Femoral nerve impingement or hip and knee problem?


(Oregon)


I had a lumbar fusion L5/S1 and hemilaminectomy about six years ago to stabilize a retrolythesis and to correct a L5 herniation which led to a foot drop.


I began having issues this fall enough to push me to seek a follow-up reevaluation of the lumbar spine. I now have spinal stenosis both central/lateral at L4/L3. Also, a far right lateral herniation exists at L4. I did manage to get through that flare.

However, recently,after some strenuous activities I have developed severe lower back pain, right sciatic glute pain, that crosses over into the groin causing groin pain; front quad pain that extends to the knee.

The knee is sore to the touch as well as parts of quad. This is exceptionally painful and is interfering with my ability to walk, climb the stairs (both painful), and painful to rise from sitting position to standing after having sat for awhile.

After doing some web research came across your Chiropractic Help site and strongly believe what I am dealing with is worsening of the far right lateral herniation which is now impinging on the femoral nerve.

I'm fairly certain that this is coming from my lower back as I can push on the spinal level and it feels pinched and is painful to push on that area and creates painful symptoms.

I am almost a month out on this and currently working with a PT who has I think entirely missed the boat on his diagnosis. I am seeking a reevaluation with a neurosurgeon as I can not live with or endure the level of pain I am presently enduring.

Hello JCK,
Your letter raises many interesting issues. The first is that it's most unusual for a L5/S1 lesion to cause a foot drop; anyway the surgery obviously helped.

There is alas no long term cure for low back pain, whether you go to surgeons or chiropractors; after a serious herniation a life time of daily back exercise and common sense with lifting, and sitting, is necessary.

Your story is not unusual; after surgery the joints above the fusion have to work hard, and often give.

When you say the right glute pain 'crosses over' do you mean to the left groin and knee?

My initial thoughts on reading your story were that this is either a knee or hip problem.

Of course, it can be both a localised problem in the limb and separate but connected issues in the lower back.

It does seem that further evaluation, and a second opinion, are necessary. Make sure that your hip and knee are properly examined too.

Start doing some lower back exercises EVERY morning now for the rest of your days; before getting out of bed is best, in my book. Otherwise, even if this is exceptionally well treated, the pain will progress to yet another level.

And the days of strenuous activities like lifting grand pianos and moving the deep freeze are clearly over; that's just inviting trouble.

Having said that, if you are able to get over this problem properly without setbacks, and do daily exercises, there's a good chance you can again lead a normal life.

Good luck, I hope this contributes to the conundrum.

Dr B


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