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Bevann, it could be the onset of Facet Joint Syndrome. Of course, it is always dangerous to try to diagnose someone over the internet and especially with so little information present. But from what you have shared and described, I can make a half-educated guess. First though, let me address the latter portion of your message. You wrote: [I]“They sent me home after giving me a back x-ray and [B]a shot for the pain[/B]. I need to have an MRI done on Monday and I have doctor’s appointment with [B]a neurosurgeon[/B] on Wednesday. To top it all off, the evening of 1/2, I was [B]real shaky[/B], but made it to the bathroom with my walker. Coming out of the bathroom, [B]it didn’t feel like I had any legs[/B] so I fell. I have not fallen since then, but all this scares me because it is something new.”[/I] I believe the shaky part was a result of an adverse reaction to whatever palliative medication (or dosage) was in the injection they gave you at the ER. While there are physical reasons for a person to feel muscle weakness or unsteady on their feet, feeling [B][I]“shaky” [/I][/B]usually suggests that there is a systemic problem present --- an infection, an allergic reaction, an overdose, poisoning, abnormal blood chemistry, etc. So if you haven’t experienced it again, it probably will not reappear unless you are reintroduced to whatever caused it. If you have an ulcer and they gave you a shot of morphine as an analgesic you will definitely become VERY SHAKY, so you may want to discuss that with your doctor. You mentioned seeing a neurosurgeon on Wednesday. Hopefully, you meant a neurologist. A neurosurgeon may schedule you for surgery before ruling out other causes that may not call for surgery. A neurologist should run a battery of tests to determine the cause, including a nerve conduction study.

Facet Joint Syndrome is a common cause of pain related to the spine. The facet joints are the connections between the vertebrae in the spine. They are like any other joint in the body such as the knee or elbow that enable the bending or twisting movements of the spine. The facet joints can get seriously inflamed after a back injury or due to arthritis or other spinal diseases and cause pain and stiffness. When the facet joints are effected in the neck or cervical spine, it typically causes pain in this area as well headaches and difficulty rotating the head.

When the facet joints are effected in the back, people usually complain that they have to turn their entire body to look over to the right or left, and often walk in a hunched over position. Pain can be felt in other areas such as the shoulders or middle back area. [B]Low back pain is most commonly caused by Facet Joint Syndrome[/B]. Pain is felt in the lower back and sometimes it can be felt in the buttocks as well in the thighs, usually not going below the knee. Inflammation of these joints can cause stiffness and difficulty standing up straight and getting up out of a chair. Additionally, as the problem worsens, which it inevitably does, the symptoms mimic peripheral neuropathy where the nerves die or turn numb, or they could become hyper-stimulated as with meralgia paresthetica (Bernhardt-Roth syndrome, lateral femoral cutaneous neuropathy). Some patients may describe paresthesias or dysesthesias. Paresthesias are abnormal sensation perceptions, such as tingling, numbness, burning, itching, prickling, cold and warmth that have no apparent physical cause and are not triggered by natural skin reactions. Dysesthesias are [U][B]distorted [/B][/U]perceptions of ordinary tactile stimuli (burning, tingling, itchiness) -- a condition in which light physical contact of the skin causes pain. Changes in posture or prolonged sitting or standing may cause a variability of symptoms. The discomfort, including loss of sensation in the legs, may suddenly disappear and reappear for no apparent reason.

If there are no accompanying nerve symptoms or problems, compression of the L2-L3 vertebrae due to injury, degeneration or [B][I]“bulging discs”[/I][/B] will cause the facet joints to refer a lot of pain constantly – [B][I]“the most severe racking pain in my lower spine”[/I][/B].

The diagnosis can be confirmed by an injection of local anesthetic and an anti-inflammatory medication into the joints that are effected. Relief of pain can be immediate and dramatic following this procedure. However, most neurologists, orthopedists and rheumatologists advise against repeated injections of corticosteroids directly into joints, including joints of the spine, because it can cause degeneration or damage to joint cartilage, and exposes the patient to a possible dural leak (where the dura mater of the spinal cord is nicked resulting in dangerous spinal fluid leakage). Possible side effects include pain at the injection site, infection, excessive bleeding, nerve damage, or spinal cord inflammation.

For chronic cases of facet joint syndrome, where the pain relief from the injections is short-lived, a procedure called Radiofrequency Rhizotomy can be performed. There are nerves that arise from the facet joints that carry the pain impulses to the brain. This transmission can be blocked by heating these nerves by radiofrequency waves. The pain relief from this procedure usually lasts around 6 months to a year. Again, it is not a permanent cure or resolution.

One permanent solution to this problem is to have parts of the facet joints burned off laparoscopically with a laser. There is a world-class medical facility named the Laser Spine Institute down in Tampa, Florida that specializes in this procedure. I don’t know what they charge for this kind of procedure on the back (L2-L3), but I had it done on my neck and I have had no problems (and am pain-free) since the operation (July 13, 2006).

Good luck. I can certainly empathize with your plight.

-- Citadel72





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