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Can anyone explain, or has had personal experience, why with my significant flare up of L4-5, L5-S1 disc bulge, I have significant new pain on the iliac crest and hip joint? I've searched all sorts of anatomy/physiology resources and still can't find an answer.

New MRI was done and it reads the same as 3 yrs least by the radiologist report.
When I saw my original cervical spine surgeon he zeroed right in on a torn L4-5 annular tear, and I had foraminal steroid injection and a month later facet injections. This recent flare includes low back pain (especially with rotation/bending forward) and numbness/tingling sciatic aching into the big toe, and the pain in the hip joint and iliac crest. When the flare suddenly escalated, I was having posterior burning pain in the right thigh as well. Now 2 weeks later, the right side has settled down, but the left side from back (waist) down, iliac crest, hip joint, lateral thigh (sometimes anterior thigh), some mild calf, and occ. tingling big toe. I still have intermittent slight weakness in foot but only when driving home from work and use left foot for braking - weakness is when I take my foot off of the brake and it flops just a little. I'm fine when laying down.

For what it is worth the current MRI states:
L1-2 no evidence of disc herniation, canal or foraminal stenosis
L4-5 there is broad-based posterior disc bulge with a small central superimposed disc protrusion and mild ligamentous hypertrophy causing mild canal stenosis. There is no significant bilateral foraminal narrowing.
L5-S1 there is a central disc protrusion causing focal compression of the thecal sac.
Conclusion: mild disc protrusions at L4-5 and L5-S1 without no significant canal stenosis. Minimal if any foraminal stenosis at L5-S1. These findings are unchanged when compared to the previous examintion (2006)

Anyone have any thoughts? Thanks!

I've already am fused C3-6 and now have a local spine surgeon for my care.
Hi sk84life

First off, I want to tell you that I am no expert and have not been here very long. However, I have the same pain as you...clear into my toes.

I have had lumbar nerve blocks and they seem to help with the leg pain.

As for the hip and iliac pain, I still have that. I do know for me, I have a slippage. A small one but still a slippage and my PM has me wearing a brace when I bend. I also have what is called a pars defect. You may want to have your doctor look for those.

Also, my hips are not level so that also contributes. Probably not much help, but I hope so. If nothing else, you are not alone! :)
Thanks for letting me know I am not alone.....but I really want to know 'why' I hurt so bad. The hip and lateral leg is especially painful.

I have left a message for my doc to LOOK at the films himself and also to look at the facet joints. While they said no change from the previous MRI several years ago, they totally missed a torn annulus at L4-5 with foraminal stenosis. I just don't want to wait 4 months to get a proper diagnosis like I did 3 years ago!

I don't know if I can put up with this pain forever. As for a brace, couldn't wear one with my line of work. But thanks so much for your reply and suggestions.
Ditto on pain and symptoms. Hip, groin, butt, leg, calves, ankle, top and bottom of foot and toes. Did you look at the dermatome map in the resources you looked at?
Yes, I have looked at dermatome maps ad nauseum......but in descriptions of pain from lumbar discs the iliac crest is not mentioned nor shown. The only thing I have found is a muscle insertion on the crest area.

When I had an epidural steroid 3 years ago (just a bland one, not a specific focused on) the doc said it was not uncommon to hear patients complain of the iliac crest pain. And that one epidural did relieve the iliac crest pain, but nothing else.

Thanks for your thoughts!
Is it that you are in a flare or that you have new pain at the illiac crest that concerns you? Your MRI can look the same but you can have a serious flare. I was told without correction it will be there probably for life and continuous flares. You could have serious inflammation. Sometimes the flare will calm down - sometimes not and it may spread and worsen during the next flare with new areas. Patients with disc problems and back pain, sciatica start over compensating, walking differently, when we sit it can get irritated, etc.. I am in a flare right now after having relief since June from injections. Going first week of December for anothe round.

What you describe fits the sciatica radiculpathy profile for L5/S1 from my own experience, I have pain in all those areas too. However, I have a very nasty central canal extruded herniation.

An interesting read I found was on Iliolumbar Syndrome - another overlooked cause of Sciatica. Iliolumbar syndrome-- also known as lumbosacral sprain--is a frequently unrecognized cause of sciatica that results from inflammation, sprain, or tear of the[B] iliolumbar ligament[/B]. This ligament bridges the transverse process of the fifth lumbar vertebra and iliac crest. From this it would kind of make me think that when we get imbalanced from the disc problems it would put strain on these other parts.

Patients complain of pain that varies from a constant, dull ache aggravated by activity to extreme severity. Pain is usually localized to the [B]posterior portion of one or the both iliac crests [/B](patients can often point to the precise site), but may spread across iliolumbar region.

The typical sign is tenderness of palpation of the posterior iliac crest on the involved side. Increasing pain with lateral bending away from the involved side is the characteristic sign of ilio lumbar syndrome.

Neurological examination is normal in patients with iliolumbar syndrome.

It is treated by local injections.

If you go researching down that path of muscles and nerves you might find something you are looking for.
Thanks for pointing me in another direction and after doing some more research, I think you are right about the iliolumbar ligament being responsible for the iliac crest pain. So that explains at least part of the overall problem.

I see spine doc on Tuesday to review MRI.
In addition, I should note, I had started with a rheumatologist last spring and he feels I have mild SLE. When my persistent neck pain reached a breaking point (and PT, TENS, NSAIDS had not relieved the pain) he had me take prednisone 5 mg a day. After the second dose, all the neck pain resolved, he felt I had been in a long flare. Neck has been great since then with only maybe one day a week needing the low dose prednisone.

So with this low back episode, I started the prednisone without resolution, and even upped it to one day of 10 mg but without significant effect. Advil takes the edge off but still needed 1/2 tab of vicodin after work to cut the pain. Last night was the first time I didn't need the vicodin and the pain seems to be receding a little.

Thanks again for your imput!

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