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Q. Why does my back pain increase while sitting or laying down?

Answered by
Dr. Muhammad Shoyab
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Apr 28, 2022

Hi doctor,

I have been suffering from back pain (right side only) for two years, and this hurts a lot when sitting or laying down for a while (like 20 seconds). So I got an electromyography test that showed mild chronic dysfunction on the S1 nerve. I also got a few MRI and CAT scans done. After this, I have been to the pain unit and got various treatments as below:

1) SI steroid injection: No improvement found.

2) L4 to L5 and L5 to S1 facet joint steroid injection and radiofrequency ablation of these facet nerves: No improvement occurred.

3) L5 and S1 nerve radiofrequency ablation: A very mild improvement happened during three weeks, but still, I cannot sit for more than one hour with no pain.

I visited various traumatologists and neurosurgeons, and they checked the lumbar MRI scan, but it was interpreted differently, which could lead to undesired surgery. Therefore, I thought it would be good to share the MRI images with a specialist in radiodiagnosis and get your feedback. Currently, I am not taking any medications. But, earlier, I was taking analgesics, anti-inflammatory drugs, corticosteroids, and Pregabalin. But, none showed significant results. So, could you please advise on what could be causing my lumbosacral pain and whether any nerve is affected? Kindly help.

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#

Hello,

Welcome to icliniq.com.

I understand your concern. I have gone through your provided X-ray and MRI (magnetic resonance imaging) images (attachment removed to protect the patient’s identity). The diagnosis is crisp and clear and correlated with your symptoms. However, it would have been more convincing and comprehensive if you had provided the CAT (computed tomography) scan images. Nonetheless, the findings of X-ray and MRI are:

1) Old fracture at the right-sided inferior articular process of L4 (lumbar), located just inferior to L4 and L5 facet joint (I am sure this appears on the CAT scan).

2) Left-sided nerve root compressions at L4 to L5 and L5 to S1 (lumbosacral) levels due to disc herniations.

3) Facet arthropathy at multiple levels.

4) SI (sacroiliac) joints are not included in the MRI, but they seem to be fine on the X-ray.

Since you already have nerve dysfunctions, I suggest you discuss whether it would resolve through surgery with the concerned surgeon. For the fracture, which is perhaps the source of your intense and endless pains, I suggest you follow the decision of the orthopedics and spine surgeon as to whether surgery is required or not. I hope you will now have confidence regarding the imaging findings and diagnosis.

I hope you get well soon.

Thank you.


The Probable causes:

1) Inferior articular process fracture.

2) Nerve root compression.

3) Facet arthropathy.

Probable diagnosis:

1) Inferior articular process fracture.

2) Nerve root compression.

3) Facet arthropathy.

Hi doctor,

Thank you for the information. It all makes sense, and I see the fracture you mentioned by looking at the X-ray image. Regarding the nerve compression, I feel the pain on the right side. Is it on the left side where you can appreciate the compression and not the right one? I am providing the CAT scan images so you can double-check if there is a fracture or any other issue. Kindly help.

#

Hi,

Welcome back to iclinq.com.

I understand your concern. The fracture with sclerosis (old) is identified on the CT (attachment removed to protect the patient's identity), and also easy to see the distorted configuration of the bones (malunion). That produces stress on the spine as it transmits your body weight through the distorted configuration. In that case, I suggest consulting orthopedics for appropriate treatment. The nerve compressions are present on the left side at L4 to L5 and L5 to S1 levels, and I think this produces the "mild chronic dysfunction on the S1 nerve" that showed up on EMG (electromyography). Your right-sided pain may not be associated with these nerve root compressions. I hope you now have a clear understanding of your CT and MRI.

Kindly revert in case of further queries.


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