Expert: Dr. J. Shawn Leatherman - 12/5/2006

Question
my dad started out with severe lower back pain. it preceded to his hip, then the left leg, and now the right all within a weeks time. he is experiencing a burning sensation down his leg, along with severe pain, and he said he feels like his knee cap is going to explode. x-rays were negative. no edema or redness. percocet and morphine do not help. he just had an mri. he can walk for only a short period of time. sitting does not help, he has to lay on the floor. any suggestions of what could be causing this?

Answer
Dear Samantha,

Yes...I have quite a few ides of what may be causing this; Degenerated disk, canal stenosis, neuroforaminal encroachment, bulging disk, sacroilliac dysfunction, etc... or a combination of the above!!

You see Samantha, he really needs a complete orthopedic na neurological examination from a doctor who is an expert in musculoskeletal issues.  I am assuming that he either went to his general practitioner or the emergency room and they took a brief history then x-rays.  This is often the case without appropriate examination.  Reporting that the x-rays are negative doesn't really mean anything to me...negative for what?  Arthritis, tumor, fracture...this is typically what the medial professional will look for an x-ray.

Now, my opinion is quite limited at this time, because I do not have a full medical history, a recent history concerning the onset of pain/injury/possible dysfunction, I can't see the x-rays for myself, and I have not had the opportunity to examine him.  The MRI that has been ordered is a better test for visualizing the disk, nerve roots, and spinal canal.  I suspect that from your information, that you are going to find a central disk bulge with either cord compression (thecal sac) canal stenosis, and narrowing of the neuroforamen on both sides of the spine.  This would mean that the nerve roots have been irritated and likely compressed causing the pain that moves down the leg...sometimes referred to as sciatica.  For a thorough explanation with relevant anatomy explained, check out these two pages of my website:  

http://suncoasthealthcare.net/dsc.htm
http://suncoasthealthcare.net/sa.htm

I would recommend that you encourage your father to get an evaluation from a Chiropractic Physician.  These are the types of problems that we deal with on a daily basis.  I would also recommend that you get the x-rays to take to the doctor...chiropractors look at x-rays not only for frank pathology, but also for structure which is quite different than just looking for pathology.  Variations of spinal structure frequently lead us to a better understanding of the problem and allow for a more effective treatment program to be designed.  You will also need to make sure the MRI results are available for consideration as disk problems are treated a bit differently than facet joint problems, and rehab will be different as well.  Hopefully this will not turn out to be so severe that it is beyond the scope of chiropractic care, but a surgery is also a real concern at this point.  Bottom line is that the MRI will tell you a lot. Diagnosis and treatment will be easier to approach after you get the results.

I wish your dad the best of luck.  feel free to follow-up if you have any further questions.

Respectfully,
Dr. J. Shawn Leatherman