Stenosis and Degenerative Facet Disease

Problem: Today I had a 62 year old man present with severe low back and leg pain. On taking his history, he stated that his low back hurt worse first thing in the morning and again late at night. He also stated that his pain was increased with slightly bending over say the sink to wash dishes or shaving. He also stated that his low back and leg pain was decreased by sitting down. On questioning, he stated that when he shops he needs to lean over a shopping cart. And while shopping his pain can be relieved if he sits down for a few minutes. I ask him if his pain immediately goes away while sitting or does it take a few minutes to historically differentially separate vascular claudication from stenosis. He has a past history of MRI study showing 2 bulging disc and has had 2 lumbar epidural injections with little success. You know God gives you the right to have more than one thing going on at a time an I think this patient has taken him up on that idea. After taking his history, I have a theory that he had two primary problems 1) lumbar stenosis and 2) degenerative facet syndrome. I feel that his bulging disc may in fact be a red herring and not causing his problems. I did a complete and thorough examination including posture exam, orthopedic test, neurological test, palpatory exam, spinal exam, range of motion and digital muscle weakness exam. Next I completed a surface NCV and EMG of his spine and lower extremities. I ordered X-rays of his lumbar with obliques at the hospital and compared them to his recent MRI films. Discussion: On imaging he in fact does have both soft tissue and bony stenosis. The lumbar canal was narrowed to 9mm at L4 and L5. Since he did not have any pain with a straight leg raiser or well leg raiser and was able to tandom walk heel/toe with no other neurological deficits, I concluded that his bulging disc were red herrings. Spinal stenosis, a narrowing of the spinal canal, which places pressure on the spinal cord or nerve roots. If the stenosis is located on the lower part of the spinal cord it is called lumbar spinal stenosis. Stenosis in the upper part of the spinal cord is called cervical spinal stenosis. While spinal stenosis can be found in any part of the spine, the lumbar and cervical areas are the most commonly affected. Patients with lumbar spinal stenosis may feel pain, weakness, or numbness in the legs, calves or buttocks. In the lumbar spine, symptoms often increase when walking short distances and decrease when the patient sits, bends forward or lies down. Cervical spinal stenosis may cause similar symptoms in the shoulders and arms. In some patients the pain starts in the legs and moves upward to the buttocks; in other patients the pain begins higher in the body and moves downward. Treatment: I started him on phisotherapy including Interferrential current (IFC) for 15 minutes along with hot pads. I also started him on ultrasound over the lumbar paraspinal muscles and facets. I started him on DTS Decompression Traction; Cox Flexion/Distraction; and chiropractic manipulative therapy. If he does not improve in two weeks then I will send him for lumbar facet injections. I feel he will ultimately need the facet injections. However if he needs facet injections I want them to be done under floro guidance at the hospital or surgery center. I am also talking to him regarding his overall health and his future health goals and life expectancy. If he develops neurological deficits then I will immediately refer him back to the neurosurgeon for surgical decompression.
Dr Greg Millar

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Interesting Case

Problem: This week I had a 43 year old lady present with chronic fatigue, chronic headaches and pain over all four quadrants of her body. She had yeast overgrowth but did not know it. She had been diagnosed with Fibromyalgia, Irritable Bowel Syndrome, Interstitial Cystitis, Endometrosis, Allergies, Type II Diabetes, Rheumatoid Arthritis, Sinus Problems and Thyroid disorder. Examination revealed tight and tender points across the body with moderate spasms. Numerous orthopedic tests were positive. She had both sensory and motor loss to the upper and lower extremities. She has a past surgical hx of gallbladder and hysterectomy. She has been in several past major auto accidents. She has had past severe hormone problems with past long and painful menstrual periods, severe mood swings and moderate PMS. She has current hormone problems in that she has hot flashes still and every night she goes to bed cold and wakes up about 3-4am sweating and very hot. She has been to numerous physicians. Her primary care physician tells her her problem is in her head and offers nothing to help. In taking her history, I also discovered that her body temperature is always very low in fact her body temp runs around 97.5 and I suspect Wilson's Temperature syndrome as well. I understand in the endocrinology community especially in the Eastern US that Wilson Temperature Syndrome is an unthinkable and unfounded diagnosis. But I think she has it anyway. By the way, this lady ate NO fish EVER and did not drink water. Instead she drank Mountain Due and Coffee all day long. Test: Her Sed Rate was 28/20. Her EBV IgM, IgG and nuclear antibody were all positive and very high. X-Rays demonstrated a mild to moderate scolosis with a loss of cervical curve and degenerative disc disease, spondylosis and moderate loss of disc space through out the spine. Her Complete Blood Count with Differential demonstrated a mildly elevated white count with elevated eosinophils and basophils both possibly elevated to allergic reactions and possible parasites in the case of eosinophils. Discussion: I have seen many patients in the past with this same sequella of symptoms and problems. The first things we need to do is get them sleeping, get them off Mountain Due and Sugar and ON Water and Fish oil. I have consulted infectious disease just to be on the safe side. I think she may have food allergies as well as a permeable/leaky gut and disbiosis. I think she may have bulging disc and other musculoskeletal problems as well. I also took her off ALL Sugar. NO foods that contain any sugar and started her on probiotics. I want her to start stretching daily for the FMS. This is one of those onion cases. These people have many layers of problems and we'll take them one at a time. I will update you on her progress. PS... She will get worse before she gets better. But I think with God's help we can walk her out of the woods. Dr Greg Millar



Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.