Lumbar Pain: When to Seek Neurosurgery Consultation

Lumbar spine issues

I'm sorry to hear about your situation.
Initially, you thought your lower back pain was related to your menstrual cycle, but later you felt that something was not right as the pain persisted.
You haven't experienced any falls or collisions, and you've been careful when lifting, standing, or squatting, following your doctor's advice to rise slowly from a squat.
You have consulted a neurosurgeon and had X-rays done, which showed no issues.
An orthopedic doctor also performed X-rays with similar results and suggested that it might be a ligament or nerve strain, recommending some stretching exercises.
However, over the past month, your condition has not improved and seems to have worsened.
Aside from when you're sleeping, you experience pain in your lower back at all other times, and now even bending over to put on or take off your pants causes unbearable pain.
Would it be advisable to schedule another appointment with a neurosurgeon to discuss your symptoms, or do you think you might have initially chosen the wrong specialty? Thank you.

Yi Hsuan, 20~29 year old female. Ask Date: 2018/04/21

Dr. Lai Zhaokang reply Neurosurgery

Hello, please schedule another consultation with a neurosurgeon.
May I ask if an MRI can be performed? It would be best to consult a neurosurgeon with a specialization in spinal disorders.
Best wishes to Dr.
Lai Chao-Kang, the Director of Spine Neurosurgery at Changhua Hospital.

Reply Date: 2018/04/21

More Info

When it comes to lumbar pain, especially when it persists despite conservative treatments and imaging studies show no significant abnormalities, it is essential to understand when to seek further evaluation, potentially including a neurosurgery consultation. Your situation, characterized by ongoing pain that has not improved with conservative measures, warrants careful consideration.

Firstly, it's important to recognize that lumbar pain can arise from various sources, including muscular strain, ligamentous injuries, disc herniation, or even nerve root compression. Given that you have already undergone X-rays and consulted with both neurosurgery and orthopedic specialists without finding any significant issues, it may be beneficial to explore further diagnostic options. Magnetic Resonance Imaging (MRI) is often more sensitive than X-rays for detecting soft tissue abnormalities, including herniated discs or spinal stenosis, which could be contributing to your pain.

If your pain has worsened over the past month and is affecting your daily activities—such as bending to put on pants—this is a red flag. It suggests that the underlying issue may not be resolving and could potentially be more serious than initially thought. In such cases, a neurosurgeon can provide a comprehensive evaluation, including a detailed history and physical examination, to assess for any neurological deficits or signs of nerve involvement.

Moreover, if you experience any of the following symptoms, it is crucial to seek immediate medical attention:
1. Progressive weakness in the legs or feet.

2. Loss of bowel or bladder control, which can indicate cauda equina syndrome, a surgical emergency.

3. Severe pain that is unresponsive to medication or worsens with time.

4. Numbness or tingling that radiates down the legs, particularly if it follows a specific nerve distribution.

In your case, since you have been cautious with movements and have followed medical advice without improvement, it may be time to revisit the neurosurgeon. They can reassess your condition and determine if further imaging or interventions are necessary.
Additionally, consider discussing your pain management strategies. Sometimes, physical therapy can provide significant relief, especially if there are underlying muscular or postural issues contributing to your pain. A physical therapist can guide you through specific exercises tailored to strengthen the lumbar region and improve flexibility, which may alleviate some of the discomfort.

In summary, given your persistent and worsening symptoms, it is advisable to consult with a neurosurgeon again. They can provide a more in-depth evaluation and determine if further diagnostic imaging or treatment options are warranted. Your health and comfort are paramount, and seeking a second opinion or further evaluation is a proactive step in managing your lumbar pain effectively.

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