Chronic Debilitating burning sacrum pain

Tagged: Burning sacrum

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AmberDawn
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June 2, 2016 at 12:07 am

Post count: 1

#22290

Hello this message is in regards to my mother Chris. Chris is 60 years old, has been suffering with low back/glute pain for the last 18 months and has been off work on long term disability. It is very painful for her to sit, stand and walk.

She has had MRI, cat scan, xray, bone scan, blood work, pelvic ultrasound etc. She is in a chronic burning state with no relief in 18 months. Most aggravating is lumbar extention and sitting. Nothing relieves her pain but does get slight relief seated on the toilet which takes pressure off her coccyx and she leans forward.

She has had a free handed coccyx injection, bilateral facet injection of L5-S1 under fluroscopy and just recieved a bilateral SI injection under cat scan yesterday. The MRI has shown slight disc bulge and herniation in the lumbar vertebrae but the neurosurgeon does not seem convinced it is the disc. I understand that with restriction and pain in lumbar extention with no aggravation in flexion the facet seems to be the culprit. Osteoarthritis of the facets wearing on the cartilage, bones spurs bracing for stabilization creating neural impingement. Sacral burning pain with no sensory or motor loss. Pain os centralized in sacrum.

There is degeneration shown on MRI of L4-5 and L5-S1 but the bilateral facets that were performed were only at L5-S1. I don’t understand why both levels were not done. Neurosurgeon stated that after SI injection there would be diagnostic testing of the discs. I feel we need to go back to the facets? Her pain over the last 18 months has increased which makes me also think osteoarthritis.

Her GP has her on opioids of 18-20mg of Hydromorphine and 50mg of Lyrica. They don’t seem to do much for the pain but possibly increase it with the prolonged use and increased dosage. Opioids don’t seem to be effective for chroic non cancer neuropathic pain. My mother is in tremendous pain and suffering with multiple side effects from the medicactions and is down to 95lbs. She is very sore in her glutes and her sacrum and coccyx constantly burn. Which also makes me think coccyxadinea. Her coccyx injection was free hand so maybe another under fluroscopy. Post coccyx injection she was in increased pain for 2 weeks and then was seeming to turn a corner but then her pain shot back up. Can anyone injection take that long to be effective. She went on Lyrica around the same time so maybe it was the medication.

It can be so many things, disc, facet with bone spurs impinging, SI joint, stenosis, myofascial trigger points. Her standing assessment is sway/flat back. Her pelvis is posteriorly rotated, her facets locked in extention, her sacrum is torsioned. Her body gets really aggravated by pt and chiro and her body does not want to hold the adjustments. I am thinking prolotherapy for trigger points? Any advice? Thank you so much for your time.

A concerned daughter
Amber

Donald Corenman, MD, DC
Moderator

June 4, 2016 at 10:47 am

Post count: 8660

#22314

Buttocks and leg pain that increases with standing and walking could be stenosis pain. See https://neckandback.com/conditions/lateral-recess-stenosis/, https://neckandback.com/conditions/lumbar-spinal-stenosis-central-stenosis/.

Your MRI findings (but not the radiological report) do not note significant compression (“The MRI has shown slight disc bulge and herniation in the lumbar vertebrae). There could be instability which is not noted on MRI but only on motion X-rays. Facet pain will localize in the lower back and occasionally the SI joint but will not radiate to buttocks or leg.

Chronic burning pain could be an indicator of nerve injury, especially in the sacral region. There is a condition called pudendal neuropathy which could cause these symptoms. I don’t have an explanatory topic on this subject yet.

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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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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