What is the reason for the increasing back pain while sitting that I have since two years?

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 and last reviewed on: Jun 29, 2023

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 (magnetic resonance imaging) MRI and computerized axial tomography (CAT) scans done. After this, I have been to the pain unit and got various treatments as below: 1) Sacroiliacs (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.

#

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 include: 1) Inferior articular process fracture. 2) Nerve root compression. 3) Facet arthropathy. The probable diagnosis may be 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 Computed tomography (CAT) scan images so you can double-check if there is a fracture or any other issue. Kindly help.

#

Hi,

Welcome back to icliniq.com. I understand your concern. The fracture with sclerosis (old) is identified on the computed tomography (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 magnetic resonance imaging (MRI). Kindly revert in case of further queries.


Was this answer helpful?

 | 

Same symptoms doesn’t mean you have the same problem. Consult a doctor now!



Related Questions:
Is locked-in syndrome treatable?

I cannot move or do anything but I react to pain ...   Read full

Understanding Low Back Pain

.. commonly found in young and school going individuals these days unlike it was believed as a disease of old age. So this is a small article giving a basic understanding of low back pain in the young hard working generation .   Read full

Please interpret MRI taken for lower abdominal pain and gas problem.

Hi, Welcome back to icliniq ... Hello doctor,I have left side lower abdominal pain and gas problem ... However, it is a benign pathology but if the pain is botherin   Read full

Also Read Answers From:

ideaComprehensive Medical Second Opinion.Submit your Case

Also Read


PCOS and Liver Problems
The hormonal imbalances in polycystic ovary syndrome could cause liver diseases. Read the article to know the relationship between these medical conditions.  Read more»
Inferior Alveolar Nerve Lateralization Technique
The inferior alveolar nerve lateralization technique is a surgical lateralization technique to reposition the nerve. Read the article to know more about this.  Read more»
COVID-19 and Ebola: Similarities and Differences
This article gives a comparison and broader overview of the outbreak of the two deadliest diseases that showed a greater incidence over the last two decades.  Read more»

Ask your health query to a doctor online?

Ask a Radiodiagnosis Physician Now

* guaranteed answer within 4 hours.

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.