Question
Dr. Ornstein,
Thank you so much for your time.  I am a 46 yr f. with a history of burst fractures In L1 and L2 . As a result I had fusion and a spinal cage placed from T12 to L 4.  Since the beginning of October, I have been having terrible pain.  I work as a preschool teacher, so you can imagine there is a lot of bending. I have so much pain every day in my low back right in the middle.  I also have pain in my buttocks, and hips, front thighs, knees and sometimes ankles.  I wake up 10x a nt because I need to change position due to pain.  I work, and can't function after.  I just am in constant pain.  I am doing aquatic therapy 2x a week for an hour and a half minimum.  I am getting depressed as this doesn't seem to be improving the pain.  I love my job sooooo much.  I can't imagine having to stop.
Have you any advice?  I do have a pacemaker and I'm on Coumadin.  I want to be excited about work and love teaching, and I find myself In tears at the end of the day.
Thanks!
Chris

Answer
Hi Christine,

Sorry to hear about this. Typically, a facet joint or sacroiliac joint problem will not refer pain to the ankles. Sacroiliac problems are generally in the back of the thigh and not the front. Now, that is not to say these structures cannot be involved, however, it would seem more prudent to look more centrally at the lumbar spine.

If diagnosing between facet joints or sacroiliac problems, in addition to some orthopedic tests, injection can be done that can be diagnostic regarding the site injected and relief obtained.

With your history, you would have to rule out any problems with the fusion you had or problems with the vertebrae below. After orthopedic and neurologic testing, I would presume x-rays and an MRI exam would be performed. Any problems with the discs or stenosis can be assessed, along with possible instability either at or below the fusion.

I wish I could be more helpful, however, this would certainly necessitate a detailed and thorough examination. If it is possible to have an assistant help you at work, that might be a good idea until the problem can be diagnosed and you can get some treatment. It seems you are suffering so much and this problem needs to be addressed expeditiously. Waking up at night is not good, you need a good night's sleep to be able to function at your job, and this can also affect depression.

I wish you all the best and hope you can have this taken care of as soon as possible.

Kind regards,

Dr. Steve
www.necksolutions.com