Buttock pain, referred pain from lumbar region?

Tagged: delayed surgical decompression for lumbar nerve pain

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Ptb1230
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February 10, 2019 at 1:52 pm

Post count: 7

#30135

Hi
Thanks for your previous response. I am aware I have asked lots of questions and hopefully this will be my last. In response to your reply, I have had the nerve block an additional injection into the lumbar region which both have failed in the last 24 months. My current situation is that I am unable do any form of physical activity without being in considerable pain (4/5 out of 10 on a good day and 7 upwards on a bad day which is most days), sitting down continues to bring on the buttock pain within minutes of driving and standing still for more than a minute brings on pins and needles within the thigh and foot. Additional to these existing issues I have now began to experience hip pain(left side once again) which radiates occasionally into the groin (left side, from original pain) expecially when walking. I am awaiting an appointment with my consultant in which I know he will arrange another MRI SCAN, but my concern is that this will show only a minor bulge to the L5 S1 region again and he ends up suggesting that it is not worth surgery.
Your advice has been very informative and I look forward to your response.
Pete.

Donald Corenman, MD, DC
Moderator

February 10, 2019 at 10:18 pm

Post count: 8660

#30138

Nerve blocks don’t have to yield long term relief to be a success. It would obviously be better if nerve blocks would have long term relief but their value is also in diagnosis. A nerve block that yields pain relief for the first three hours is diagnostic. That is, the structure that is anesthetized and gives relief of your typical pain is the pain generator.

Buttocks pain is the “grey zone” that can be generated from the disc or from the nerve, depending upon symmetry, unilaterality and triggering activity.Hip dysfunction can induce groin pain and even occasionally buttocks pain. Hopefully this surgeon will not only use MRI scans but will use motion X-rays to determine if instability or collapse is present.

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

December 4, 2019 at 10:33 am

Post count: 7

#31617

Hi there

Than you for your previous response.

I know it’s been a while since my last post, but I would like some additional advice please before I see my consultant once again to possibly discuss a date for surgery. Over the past few months I have ceased any form of exercise as this aggravates the symptoms I have been having. However, I have been doing Pilates for some months now, at my consultants recommendation, only for this to also aggravate my symptoms. Recently I had to take off work after a Pilates session, as this caused pain in the lumbar region of my back, left side hip and provoked the pins and needles into action once again. I have recently had an MRI scan which shows that the disc has not improved. My concern is that every time I do any form of sustained exercise I end up with referred pain from the disc. Would I be right in thinking now is the time to accept my fate and succumb to surgery as all other options have failed. If so, will I be able to resume any form of exercise once rehabilitated.
Many thanks
Pete

Donald Corenman, MD, DC
Moderator

December 5, 2019 at 6:07 am

Post count: 8660

#31632

If your life is restricted (a condition called impairment) due to aggravation of symptoms every time you try to exercise and symptoms are not improving over time, it is my opinion that surgery needs to be considered. Now the type of surgery I cannot tell based upon our last couple of conversations. There are some conditions that don’t respond to 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.

Ptb1230
Participant

May 10, 2020 at 10:11 am

Post count: 7

#32526

Hi again

I am aware that I have asked lots of questions in the past, but I wanted to get some advice if possible please. I am still suffering with buttock and leg pain in the left side (pins and needles etc.) but this has been managed only slightly with gabapentine and amytriptiline. With this been relatively managed I tried to return to some exercise in the form of jogging, this was going ok for about 8 weeks, when suddenly I began to feel pain in my right buttock and leg when trying to lift my leg. I have since stopped any form of exercise (including walking as this brings the pain on) but this has not decreased the pain. Is it possible that the herniated disk at the L5, S1 region could be causing this pain which is now on the right side. I have done some research as I though it might be linked to my hip flexors, but all the info doesn’t seem to point in that direction.
Any advice will greatly received.
Many thanks
Pete.

Donald Corenman, MD, DC
Moderator

May 10, 2020 at 11:11 am

Post count: 8660

#32529

I would suspect a new disc herniation or a stenotic condition (like foraminal or lateral recess stenosis) for the cause of your new pain. A new MRI is warranted.

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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