Tagged: Newest MRI report
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Good afternoon
I have been living with tailbone pain for years. It mostly just affected me on long car trips and events that require sitting on hard bleachers (high school basketball games) upon rising from sitting position it can actually take my breath away..but once i am standing i would be fine. Starting this past May..I thought i was developing hemorrhoids. of course i just tried to treat it myself with OTC products. I have a pharmacy under my bathroom cabinet. It did not get better only worse, so on July 3rd I went to my annual well woman appointment and mentioned to her that I had hemorrhoids and i could not get rid of them. she checked and said that i did not have any. I described the pain i was feeling and she referred me to a gastroenterlogist. My tailbone pain which i thought was hemorrhoids was now affecting my rectal area. Extremely painful bowel movements (I drink miralax every night) it felt like a sharp knife inside of me. So I saw the gastro doctor and he also confirmed that i did not have hemorrhoids. suggested that i have a colonoscopy done, which i did and it came back clear (I dont have to get another one for 10 years) i explained the pain to him again, mentioned my tailbone and he said that was what was giving me the problem and i need to see a pain management dr. or orthopedic. I had an MRI completed and it came back and said my coccyx was normal, it did list alot of other issues, as well as enlarged, retroflexed uterus with fibroids. So Dr. thought that could be pressing on my rectum causing me the severe pain. I had a hysterectomy done last week. It did have to be abdominal due to enlarged uterus and i have had 3 c sections and alot of scar tissue. i am recovering fine, but my dr said the next morning that it did appear that it was causing me the issues, and sure enough after all pain meds wore off and i was able to move my bowels, the pain returned. I failed to mention that i did have a ganglion impar block done a week and a half before the surgery and also have been put on gabapentin.(3 times a day) i think the block worked for a total of 1 week or just a little longer. I am at a loss and ready to give up. Spine ortho..did have me get another MRI just on the back. it shows many things but does not mention my tailbone. he wants me to have a steroid injection for a disc extrusion. I am tired and almost out of money for all this.He also suggested that i have a Bone Spect done..(scheduled for next week) i cannot have the steroid injection until i am fully recovered from surgery.so i just continue to suffer. i apologize for the long question or the circumstances leading up to it. i dont know where else to go. on my latest MRI is shows Posterior central disc extrusion narrowing the thecal sac to 8.5MM with contact of the desecending right greater than the left L5 nerve roots. mild facet arthrosis, disc height loss and foraminal disc components contribute to the mild right and moderate left neural foraminal stenosis with disc material contacting the exiting left L4 nerve root. Samll disc bulges seen L3-L4 with mild facet arthrosis at L3 L4. there is alot more on the report but he pointed this one out. It also says extrusion tracking below the level of the disc space spanning 13 MM in Raniocaudal extent measuring 7.5 MM APx 29MM transverse. this narrows the thecal sac to 8.5MM . Now i dont know what any of that means, but i can tell you that this pain in my tailbone has altered my life for the past 4 months. I am find upon waking for about an hour and half.once my bladder, but mostly my bowels feel full and i have to use the restroom,the sharp pain is there and it does not leave for hours and hours.The pressure and pain are nearly debilitating. i have not been able to work at my office,because i cannot sit. Am i seeing the right dr. for this? i truly feel like someone just needs to look at my tailbone. Can you give me any advise or direction? am i on the right path. I have tones of information but it is alot to put on this page.. i have already take alot of your time.
Thank you so much
ConnieIt sounds like you may have either pudendal neuropathy, inflammation of the nerve that supplies the area around the genitals or coccydynia, a painful malfunction of the coccyx. The differential is to really rule out coccydynia, which is a mechanical condition of painful ligaments of the coccyx. That is typically performed with an anesthetic block of the painful ligaments.
The fibroids of your uterus can be ruled out as a pain generator (“I had a hysterectomy done last week”). Your sympathetic nerve block does give a clue (“i did have a ganglion impar block done a week and a half before the surgery … i think the block worked for a total of 1 week or just a little longer”). There is a condition called CRPS (complex regional pain syndrome) in which an injury to the sympathetic nervous system causes an inappropriate connection to the pain pathways. The diagnosis is to block the ganglion and gain relief which is what happened to you.
This result does not 100% certify that you have CPRS, but it is more likely that you do. I still would find a specialist that could evaluate your coccyx and see if you have coccydynia. It is unlikely that your spine problems are causing this tailbone pain but it is not impossible. See if an epidural would give you relief and if so, possibly fixing the spine could give you relief. I am suspicious that this epidural won’t help you or that spine surgery will help.
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.Thank you so very much for replying. you are the one and only that has even acknowledged me. I am on the search for a 2nd opinion before i go and have this Bone Spect/CT of the sacrum & coccyx. i am sure that is going to cost me some more $$.. the steroid injection is not scheduled yet since i am recovering from surgery. I did fail to ask if a MRI of the Lumbar spine would show the coccyx? I did not see any mention of it. However it was mentioned on the pelvic MRI prior to my hysterectomy. it stated it was normal. I have seen primary care physician, OB/GYN/Gastroenterolgist, Orthopedic spine/pain management Dr. So at this time i am not really sure who to see? i have searched and i found Neurologist that specialize in the spine.. maybe this is the dr? i am just looking for relief any way i can. But i cannot get ganglion blocks for$745 that only work a few days. I really want to be able to take car trip to see my grandkids for Thanksgiving. I dont take any of the pain meds execpt for the 800MG of ibuprofen that was prescribed after surgery. I do not take tramedol, hydrocodone or any other strong medicine,because i cannot function while taking them. so it is unlikely that the neural foraminal stenosis where the disc extrusion is located and the nerve root contact at the L5 is causing the extreme pain in the tailbone and the sharp stabbing and throbbing after BM. well.. i guess this is the process of elimination. I so appreciate your reply. Thank you again
Lumbar MRIs typically do not include the coccyx. That would be a pelvic MRI. Look up pudendal neuropathy to find a specialist that can help. I know that some patients get spinal cord stimulators for failed treatment. I cannot rule out the L5 nerve causing your pain but it is unlikely.
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.Dr. Coleman
Thank you again for your time. I am seeing a different Spine orthopedic this Friday. I am hoping to get more clarification from him. The first one i called to schedule just off a google search for my area, as i had to get in to see one before i could have my hysterectomy. I do not think he even remembered anything he told me from the first visit which was very short and basically was scheduled for ganglion impar block and gabapentin. So after a lot of thought and research, i decided to seek out and ask my gynecologist for a referral on someone in our area. I wanted to mention, that this week i have felt a little better..maybe it takes a while for the block and or the gabapentin to work? I had the block done on 09/11 and started taking the medicine the 10th 9(day before the procedure) I only took 1 per day for 5 and then 2 per day for 5 days, and finally 3 times per day. While the pain is not completely gone, i am able to tolerate it more and at least function during the day. now.. i do not want to live with this pain. I have what I hope to be a very long bright future ahead of me! Would love to get back to working out and my evening walks. I know I cannot right now, due to recovering from surgery, but hopefully in just a couple of more weeks that will be done. I have been so focused on the pain in the bottom and dreading BM that i consider everything else secondary. On my first visit the Dr. did a few test in room. One of which was reflexes. My left side is definitely different from my right. I have zero reflexes in my left foot, while the tool he used on my feet was sharp on the right foot and very dull on the left. That was very weird. lol I have delt with lower back pain and of course cannot ride in the car very long for years now. Like i said in my prior post, it takes me holding the handle in the car and trying to ease out slowly as the pain can take your breath away. so i wanted to break down the last portion of this MRI on the lumbar so maybe i can know a little more when i go in this week.
L4 L5 posterior central disc extrusion tracking below the level of disc space spanning 13mm in raniocaudal extent measuring 7.5mm AP X 29 mm Transverse. This narrows the thecal sac to 8.5mm with contact of the descending right greater than the left L5 nerve roots.
Impression:
L4 L5 Posterior central disc extrusion narrowing the thecal sac to 8.5 mm with contact of the descending right greater than the left L5 nerve roots. Mild facet arthrosis, disc height loss, and foraminal disc components contribute to the mild right and moderate left neural foraminal stenosis with disc material contacting the exiting left L4 nerve root. Small disc bulges seen L3 L4 with mild facet arthrosis at L3 L4
it seems like these 2 paragraphs are just repeating each other unless Impression means the final things the radiologist noticed and wanted to make Dr.aware of.
Also.. i am going to be honest. I really do not want temporary fix for this. I know its not a good reason, but at this point after going through everything i have this year. I met my annual deductable. i can tell you that once the new comes around, I will be done. I will not endure any more expensive tests, injections etc. I just cannot do that. So if there is a way i can have this fixed and resolved, that is what I want to do. Any suggestions on what i should ask the doctor would be greatly appreciated. I really want to live normal and do all the things i love again. especially with my grandkids. hopefully looking forward to 2020. Thank you so much for your time again, i hope i havent taken too much of it and i may have done some repeating, but did want to add the lower back pain to my symptoms.You note your; “reflexes. My left side is definitely different from my right. I have zero reflexes in my left foot, while the tool he used on my feet was sharp on the right foot and very dull on the left”. This indicates involvement of the S1 and possibly L5 nerve roots with reflex deficit and sensory loss.
Your MRI report notes; “L4 L5 posterior central disc extrusion tracking below the level of disc space spanning 13mm in raniocaudal extent measuring 7.5mm AP X 29 mm Transverse. This narrows the thecal sac to 8.5mm with contact of the descending right greater than the left L5 nerve roots”. This is a very large disc herniation compressing the left L5 and probably S1 nerve roots.
You most likely need a microdiscectomy for this large herniation.
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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