pain on tail bone, with an L4L5 disc herniation

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nikolaus
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January 15, 2012 at 10:03 pm

Post count: 11

#5381

Hi doc,

I have contacted you before. I have one more problem for which I ask for your help.

I am considering microdiscectomy as an attempt to solve sciatica, back pain and antalgic scoliosis – although during the last month I have seen significant signs of pain improvement both in lower back and in sciatica pain levels. The pain in the lower leg has improved substantially (although the nerve is still pinched since I still have a positive raise leg test), and burnings feelings in lower back have subsided a lot.

As the pain was reduced, I noticed significant tailbone pain and a little numbness that lasts for only a couple of seconds, but only when it is compressed. Eg. if I sit on a chair and put my weight on the tailbone I feel a lot of pain on the tip of my tailbone after I try to get up. My doctor says that this pain can be caused by a disc herniation at lower back. However, if I sit on a chair and I put my weight on the left bone of the pelvis (I don’t know the medical term, but I think you can visualize it, just lean on the left or no the right while sitting) or on the right bone of the pelvis, I feel no pain. If I sit on a toilet normally (where there is no tailbone compression) I do not feel that kind of pain. If the disc herniation caused that pain, shouldn’t I be feeling pain even in toilet since the disc is compressed?

So, I want to proceed to the surgery, but I do not trust doctor’s opinion. I want to be sure nothing else is going on because the sciatica pain seems to be improving.

My question is can a left paracentral disc herniation on L4L5 which compresses the spine cord and the left nerve, cause pain at the tip of the tailbone?

To which doctor should I go so that I can verify that this pain does not originate from something else? dermatologist? orthopedician?

Donald Corenman, MD, DC
Moderator

January 15, 2012 at 10:16 pm

Post count: 8660

#5382

Pain at the tailbone or in anatomic terms, the tip of the coccyx, is pain that may or may not be caused by the disc herniation above this level. The coccyx is served by the S2-4 nerve which are below the disc herniation level that you have. None-the-less, I have seen patients who complain of tailbone pain gain relief from a microdiscectomy at your level. This must have been referral pain or sclerotomal pain from the disc.

You have this tailbone complaint only when the coccyx is loaded (pressure placed directly on the coccyx). This might be something independent of the disc herniation above such as coccydynia- a “sprain” of the ligaments around the coccyx bone.

As far as the need for surgery, if you have no motor weakness and you are improving, the indications for surgery become softer. It really depends how much pain and dysfunction you have and how long it has been since onset of symptoms.

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.

nikolaus
Member

January 16, 2012 at 12:43 am

Post count: 11

#5383

I understand.

I have been 4 months in bed and 4 months with difficulty walking. My problem is that there are clear signs of improvement month by month. On one hand I want to remove the herniation so that I can return to normal life faster, on the other hand it is obvious my body tells me it can heal if I give it more time.

My MRI on lower back shows no abnormality to the coccyx. So I guess it could be a soft tissue problem or not as you describe.

How could I know? orthopedic surgeons that have seen me only seem to care about the MRI and the disc herniation.

So, could you tell me which doctor specialty studies coccyx pain? orthopedicians? or dermatologists? or sth else.

Donald Corenman, MD, DC
Moderator

January 16, 2012 at 2:08 am

Post count: 8660

#5384

The specialist that would know the most about coccyx pain is the spine surgeon. I can tell you that no one will know if the pain in your coccyx will go away with surgery.

The fact that it has been 8 months with disabling pain- 4 months being bedridden signals that you most likely would benefit from surgery for this disc herniation. It probably would have been more beneficial to have had surgery months ago, but ask your spine surgeon what his opinion is. I believe he or she will think you are a candidate for surgery.

The coccyx can always be treated as a separate issue if the coccyx pain does not improve.

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.

nikolaus
Member

January 16, 2012 at 5:52 am

Post count: 11

#5385

K, I see.

I would like to thank you once again for your quick answers (I thank too much, lol).

The idea of the forum is great and the answers you provide are very helpful to many of us.
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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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