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  • Mcnab
    Participant
    Post count: 7

    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
    Post count: 7

    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
    Post count: 8656

    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
    Post count: 7

    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
    Post count: 7

    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
    Post count: 8656

    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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