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SI pain vs L3 L4 disc buldge questions

grandmesamomggrandmesamom Posts: 181
edited 06/11/2012 - 7:56 AM in Sacroiliac (SI) Joint Problems
I have a few questions that I hope someone can comment on. I have had chronic left sided back pain for over five years. It has become excruciating the last nine months. I was told it was arthritis and just learned to live with it. The pain is on my left side,radiates to my quad muscle,hip and have deep groin pain. I have difficulty standing and walking for long periods.I have history of L4 L5 fusion and my sacrum actually fused itself into my L5. My MRI didn't show anything because of the artifact. My Physiatrist feels the pain mimics the L3 L4 .My PT strongly feels it is my SI joint. My leg muscles are weak and very stiff. My PT says my pelvis is rotated forward. I am in excruciating pain when she focuses on the left SI joint. I also have noticed that my left thigh is starting to atrophy compared to my left. Is that normal?
Is weakness normal? I was given a medrol dose pack and my pain was significantly improved for a short time. I am being sent to a pain Dr this week for possible injections. Would it be up to him to figure out the source of my pain? I just feel I should have an accurate diagnosis before starting on injections. I read the posts on how painful the injections are and I have always avoided them in the past.
Any other thoughts or insights on the path I should take?
Thank you


  • These are very good questions. First lets address the weakness. You have noticed atrophy of the quadriceps muscle. This is not normal. So the question arises is the there a structural problem seen on your MRI that could correlate with a possible L4 vs L3 radiculopathy (moderate to severe foraminal stenosis at L4-5 vs L3-4, focal disc herniation not disc bulge at L3-4. So an elecrodiagnostic evaluation would be helpful more specifically the EMG needle portion. The physiatrist can pick up on qualitative changes to the muscle and if he sees "not normal findings on the EMG screen then he may explore muscles also innervate by the L4 nerve root below the knee.

    Now what is the differential for some with a previous interbody fusion at L4-5. If the fusion took care of symptoms you had at that time and later developed a new set of symptoms then it is possible your current left sided low back pain that radiates into the quad/groin could be emanating from the L5-S1 facet joint or the L3-4 facet joint. Fusions can cause pain to adjacent segments and having a diagnostic injection preferably a medial branch block to anesthetize the facet joint at L3-4 and L5-S1 on separate visits looking for greater than a 75 percent reduction of your current painful symptoms could be useful in at least eliminating or ruling in a potential source of your low back pain. Also the sacroilaic joint could be a potential pain generator. The best method to figure if the sacroilaic joint could be a significant source of your peripheral pain (less likely the low back if it not lumbosacral) would be to perform a diagnostic sacroiliac joint injection under fluroscopic guidance using an anesthetic as the solution and confriming needle placement with xray and contrast. For ocnsistency of results this should be performed on 2 separate visits.

    Once again if the diagnostic lumbar medial branch block at L3-4 or L5-S1 helpes to clarify a good portion of your low back pain on the left side but not the peripheral pain then the next step would be to have a diagnostic sacroilaic joint injection.

    There is alot to think about here. Figure out the muscle atrophy is true neurologic weakness. Then figure out the low back and peipheral pain. best
    Amish R Patel DO, MPH
  • Thank you for the detailed reply as it was helpful. Went to a leading university in chicago and saw a pain specialist. We are goig to try L3 L4 ESI under xray. He said if that doesn't work they can try other things.My strength was graded 3/5 on my left leg. The atrophy is very obvious now in my quadricep. I don't know what they will offer next but am frightened about weakness.
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