[goawaysciatica]

#5805

Hi Doctor,

I am now 28 and have suffered from varying degrees of sciatic symptoms for 3 years now. I was a perfectly healthy person before and used to enjoy sports and staying fit. At 25 I suddenly developed pain in my back & leg which has stayed in varying degrees for 3 years now.

I was diagnosed as having sciatica. I have had slipped discs identified at L5 S1 and in my mid back, a microdiscectomy on my L5 S1, physiotherapy, an epidural steroid injection and most recently an ablation.

I feel kind of ok these days but the symptoms remain present below the surface. I’m not in terrible pain, but I would really like to get back to being active and doing exercise and each time I have tried I have suffered a relapse.

I was trying to investigate if there are potentially any missed problems causing the sciatica. I have read that because it is most or very common for it to be a herniated disc, sometimes other issues can be overlooked. I have read about piriformis syndrome causing very similar symptoms and was wondering if I might have an additional undiagnosed problem as well as the slipped discs, such as piriformis syndrome. Are there any ideas that I might pursue that could be causing (sciatic) problems in addition to the herniated disc?

Many Thanks.

[Donald Corenman, MD, DC]

#5809

Piriformis syndrome is exceedingly rare and very over-diagnosed. I have seen 3 cases in thirty years of practice. Why piriformis syndrome is over-diagnosed is that irritation or compression of the sciatic nerve refers pain here almost 100% of the time. The more the nerve is irritated, the further down the leg the pain will radiate; buttocks, thigh, calf and finally foot. If the nerve is only mild to moderately irritated, the pain will only radiate down to the buttocks which is commonly but incorrectly referred to as “piriformis syndrome”.

You note you have a “slipped disc”. Discs really cannot slip as they are firmly attached to the vertebral bodies. You could have a bulged disc or a spondylolisthesis (see website for description of isthmic and degenerative spondylolisthesis) and those condition could cause pain. Lateral recess stenosis and foraminal stenosis (see website) are common causes of nerve pain and might have been overlooked. Read your MRI report for any indication of these problems.

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.

[goawaysciatica]

#5917

Hi Doctor. Thank you so much for your speedy and helpful reply. All information on this issue is so helpful. I will read further around your site and will reply tomorrow as I am trying to fix this problem. Thanks again.

[goawaysciatica]

#5971

Hi Doctor,

Thanks again for replying to my message. This site is very helpful and interesting, with lots of useful information for people such as myself trying to improve back problems.

I found my most recent MRI report and have pasted it below. It is from September 2011 and was taken because I had experienced a strong relapse around 9 months post microdiscectomy. I am inclined to believe that the bulge may have receded a little and improved since then, as overall the pain has lessened and I am more mobile and able than previously and am close to how I was prior to the relapse. (I could be wrong, but this would be my humble guess)

MRI report-

“Findings: . The conus and cauda equine appear normal. There is normal lumbosacral vertebral alignment. No vertebral collapse or focal bone marrow lesion is identified. Disc dehydration with loss of height is present at L5-S1. At this level there is a prominent annular bulge slightly more pronounced on the right side but no obvious nerve root compression. The annular bulge extends into the exit foramina on both sides with contact between the bulging disc and L5 exit nerve root on the right side. Minor bulging is also present at L1-L2 also slightly more prominent on the right side with distortion of the thecal sac and slight compression of the adjacent nerve roots. The exit foramina appear otherwise intact. The articular facet joints appear normal.

Conclusion: Disc bulging at L1/L2 and L5/S1 more pronounced on the right side.”

The trouble is I have residual sciatic symptoms from the microdiscectomy that preceded this relapsed bulge in September and have remained to today, whilst I have largely recovered from the relapse.

This is why I was asking about piriformis syndrome. I have had several expensive treatments to attempt to relieve or solve these problems, but they have remained almost unchanged ever since the op. I was wondering if perhaps they were targeting the wrong thing or had missed something. I accept that piriformis syndrome is probably very rare, so I’m guessing I could be clutching at straws there, but I have already beat the odds of recovery from the microdiscectomy. My surgeon said that this operation had a 90% success rate and I don’t really feel I have come into the successful category.

From the information and suggestions that you gave me, I could fit my symptoms partially into most of them, as described on your site, but perhaps the best fitting one would be lateral recess stenosis. My symptoms are not terrible right now, but have been permanent since the op, with variable pain in my leg & buttock and a permanent pain on the bottom of my foot. My real desire, if achievable, is to get back to being active. I could live with pain if I could get my active life back, but at the moment I am fearful of doing anything too active, in case something happens again.

If you have any thoughts regarding the MRI report, or ideas for treatments that I might try, or investigate I would be very grateful. I have also heard of a company called Regenex that are doing stem cell treatment. I have considered this, but I approach it with caution, as it may be too early stage according to some who I have spoken to.

Many thanks again for your assistance and website.

[Donald Corenman, MD, DC]

#5974

Let’s define your symptoms. Do you have pain with standing and walking or with sitting? Where does the pain start and where does it radiate to? What makes the pain better? What is the average intensity of the pain on a 0-10 scale and how bad can it get?

Do you have standing X-rays and flexion/extension X-rays? If so, is there an angulation on the AP of L5 on S1? Is there any slip of L5 on S1 with the flexion/extension X-rays?

The MRI report notes foraminal stenosis of L5-S1 on the right. There also may be lateral recess stenosis but many times, this goes unidentified by the radiologist so we cannot assume this to be present. Remember that the MRI is performed in the supine position (lying down) so the standing X-rays give important information regarding the effect of gravity on the spine which may not be noted on the MRI.

Do not use stem cell treatment. This is a current fad in spine treatment that needs years of refinement if it is to be useful. Right now, I think it could be dangerous.

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.

[goawaysciatica]

#5992

symptoms:
Variable/changeable over the period since my microdiscectomy (which was November 2010 – 17 months ago)
Pain in lower back. (sciatic) Pain radiating from right buttock through leg thigh, hamstring, groin (occasionally), through calf, permanent pain at the bottom of right foot. (this foot pain was not permanent before the microdiscectomy… it was occasional)
I get ‘minor’ muscle spasms in my leg, often feel cramp in it and generally there is mild pain. The pain is not terrible and is generally bearable. However, it prevents me from exertion or exercise, as this can aggravate it or even cause a relapse. It is restrictive and this is what I would like to fix. I had trained to be a ski instructor and played soccer as well as keeping fit… but have not really been able to do any of this for 3 years now.

average intensity of the pain is currently 1-3 most days, but has probably been up to a 7-8 at worst. I had a bad relapse in August and it has been slowly, but progressively better since then, but I think this is largely because I have ceased any kind of exertion, for fear of relapsing again, as well as having paid for treatments including a steroid injection, physiotherapy and an ablation.

Walking/sitting/lying… I am currently ok with. Pain is always there. not much difference in each… however, walking is better, perhaps because it takes my mind off it… but whilst jogging it begins to return to mind.

I have no x-rays. Might these be a good idea? I have had 3 MRI scans: 1 in 2010 and 2 in 2011.

Thanks.

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