested individually through the #1 Lab in the country (metametrix Labs). The testing is relatively simple at home test kit which is sent through a prepaid fed ex package and cheap at $99.00...(the National Football League and Major League Baseball pay $350.00 per test for their players).  Moreover, the supplements are top notch.  My family and I take them, and I have seen great results in my patients.  I think you should get tested for a baseline product, and also incorporate glucosamine/MSM for your joints.  

Anyway, see how the cortisone injection works, and let me know if you would like information on how to get tested for customized nutritional support, I would be more than happy to help set you up and get you a testing kit, the rest you can handle.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net