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Had a patient today with axial low back pain exacerbated by oblique extension with radiation into the posterior thighs bilaterally. No radiation distally to the knees. He gets intermittent paresthesias in his toes. He was treated outside the practice with 3 lumbar ESI (surprise, surprise) with no relief and several months of PT. He had an EMG (which was surprisingly pretty thorough) which demonstrated evidence of chronic L5 radic and segmental demyelination.
Exam: Strength/reflexes normal, semental tenderness lumbar paraspinals. Pain exacerbated by oblique extension bilaterally.
MRI: small central disc at L4-5, facet arthropathy lower segments.
The question is..would you guys try lumbar medial branches to rule out facet as pain generator? The only thing that is throwing me is the paresthesias mainly in the great toe (b/l) which is suggestive of L5 involvement, and the evidence of segmental denervation on EMG. Unfortunately, if he gets no relief from dx MBB, I may have to send him for surgical eval...
just curious...
Exam: Strength/reflexes normal, semental tenderness lumbar paraspinals. Pain exacerbated by oblique extension bilaterally.
MRI: small central disc at L4-5, facet arthropathy lower segments.
The question is..would you guys try lumbar medial branches to rule out facet as pain generator? The only thing that is throwing me is the paresthesias mainly in the great toe (b/l) which is suggestive of L5 involvement, and the evidence of segmental denervation on EMG. Unfortunately, if he gets no relief from dx MBB, I may have to send him for surgical eval...
just curious...
