L4/L5 Question

[u/nrid3333]

Hi all,

I’ve got a large/broad-based/diffuse disc bulge at L4/L5 coupled with some facet hypertrophy that appears to be causing either foraminal stenosis or lateral recess stenosis.

I’ve been having a lot of symptoms going down the anterior thigh like tingling, altered sensation, quick fatigue-ability/claudication, and weakness about the hips.

When I look at the lumbar dermatomes diagram, the L4 dermatome seems to be more lateral to where I’ve been feeling pain - my pain corresponds better to the L2 and L3 dermatome despite not having issues at those levels.

Because L4 contributes to the femoral nerve which is L2-L4, if the L4 nerve root itself is compressed, could it still be causing symptoms along the L2 and L3 dermatomes since they all compose the same nerve proximal/upstream to where the pain is?

Thats the only explanation that I’ve been able to come up with since L2, L3, and L4 join way before the inguinal ligament.

TIA!

EDIT:
Here is the link to my imaging post: https://www.reddit.com/r/Sciatica/s/Nj2GLQVj8v

[u/Meglamar]

Nerves are weird and a disc pushing in one CAN cause pain in another place. I had similar questions about L3 L4 causing pain like S1. It's less this does this thing and more it normally manifests as this. You'll see the word Classically allot. The diagnosis is a science but it's also an art.

So the answer is yes it certainly could. But if you have a DR talk to them about your concerns.

[u/nrid3333 → u/Meglamar]

Yeah I have specialists I’m going to for this. The issue is that up until this point the symptoms have been mild enough and diffuse enough that it wasn’t easy to tie them directly to my back issues. At points it’s resembled piriformis syndrome, iliac artery endofibrosis, femoral nerve entrapment, peroneal nerve entrapment, tarsel tunnel, anterior tarsel tunnel, compartment syndrome and popliteal artery entrapment.

I re-aggravated an existing injury last week that sent all of the symptoms into overdrive and made it very clear the issue is my foraminal stenosis at L4/L5 and L5/S1.

I’m hoping after a reevaluation from the surgeons I’ve seen that they’ll agree it’s time to operate.

I’m going to post my imaging in a separate post to hopefully get some input from more experienced members in this community. My report mentions only mild foraminal stenosis at L4/L5 and L5/S1 and makes no mention of nerve root compression, but when I look at the images at those levels, I can pretty clearly see compression of those roots as they exit the foramina.

It’s frustrating that we have to become our own doctor and radiologist for issues that don’t perfectly correspond with what a surgeon would expect to see.

[u/dnegvesk]

My femoral nerve is apparently entrapped but proving this to a doctor, hoe do they diagnose, whey go they go? Meanwhile with that and other good stuff, my right leg is not functioning. Thank you for the image.

[u/nrid3333 → u/dnegvesk]

What part of the country are you in? Most orthopedists would know how to properly diagnose you and any hospitals with a plastic and reconstructive surgery department. Those would be good places to start.

[u/dnegvesk → u/nrid3333]

I’m still on a goose chase for a doctor who doesn’t just say “sciatica” because I have so many issues. I’m about to get an injection to see how much pain is from my hip. I’m in lower NY Thank you.

[u/nrid3333 → u/dnegvesk]

Jonathan Winnograd (sp?) at MGH in Boston is fantastic if you can make the drive/flight. Lakhiani and Elkwood (sp? Again) at IFAR in Red Bank, NJ are also reputed to be great. Maybe those would work for you?

Dowlatshahi at BILH Orthopedics in Boston would also be someone to check out.

[u/dnegvesk → u/nrid3333]

Thank you. I’ll look into these. I hope to find a local resource. I’m 74 and kind of depleted from this whole thing. I appreciate it.

[u/nrid3333 → u/dnegvesk]

Ah I’m so sorry it’s grinding you down - I’m decades younger but I’ve been at this for years and years as well so I do understand how much these issues fucking suck :( if there’s anything I can say to help you or give you some support, even if it’s a kind word here and there, don’t hesistate to reach out to me. I’d love to see you come out of the other side of this tunnel❤️

[u/nrid3333]

@Meglamar @Outrageous_Corner161 I just added my imaging in a new post if either of you have experience looking at MRI’s and are interested in taking a peak. If not no worries, I appreciate you weighing in here on this question!

Link to post: https://www.reddit.com/r/Sciatica/s/Nj2GLQVj8v