Scan Medical Insurance

My Dad has severe leg pain and no treatment is working I have listed all the information below please help!?

What started off several months ago as just fatigue and tiredness in his legs which would go away while sitting or sleeping, has now turned into severe pain in his legs (from his waist down to his ankles) which is constantly with him. It is bearable pain when sitting or laying down but quickly becomes unbearable when standing or walking. This major change happened approx. 10 weeks ago and the only thing that we can figure to explain this change was a missed step coming down the stairs which resulted in a loss of balance and awkward recovery that twisted the back and seemed to hurt something internal to the spine area. Have since had an X-ray and MRI which continues to show the formerly diagnosed spondylolisthesis. This diagnosis has now been discounted by Dr. Quigley (Spine specialist) as the source of the severe pain in the legs. Dr. Quigley feels that "spondy.." is not the likely source of the pain and that further testing is required to make a more accurate diagnosis. While we wait to figure out the root cause of the issue, dad's pain seems to be uncontrollable resulting in him being extremely restless. In order to control the pain have tried the following since 3/19/10: - 3 epidural shots in the back with the last one administered on 5/1/10. There was no relief at all from these shots - Oxycodone (10 - 325mg) - 1 tablet every 6 hours (Hit or Miss Relief) - Fentanyl 25mcg Pain Patch - replace every 72 hours - Prescription given on 4/1/10 to replace ineffective Oxycodone. Once again Hit or Miss relief. - Lyrica (50mg) - prescribed on 4/6/10 by Dr. Loev Overall medical history: - No history of vascular/muscular pain in the past - No history of arthritis - No history of heart disease or diabetes - No medicines taken on a regular basis Chronology of treatment (prior to onset of excruciating pain): - Primary care physician Dr. Anoma Bandara referred dad to a vascular specialist Dr. Robert Fox (Jan 2010) - Dr. Fox did a sonogram and found no vascular issues and requested MRI's of the spine (results and images on CD) and referred dad to see Dr. Quigley (Orthopedic surgeon) - completed in Feb 2010 - Meanwhile Dr. Bandara reviewed the MRI report and referred dad to see Dr. Zachary Levine a neuro surgeon from the Brain and Spine institute - Dr. Levine asked for an X-Ray to be done (results and images on CD) and recommended against any kind of surgery based on Dad's age and instead recommended physical therapy. - completed in Feb. 2010 -In order to pursue possible parallel diagnosis of the issue also saw Dr. Quigley (spine specialist) who prescribed some steroids to attack possible inflammation in the spine area and possibly relieve the pain. He diagnosed the condition as "Isthmic Spondylolisthesis". After a weeks worth of taking the medicine there was no improvement. Dr. Quigley then recommended injections directly in the spine to possibly provide relief. Since the conditions worsened: 3/19/10 to present - 3 epidural shots to the back - Medications listed above all prescribed after the onset of the intense pain - Another X-Ray and MRI of the back which still shows the spondylolisthesis at L5-S1 - Met with Dr. Quigley (spine specialist) again and he no longer feels that the pain in the legs is caused by the spondylolisthesis seen in the back based on the fact that there has been no relief from the 3 epidural shots that were administered. - Also performed the following tests - full body bone scan (showed no problems) - nerve conduction study and EMG (showed some erratic nerve issues at the L5-S1 vertebrae which confimred what was seen in the MRI) - An array of blood work (everything was fine) -Saw a different vascular surgeon and repeated the ultrasound test which showed no vascular problems -Saw a rheumatologist who also confirmed that there were no signs of arthritis -Saw a different neurosurgeon who asked us to pursue with a neurologist to determine the source of the pain. -Currently waiting to see a neurologist for follow up -Currently undergoing physical therapy to basically stretch the muscles and provide some heat -Also currently undergoing aqua therapy in a pool to help get the legs moving -Have also had 4 appointments with a licensed acupuncturist -None of the above therapies have provided any relief and the conditions with the leg pain are still the same

Public Comments

1. WOW! Pour guy. When you say the vascular surgeon performed "an ultrasound" do you mean an arterial or venous doppler? If it wasn't, I'd ask for one.
2. What kind of pain? 1. Shooting 2. Burning 3. Throbbing 4. Dull 5. Aching Thers is something unstable in his in LS and SI joint plus spondy is a big contributor. Since everything looks clean on a testing side, it would be fare to assume that origin of the pain is mechanical. Meaning it comes from his joints which put pressure on his nerve roots. Was MRI done Standing or Prone. If done prone, MRI will not show the real problem since your father feels better in a prone position the same thing for XRAY - must be done in weight bearing position. Check his hip level and see if one side is higher than the other. If yes, his SI joint has a problem and Spondy will cause additional pain. What is the grade of his spondy 1-4? To be continued after you answer some of my questions.
3. The very concise history really shows up one glaring problem the EMG test at the L5-S1 along with the MRI is a nerve related, has a nerve block been localised to just the L5-S1?
4. Your father has had a very thorough medical work-up and he's had most of the tests that I'd be concerned about. I agree with the chiropractor that it does appear to be mechanical and not vascular. However, what we do not know from your post is the degree of the spondylolisthesis. Spondys are generally rather benign entities that commonly occur as we age (known as a degenerative spondylolisthesis) or can occur early in life and might progress until the 5th decade of life. Degenerative spondys are generally stable entities are are rarely serious enough to be a major source of symptoms. If your father has a slip that has possibly progressed since childhood, certainly this could be evaluated if he happened to have x-rays in the past. Certainly, if it has progressed, it could be a sign that the segment is, indeed, unstable. the other possibility is that this is a traumatic spondy...in which case it's quite likely it's a source of symptoms. Unless your dad had x-rays in the years past, it would be difficult to tell. Spondys generally do not become clinically significant unless the slip has progressed to a grade III or IV (50-100% slippage relative to the vertebral body). If he is a grade III or IV, with the signs that he has, this is almost always indicative for surgery. I also agree with the chiropractor that if the studies were done in a lying position, it might not be telling the whole story. We know he is already comfortable when off his feet. We need to know what is happening when he is moving or standing. If it were me, ordering films, I would have included flexion/extension films or a dynamic weightbearing MRI (harder to find places that do this)...this way, we can see what happens when he moves or is weightbearing. Overall, it does sound like some type of obstructive process on the spinal column. Spondylolisthesis can certainly be a cause, but so can just plain old stenosis. Stenosis MIGHT be confirmed on an MRI, but the myelogram is the most sensitive test for ruling out stenosis. You did mention that age was a factor in determining surgery...but what is his age? Best wishes.