Buttock pain, referred pain from lumbar region?

Tagged: delayed surgical decompression for lumbar nerve pain

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Ptb1230
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November 21, 2016 at 5:27 am

Post count: 7

#23468

Hi there
For the past year and a half I have had chronic left buttock pain that tends to be mainly at the top but is sometimes located centrally, I have received physio on the NHS in England which consisted of McKenzie stretches for back pain (I have no back pain whatsoever) which only aggravated the symptoms, the pain symptoms tend to be a cold tingling in my buttock that can travel down to the outside of my thigh running down to the knee and are considerably worse when sitting almost instantly. I was a keen runner but had to stop all forms of activity for fear of making things worse, however my physio suggested that if running doesn’t aggravate the pain then do it but cautiously and to build up the pain threshold. Prior to this I have had an MRI Spine Lumbar and Sacral scan that suggests the following; central and left paracentral disc bulge at L5 S1 that impinges the left nerve root within the left lateral recess. Three weeks ago I had a Caudal Epidural that did nothing to relieve my pain when sitting ( this is what gets to me most). I don’t want any form of surgery, but on the other hand this is affecting my hobby of running, my family life and work. I would love any advice that can be offered to help me get back to where I was nearly 2yrs ago.
Pete.

Donald Corenman, MD, DC
Moderator

November 25, 2016 at 2:32 pm

Post count: 8660

#23488

You have symptoms of a typical herniated disc at L5-S1 causing S1 root compression. The herniation causes compression of the S1 root when sitting (normal symptoms) as well as standing symptoms (lateral recess stenosis caused). Having this pain for 1 1/2 years means you should consider surgery (a microdiscectomy). The length of time for your symptoms concerns me as chronic injury to the nerve root can occur with prolonged compression of the root.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

Ptb1230
Participant

July 8, 2017 at 12:54 pm

Post count: 7

#25452

Hi there

Thank you for your reply to my previous post #23468. I have a couple more question that I would like advice on please. First of all I am still in the same predicament as before only I have had 2 more spinal injections that gave just 2 weeks reduction of pain only for the usual symptoms to reappear (buttock pain and pins and needles on the outer thigh heading towards the knee, sometimes the pain is less severe but it is always there). I have discussed this issue with my consultant (I’m still based in the U.K.) who is now sending me for another MRI scan. He has now said that because the pain has not resided he could perform a spinal decompression but he cannot guarantee that it wil work. I also discussed whether my problem could be Piriformis Syndrome but he said it would have shown up on a previous MRI scan. Could I have Piriformis Syndrome? Or, because the problem is chronic and my last MRI scan shows a mild disc bulge at L5 S1 is this really my core problem? I have been able to perform some very light jogging in which the buttock pain does not appear or hinder me whilst running on the day after. It seems that my pain is aggravated more by sitting or standing in the same position for too long. I have tried swimming which gave some mild reoccurrence of buttock pain. If my surgeon/consultant cannot guarantee a success where does this leave me? I do not want to take medication long term but I need regular exercise as I am now beginning to put on weight which I have no doubt this would aggravate my existing problem. Any advice would be greatly received.

Pete.

Donald Corenman, MD, DC
Moderator

July 8, 2017 at 2:20 pm

Post count: 8660

#25453

I think you should go ahead with your decompression. Yes, the results may not be as great as if you had this decompression years ago but the success rate should still be in the 80-85% range. The decompression might not give complete relief but should be satisfactory to you.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

Ptb1230
Participant

November 25, 2018 at 4:23 am

Post count: 7

#29825

Hi
I am replying to chat from several months ago (25453).
I decided not to go through with any back surgery as the pain in my buttock had gone -this is over a 4 month period now. However, as the pain resided I began to experience severe pain in the groin (opposite side to the previous buttock/disk pain), this was eventually checked out and a direct inguinal hernia was diagnosed. Recently this ‘hernia pain’ had completey resided, only for my buttock pain to return, with exactly the same symptoms as before. How likely is it that the two are connected and is it usual to have sporadic groin/referred back pain?
I will point out, that throughout these months I was able to get back into jogging and the referred pain did not present itself when jogging. As mentioned before I am reluctant to have surgery, but feel this is where it is heading. Any advice would be great.
Many thanks
Pete

Donald Corenman, MD, DC
Moderator

November 25, 2018 at 9:09 am

Post count: 8660

#29826

Groin pain can be generated from an L1 nerve compression, a hip disorder, a hernia as you noted, a problem with the testicle or from an S2 nerve disorder (generally not caused by compression). Since your buttocks pain has returned and you probably still have that compression at L5-S1, a new MRI to confirm the herniation should be considered. If still present, you could consider a selective nerve root block to confirm that the compression of the nerve continues to cause your buttocks pain and have the hope that the steroid could control the pain obviating the need for surgery. Finally, if the block is diagnostic but not therapeutic, you could then consider the surgery.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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