L5 s1 degenerative disc

Tagged: Groin pain and leg pain with an L5-S1 disc tear

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Mcnab
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August 1, 2018 at 11:32 pm

Post count: 7

#28847

Hello Dr. Corenman,

I’m a 37year old male and i have been dealing with chronic pelvic and leg pain since about 4 years.
I have a degenerative disc at L5 S1 with an annular tear and i have the following symptoms:

– billateral leg pain from buttocks into outer side of foot and toes.
– billateral nerve pain and burning that goes trough the hamstrings into achilles tendon.
– Billateral calve pain.
– left and right sided groin pain and inner thigh pain
– bladder pain/urge to urinate and sensation of full bladder.
– weak stream when urinating and difficulties urinating.
– Sacrum pain
– perineum pain
– nerve pain right left of my tailbone

In addition to that i have an excessive anterior pelvic tilt.
Tight psoas and quadratus lumborum.
Si joint pain.

My spine surgeon is a well known surgeon at a university hospital who is convinced enough that my symptoms are coming from the degenerative disc and wants to do a fusion at l5 s1.
I had a second opinion at another university hospital and this surgeon has the same opinion.
I had some ESI’ at l5 s1 with no relief and an si joint injection with i think about a day about 30% relief of pain.
I have had a discogram done wich gave me center back pain during the pressure on the disc and afterwards giving me significant bladder and groin pain after the fluid was leaking out of the disc (couldn’t put pressure on the disc).

Can you please give me your opinion about what can be causing these horrible symptoms?
I had a pelvic mri, entire back mri and all they can find is the degenerative disc.
I had tons of fysiotherapy, core strengthening, excercises to loosen the psoas and quadratus lumborum and nothing helps. My surgeon says my psoas and QL muscle is tight because of the instability in my back.
Is this a possible explanation to all the aditional symptoms?
When i press my left lower abdomen firmly all my perineum pain and pelvic floor pain is triggered. Can this be psoas related?
Thank you very much for your advice and help.

Kind regards

Mcnab
Participant

August 2, 2018 at 1:53 pm

Post count: 7

#28853

In addition to my previous post I would like to add that when my feet and legs start burning so does my pelvic floor-perineum and my bladder start burning. It feels like its all connected. Also when u urinate i can sometimes feel it tingling in my lower back at l5 s1 and when i press the l5 s1 area firmly i feel tingling in my pelvic floor.
I also had an emg done on the genitofemoral nerve and that gave bad signals so that one seems to be involved to. An mri to track the genitofemoral nerve to see if it is impinged somewhere gave no results. I think the psoas is causing those symptoms.
I learned that the posterior femorale nerve can also be trapped at l5 s1 and that it can cause perineum pain, but can that same nerve also cause groin and testicle pain?

Donald Corenman, MD, DC
Moderator

August 3, 2018 at 2:52 am

Post count: 8660

#28858

First, we have to discuss what disc tears at L5-S1 will and will not cause. If you have an annular tear and not a disc herniation or any compression of your nerves in the spinal canal at L5-S1, some of your symptoms don’t add up. L5-S1 discs can refer pain obviously into the lower back and if this lower back pain becomes severe, can then radiate into the buttocks (sclerotomal pain).

L5-S1 will not cause deep pelvis pain or numbness around the groin and testicles. This is the area of the pudendal nerve and S2-4 which should not be affected by the L5-S1 disc. Most of your symptoms do not fit with this disc problem. Foot and leg burning is not a symptom for a simple L-5-S1 annular tear but might portend a peripheral neuropathy (see https://neckandback.com/conditions/peripheral-neuropathy/). You might have a peroneal neuropathy and a lower extremity peripheral neuropathy. I would see a well respected neurologist to see if a disorder can be identified to treat.

If your lower back pain overshadows all your other symptoms, possibly a fusion of L5-S1 could be considered but this really depends upon your symptoms and how severe the disc tear at L5-S1 really is. You also have had no reported diagnostic tests to determine how much pain this disc tear is causing (discogram, epidural or even facet blocks).

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.

Mcnab
Participant

August 3, 2018 at 4:41 am

Post count: 7

#28861

Thank you for your reply dr. Corenman.
Like mentioned in my first post, i did have a discogram done at l5 s1. When they tried to put pressure in the disc, the fluid was leaking out and i started having lots of groin and bladder burning instantly, so that did flare up my symptoms during the procedure.
When they did finally succeeded to put pressure on the disc i had a feeling that my back would explode.
Is it possible that the toxins of the fluid coming out of the annular tear is causing inflamation and thereby causing this burning bladder – groin – pelvic floor pain?
Is it possible that the tight psoas and iliacus and quadratus lumborum is causing the pelvic nerve pain.
When i lie on the floor on the left side of my hip, the pain also intensifies in the pelvic and pelvic floor region. Can my pain be caused by hip instability and can this hip instability be caused or be a result of the problems at l5 s1
Thanks for your answers.

I must say that before i started having this symptoms i was treated for a chronic inflamation of the patella tendon in the left knee and it happens that all my pain is dominated left side.

Mcnab
Participant

August 3, 2018 at 4:45 am

Post count: 7

#28862

Ps: a psoas stretch also causes numbness on the left side of the quadriceps to the knee and pressing the quadratus lumborum causes me front hip pain. Als backward lifting the leg when lying suspine on the floor on my belly causes tingling in the front hip region.

Donald Corenman, MD, DC
Moderator

August 4, 2018 at 11:07 am

Post count: 8660

#28873

You might have such a “revved-up” nervous system that simple pain generators like an annular tear at L5-S1 would cause groin pain but the referral pattern worries me. It is not common so typical expectations (success rates) of injections and possible surgery would not be accurate. I like that the discogram reproduced your symptoms in the groin and perineal areas but without a logical explanation of a direct connection, any treatment is more speculative.

Psoas stretches also stretch the femoral nerve (L2-4) so why would paresthesias from this nerve be involved in L5-S1? The most logical explanation is a neuropathy.

You might have an inflammatory neuropathy such as Lyme disease or an autoimmune phenomenon like a spondyloarthropathy.

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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