nikolausMemberJanuary 15, 2012 at 10:03 pmPost count: 11
I have contacted you before. I have one more problem for which I ask for your help.
I am considering microdiscectomy as an attempt to solve sciatica, back pain and antalgic scoliosis – although during the last month I have seen significant signs of pain improvement both in lower back and in sciatica pain levels. The pain in the lower leg has improved substantially (although the nerve is still pinched since I still have a positive raise leg test), and burnings feelings in lower back have subsided a lot.
As the pain was reduced, I noticed significant tailbone pain and a little numbness that lasts for only a couple of seconds, but only when it is compressed. Eg. if I sit on a chair and put my weight on the tailbone I feel a lot of pain on the tip of my tailbone after I try to get up. My doctor says that this pain can be caused by a disc herniation at lower back. However, if I sit on a chair and I put my weight on the left bone of the pelvis (I don’t know the medical term, but I think you can visualize it, just lean on the left or no the right while sitting) or on the right bone of the pelvis, I feel no pain. If I sit on a toilet normally (where there is no tailbone compression) I do not feel that kind of pain. If the disc herniation caused that pain, shouldn’t I be feeling pain even in toilet since the disc is compressed?
So, I want to proceed to the surgery, but I do not trust doctor’s opinion. I want to be sure nothing else is going on because the sciatica pain seems to be improving.
My question is can a left paracentral disc herniation on L4L5 which compresses the spine cord and the left nerve, cause pain at the tip of the tailbone?
To which doctor should I go so that I can verify that this pain does not originate from something else? dermatologist? orthopedician?Donald Corenman, MD, DCModeratorJanuary 15, 2012 at 10:16 pmPost count: 8436
Pain at the tailbone or in anatomic terms, the tip of the coccyx, is pain that may or may not be caused by the disc herniation above this level. The coccyx is served by the S2-4 nerve which are below the disc herniation level that you have. None-the-less, I have seen patients who complain of tailbone pain gain relief from a microdiscectomy at your level. This must have been referral pain or sclerotomal pain from the disc.
You have this tailbone complaint only when the coccyx is loaded (pressure placed directly on the coccyx). This might be something independent of the disc herniation above such as coccydynia- a “sprain” of the ligaments around the coccyx bone.
As far as the need for surgery, if you have no motor weakness and you are improving, the indications for surgery become softer. It really depends how much pain and dysfunction you have and how long it has been since onset of symptoms.
Dr. CorenmannikolausMemberJanuary 16, 2012 at 12:43 amPost count: 11
I have been 4 months in bed and 4 months with difficulty walking. My problem is that there are clear signs of improvement month by month. On one hand I want to remove the herniation so that I can return to normal life faster, on the other hand it is obvious my body tells me it can heal if I give it more time.
My MRI on lower back shows no abnormality to the coccyx. So I guess it could be a soft tissue problem or not as you describe.
How could I know? orthopedic surgeons that have seen me only seem to care about the MRI and the disc herniation.
So, could you tell me which doctor specialty studies coccyx pain? orthopedicians? or dermatologists? or sth else.Donald Corenman, MD, DCModeratorJanuary 16, 2012 at 2:08 amPost count: 8436
The specialist that would know the most about coccyx pain is the spine surgeon. I can tell you that no one will know if the pain in your coccyx will go away with surgery.
The fact that it has been 8 months with disabling pain- 4 months being bedridden signals that you most likely would benefit from surgery for this disc herniation. It probably would have been more beneficial to have had surgery months ago, but ask your spine surgeon what his opinion is. I believe he or she will think you are a candidate for surgery.
The coccyx can always be treated as a separate issue if the coccyx pain does not improve.
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