The patient first hurt his back in his 20s playing rugby. A few years ago he reinjured it while snowboarding. His current flare of pain started after using a foam roller on his hips. In 2015 he injured his right knee running which was diagnosed as caused by a degenerative meniscal tear on MRI.
The low back pain is worse on the right, and causes sudden shocks of pain. He does not get any leg pain apart from the knee pain as above. He gets some groin pain but the back is much worse, but these seem to flare up together. The pain is worse in the mornings causing stiffness which lasts about 1-2 hours. He has found certain pain relieving stretches. He works long hours as a chef which causes discomfort.
He saw an Orthopaedic Surgeon who recommended conservative management, but to proceed to anterior discectomy and fusion at L5/S1 if symptoms became unbearable.
No pertinent contributing psychosocial factors were identified.
His pain drawing is below
He has psoriasis and celiac disease. No regular medications.
Inflammatory markers are normal.
MR imaging done through the Orthopaedic Surgeon 10 months ago showed
Ultrasound guided diagnostic right hip injection with 5mL 1% lidocaine done. Pre-procedure pain 7/10 on NRS. No change post-procedure.
Oblique View
AP View
The diagnosis is confirmed facetogenic pain arising from the right L3/4, L4/5, and L5/S1 facet joints.
He will proceed to radiofrequency neurotomy of the L2, L3, L4 medial branches, and the L5 dorsal root.