Expert: Dr. Victor Dolan, DC, DACBSP - 1/19/2009

Question
I have chronic lower back pain and have had on and off for 3 years. In July 2008 I had a MRI because the pain did not go away. I have a limbus at l4. The report actually said a developmental anomaly on the anterior of l4 vetebrae. I went to two Dr.s who pretty much scratched their head and said there was not anything that could be done. I have numbness on the outside of my right leg from my upper hip to feet and my right leg is weaker than my left. My doctor also said I have toe drop on my right foot. Anyhow I went to a chiropractor who actually looked at my MRI and bot just the report and he said I have a limbus and my L4 is slightly bulging. He also said there is nothing I can do to correct this problem. I am discouraged because I don't want to live my life around painkillers. Is there really nothing that can be done to help my pain?

Answer
lower back pain,

Hello Shauney,

Sorry to hear of your Limbus bone.

You have had pain for three years, what happened three years ago?
I have some questions for you;  How old are you, have you had trauma (ie- three years ago), what treatments have you tried, do you have Lumbar Xrays from years ago-- before the pain started ?  What do you do that aggravates the pain, what do you do to relieve the pain?

At the end of my answer, you will see some additional websites to visit.  

I hate to sound like a doctor, but,,,,,,

This limbus bone may have been there your whole life, and may not be the cause of your pain.

This limbus bone could be something new, recent (ie- three years ago- trauma ?? ), and can mimic a herniated disc.

That is why I ask your age, previous Xray studies, prior history, history of trauma.

This could have been with you 'forever'.  If you have prior Lumbar Xrays, we can see if this is a new development.  If this has been with you 'forever'- if it is visible - in the past - and you did not have pain back then,,, well this may not be the cause of your pain.  If you have prior Xrays (or MRI or CT scan) and this Limbus is not there, and now it is, and now you have pain,,,, then the limbus could be a factor in your pain.

Your MRI should, of course, be viewed by a Radiologist.  There are excellent Radiologists out there- whether MD or DC (DACBR = Doctor of Chiropractic, radiology specialist).  Often the radiologist can date the 'injury'- new/ old/ developmental/ fracture.  You may need to do another MRI or CT scan- to look at changes over the last 7 months.

The MRI or CT scan should of course evaluate for herniated disc and other pathology.

If this were me, I would try to get a definitive diagnosis; have the films viewed by other radiologist(s).  Perhaps have a new study taken (MR or CT).

If this were me, I would try a course of conservative care; physical therapy modalities, acupuncture, chiropractic, even anti-inflammatory nutrition would be avenues I would consider.  Chiropractic would, of course, be my selection.  Conservative chiropractic: SOT technique, activator, adjunctive physiotherapy, and anti-inflammatory diet and supplements would be my starting point of treatment (after the old and new MR CT were viewed).

If the 'toe drop' continues through conservative care, or progresses towards 'foot drop', I would seek neurosurgical evaluation.

I am surprised that the Doctor of Chiropractic that you visited said 'nothing could be done'.  If you were to come to my Staten Island Chiropractic office- I would either recommend conservative care (chiropractic, acupuncture, physical therapy, nutrition), OR I would recommend visiting an orthopedic or neurosurgeon.

The nerve finding(s) (toe drop), require monitoring and treatment.
I would not 'do nothing'.  I would seek treatment.

Think of your history.  This may all be coming from the 'disc bulge', may be coming from the 'limbus bone', or may be from a combination.
Review the questions I have asked.

If you would like, do not hesitate to re-contact me here at AllExperts.com @ http://allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm


I hope this helps.

Sorry to sound 'Doctorish'.

Good Luck,

Dr. Victor Dolan, DC
http://drvictordolan.chiroweb.com


Additional info:

http://www.chiroweb.com/archives/17/12/10.html

https://rad.usuhs.edu/medpix/tf_case.html?&imageid=38975&pt_id=11390&topic_id=0&quiz=no#treatment

http://www.wheelessonline.com/ortho/slipped_vertebral_apophysis

http://www.nature.com/sc/journal/v42/n2/full/3101506a.html