Leg Pain
From The Back

Leg pain from the back

There are a number of different structures that can refer pain from your low back down your leg. Please take a look below for a more detailed explanation of each structure.

The most common reason for irritation or compression of the nerve in your back is a disc bulge. When a disc bulges, the slightly softer centre of the disc can bulge through the fibrous outer layers. Sometimes the softer disc material can leak out. When a disc bulges, your body tries to repair the bulge. It sends in lots of cells that reabsorb and repair the bulging disc. Your body is very good at repairing the bulging (sometimes called slipped) disc. In the vast majority of people who develop sciatic type leg pain, it improves within 3 months. Physiotherapy often helps resolve early symptoms. While the body reabsorbs the disc there is an active inflammatory response around the nerve and disc. The ‘inflammatory chemical soup’ that is surrounding the nerve irritates it and can also cause sciatica. The nerve may also be irritated if there is compression caused by the bulging disc. Your spinal specialist may consider referring you for a Spinal Injection or Discectomy or Decompression if time and physiotherapy do not help.

 

Leg Pain Lumbar Disc Bulge Diagram

There is a rare condition called Cauda Equina Syndrome. If you develop symptoms which affect your bowel, bladder and sensation around the genitals then you must seek an emergency medical opinion. If you have these symptoms you should go immediately to Accident and Emergency. Please click here to see the symptoms that you need to act upon.

At New Hall Hospital we have a static MRI Scanner with rapid access. It is always best practice to see a spinal specialist prior to considering whether an MRI would be useful. NHS patients are usually seen by a community triage service who can refer for a scan if they think it would aid diagnosis and decisions about treatment options, before referring to a spinal specialist centre like New Hall. At New Hall we see a large number of NHS.

If you have Private Insurance or wish to Self Pay, then New Hall offers rapid access Spinal Consultant appointments with fast access to MRI scan then review of these images to consider treatment options. A number of Consultants offer a One Stop service for assessment, MRI, review and treatment on the same day if appropriate.

Your spinal specialist may consider referring you for a Spinal Injection or Discectomy or Decompression if time and physiotherapy do not help.

Our joints, ligaments and discs wear as part of the normal age related process. Most of the time this does not cause significant symptoms. If, however the spinal facet joints become enlarged and worn, alongside buckling of the ligament at the back of the canal, this can reduce the space where the nerves are sitting. This can also become more significant if combined with a bulging disc, which narrows the front of the spinal canal. A combination of wear at the disc, ligament and joint can significantly compress the spinal nerves running through the canal. This narrowing is called spinal stenosis. It can become difficult to stand or walk due to leg and back symptoms. You may experience pain, tingling or numbness. Sometimes people describe a weakness or feeling of reduced power or control of the legs. Symptoms usually improve with sitting or bending forwards, such as when pushing a shopping trolley. Your spinal specialist may discuss surgical options such as Lumbar Decompression and/or Lumbar Discectomy.

Leg Pain Lumbar Spinal Stenosis Diagram

The spinal vertebrae are a complex bony structure. The section of bone that joins the spinous process (the nobbles of bone you can feel along the length of your spine through the skin) and the vertebral body, which makes up the front of the spinal column, is called the Pars Interarticularis. This is often shortened to ‘pars’. It is possible to develop a stress-type fracture across this part of the bone. This is called a lytic lesion. Sometimes this allows the front section of the spinal column to slip forward. If this happens, it is called a lytic spondylolisthesis. The amount of forward slip is recorded as a Grade 1-5. Grade 1 is a slip of 25% or less and is the most common, through to Grade 5 which is very rare, when the vertebrae completely slips off the vertebral body below it.

 Leg Pain Lumbar Spondylolisthesis Diagram

Sometimes a forward slip can occur due to wear changes in the joint, rather than a pars defect. This is called a degenerative spondylolisthesis.

Both types of spondylolisthesis can narrow the hole where the nerve comes out of the spinal canal, called the foramen and/or the spinal canal itself. It’s possible that this structural deformity can therefore contribute to the compression on the spinal nerves and development of leg pain/sciatica. This is often worse when you are walking or standing. Your spinal specialist may discuss options including Lumbar Fusion Surgery in addition to Lumbar Decompression.

The large pair of joints that sit between the base of the spine (sacrum) and ilium bone (wing of the pelvis), called the sacroiliac joints (SIJ), can be a source of low back, buttock and leg pain. You can also get symptoms such as pins and needles and numbness referred from these joints into the leg. It can be difficult to pinpoint pain or other symptoms referred from the joint as, unlike the nerves in the back that cause Sciatica, the symptoms do not follow a specific distribution pattern. SIJ pain or dysfunction, can also be similar to symptoms from the back joints or hip joints, so it can be difficult to diagnose. More information on the condition, diagnosis and treatment options can be found here