<s>[INST] my L4 vertebrae is missing and I in bad pain i have been having back pain for at least 5 yeas and now its at the point that i am in pain all the time the only thing that even seems to help is laying flat on my back with me knees up other then that position i am in horrible pain my doctor that i  went to said she does not think its my missing vertebrae that is causing the pain i lost my insurance and my parents do not want to help because she asked two nurses that are in our family. can the missing vertebrae be the cause of the pain? [/INST] Hi,From history it seems that due to severe degenerative changes in lumbar spines particularly L4 might be giving this pinched nerve pressure problem.There might be having acute PID ( prolapse inter vertebral disc ) giving Sciatica pain.Go for x-ray lower spines.Consult orthopedic urgeon and get examined.After proper diagnosis plan of treatment can be decided.Ok and take care. </s>