Severe Coccyx pain that is affecting rectal area

Tagged: Newest MRI report

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Cjdegood
Participant

June 14, 2021 at 2:26 pm

Post count: 26

#34150

Good afternoon Dr.
i did not use my original thread from months ago..(titled severe Coccyx pain) as i do not have that any longer. the 2nd injection back in December worked really well. I am only just now having some of that discomfort come back and pain dr. said he would burn the nerves next time if needed. Anyway.. i am always hearing about Flare Up? my question is how do you determine if it is just a flare up? I was told from a surgical standpoint i no longer had restrictions (back in November) so i went on vacation and have been living life normal. I am careful and do not get carried away with things. i started back exercising and small weights. (16lbs total) I am up to 4.5 miles pe60 r day walking. I love to walk, it is the best exercise i get. I have managed to drop another 20lbs since my 360 (L5 S1) fusion last June. I noticed about 5 weeks ago, that i started feeling low back pain. Not as intense because it is not keepin me awake at night. Leg pain is awful though! Same left leg as before.. i am not taking anything other than gabapentin 300mg at night before bed and 800mg of ibuprofen. this is driving me crazy.. and i am concerned and have been taking it easy for the past few weeks. I do not want to experience that type of back and leg pain ever again. It has not let up but has not gotten worse either. I am worried about it, so called the doctor and they said i could be in a flare up? how do you know? thank you so much for your help

Cjdegood
Participant

June 14, 2021 at 2:55 pm

Post count: 26

#34151

Since it took me a while to notice your repsonse and attach to my original thread.. i have seen the doctor. My xrays look good and hardware is all in place. new MRI has been ordered and waiting on them to schedule. I am back on the gabapentin and they also put me back on the Trezix as needed as well as the 800mg of ibruprofen. I am managing fine and still walking daily (5miles) i have put the weights down for now just to be on the safe side. the one thing that is different regarding the left leg pain is the stangest feeling of something wrapped around the bottom of my leg, mostly near my ankle. i can describe it as maybe like a rubberband or something tied around it? veyr strange and it bothersome at times. But overall still better than I was a year ago this time. thank you so much for your time.

Cjdegood
Participant

July 23, 2021 at 2:13 pm

Post count: 26

#34205

Dr. Corenman
Good afternoon
I had my MRI completed last month and saw my surgeon a couple of weeks ago. Described my discomfort to him and he did some tests on me there in the office. He said it appeared to be sacroilliac? prescribed aquatic PT again and to stay on the gabapentin and ibuprofen 800mg. we will revisit in 3 months. I dont feel near as bad as last year and he told me i am free to do what i want just to use my commone sense. He wants me to live my life, that is why we did the surgery. Although I am not able to actually live my previous normal life, but i can do more things now. Here is what causes me issues, i am not able to climb my stairs like normal without pain on the left side. i cannot sit but just for a few minutes before the aching and hurting starts. I can walk pretty good just across standard flat surfaces.. so i do still go for walks every day. I have to take the ibuprofen and the trezix everyday. Overall he said everything appeared fine. I can only copy what the written report says. i still have this leg pain and what i call Hip pain which dr says is not actually my hip but my sacroiliac joint?or something like that. I am back to not being able to ride very long in the car or sitting for more than 10 to 15 minutes..but if i dont move it takes longer to get going once i am up. ugh.. 7/9/2021 Thank you so much for your time and reading this.
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Report

Accession No. Patient Name/ID Study Date Sex/ Age Institution
Other Patient ID My Comment(s) Study Comments

EXAM TYPE: HF MRI LUMBAR SPINE WO CON
HISTORY: 049Y female with Z98.1:Arthrodesis. History of lumbar fusion 1 year ago per the patient.
Ongoing left-sided lower back pain, symptoms in the left leg.
COMPARISON: MRI of the lumbar spine of 05/27/2020.
TECHNIQUE: Multiplanar, multisequence MR imaging of the lumbar spine was performed without IV
contrast administration. FINDINGS:
To be consistent, the prior nomenclature will be used for this exam. However, prior to any surgical
procedure of the spine, confirmation of this nomenclature with radiographic survey of the entire
spine is recommended. The L4-l5 disc space is the caudal most well-formed disc space, and there is
a rudimentary disc space which is smaller at L5-S1. LS appears sacrailzed on the left and
sacralized or partially sacralized on the right. Intervai posterior fusion changes noted at L4-LS
with metallic hardware/artifact mildly degrading evaluation at this level, the disc space is not
well assessed.

Lumbar alignment is preserved. There:c no significant listhesis.
‘ • -.. ..
No acute fracture, compression deformity,- or frank aggressive osseous lesion.

The conus medullaris terminates normally at L1 level. The disc heights and hydration appear
maintained from T12 through L4. ·
Evaluation of the individual lumbar levels demonstrates:
Ll-L2: No posterior disc herniation, thecal sac or foraminal stenosis. Minimal left facet arthrosis
L2-L3: No posterior disc herniation, thecal sac or foraminal stenosis. Minimal left facet
arthrosis. L3-L4: Mild facet arthrosis with similar mild/trace left joint effusion.
L4-L5: Mild contouring of the ventral thecal sac is slightly right eccentric, stable, and midline
AP thecal sac diameter is 12
mm in AP dimension. The contouring may be due to postsurgical changes, not well assessed by this
exam. Interval increase patency of the subarticular recess is noted bilaterally. Very minimal
ventral flattening of the left descending nerve sheath
noted, possibly by osteophyte/osseous hypertrophy, which abuts the descending left nerve minimally.
Lateral masses are not well assessed.

L5-S1: Axial images d, o not include this level, however there ls no thecal sac or foraminai
stenosis demonstrated on the sagittai images, and no significant posterior disc herniation. No
significant facet arthrosis. No significant interval change.
Right renal lesion 1.5 cm atleast, is not well assessed, with possible peripheral wall thickening
versus artifact, arid may be
enlargedcompared to prior exam. Correlation with.CT renal mass protocol without and with contrast
is recommended. Anot” -:r right renal lower .pole lesion is 1 cm g,ossly stable. . ..
. .. , · .·· · ·.·
IMPRESSION:
Interval postsurgical changes of the disc space with posterior decompressive changes and posterior
fusion metallic hardware noted at L4-L5.
Interval increased patency of the right and left subarticular recE>.sses, with possible minimal
osteophyte or osseous hypertrophy at the posterior margin of LS, minimally abutting the descending
left nerve without contouring it.
Otherwise, the remaining Ll through L4, and L5-S1 levels are not significantly changed.
Transitional lumbosacral anatomy as described above. Nomenclature on this exam is consistent with
nomenclature on reference MRI of 05/27/2020, however prior to any surgical procedure of the spine,
confirmation of this nomenclature with radiographic survey of the entire spine is recommended.
https:1/pihulite.infinittna.com/worklist/Report

1/2

7/9/2021
Report View

Right renal lesion of at least 1.5 cm with possible peripheral wall thickening appears enlarged
compared to prior exam. Correlation with CT renal mass protocol without and with contrast is
recommended to assess for suspicious features.
Similar appearing right renal lower pole lesion of 1 cm.

2/2

Donald Corenman, MD, DC
Moderator

July 26, 2021 at 2:36 pm

Post count: 8660

#34213

You had an L4-5 fusion with a sacralized L5-S1 level so as long as this level is “stable” (and it sounds like it might be based upon the reading), the question is whether L4-5 is fused. MRIs are great for nerve roots but not too good for fusion analysis. Could you talk your surgeon into a CT of the lumbar spine? The radiologist is recommending a CT scan of the abdomen (“Correlation with.CT renal mass protocol without and with contrast is recommended”).

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.

Cjdegood
Participant

July 26, 2021 at 3:33 pm

Post count: 26

#34214

Thank you so much.. Surgeon said he fused L5 S1? I confirmed that with him after surgery because i was confused as well. i just dont understand the report nor am i able to make anything out of images on my CD so no use in me even trying. I am currently awaiting my results from the renal mass CT from urologist. I see my surgeon again in October after going to PT (aquatic) and continuing the ibuprofen. I am just struggling with pain in what I call my hip and he calls my SI joint. If i want to go upstairs in my home, i have to crawl up with my hands. LOL crazy but it does not hurt that way so i am okay doing that if necessary. I was just wondering if sacralization could cause issues with that joint? i dont know.. i will need to follow up with him in October. I think i can deal with it until then. No more long car trips or anything coming up soon thankfully. I so appreciate your time in answering my questions and concerns. Not sure if the CT on my abdomen will show my lumbar part of my spine or not, probably not since they are not really looking at that right? Thanks again for your reply

Donald Corenman, MD, DC
Moderator

July 27, 2021 at 10:52 am

Post count: 8660

#34216

The CT scan of the abdomen is not perfect but still can be read to indicate fusion status. I would start there with your surgeon and radiologist. Ask them to assess the fusion status of the L4-5 level.

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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