Should I get surgery? Tailbone discomfort when sitting, no more athletics

Tagged: Long standing lumbar herniation and surgery

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sf-corpguy
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July 28, 2017 at 12:58 am

Post count: 1

#25722

Hi Dr. Corenman,

I’m at a bit of a quandary and wanted the advice of a 2nd spine surgeon. After years of progressive but managed chronic post-exercise back and glute/hamstring stiffness and pain (prior DDD and 3mm bulge on L5 S1), suffered a disc extrusion in Oct of last year. Early one morning after 2 nights of successive spin and normal hypertonic leg and QL muscles/back stiffness/pain, I crouched down and felt a small pop. As I made my way to a cross country flight, I progressively flared up and was in spasms through the trip.

At the time, an MRI was not ordered and an ortho and pain doc I saw who gave me an SI injection were going off an older MRI (12months prior) that showed bulging but not ruptured disc. As I’ve recovered and had minimal leg pain but unable to get back to exercise, I realized this one was unlike other flare ups and had an MRI last month. 9 months since the flare-up, MRI shows paracentral L5 S1 extrusion and slight right that is sitting up against the right S1 nerve but not compressing it much. Consistent with pain of intermittent tingling in outer 2 toes on right side, mini-spasm to dull ache occasionally in right piriformis and general flexion intolerance. MRI report judged extrusion at 5mm and up against thecal sac but not creating much of an indentation into it or spinal canal.

My question, i’m manageably symptomatic in terms of radiculopathy except for the fact that I can’t sit due to tailbone and inner buttock muscle discomfort/tightness when sitting longer than 10 min (stress makes worse). As a corporate person, I no longer drive long distances and work standing most of day but it is discomforting that plane rides and meetings I can’t sit and get progressively worse to squirming and exasperated as I sit. I can sleep it off and it certainly isn’t massive pain down the leg. ESI have helped my recovery and seem to improve the sitting pain (the 1st longer than the 2nd). Prior to the herniation I feel I was getting progressive tailbone pain so that would argue the rupture may be coincidental.

My ortho said as manageable as my symptoms are, I am symptomatic at 9 months out and she could go in and make room for the nerve and clean up the extruded disc. She cautioned it wouldn’t do anything for back pain, mostly radiculopathy (which isn’t huge for me but bothersome) (she didn’t specify whether this inner glute tightness/tailbone sitting issue would or wouldn’t get better). I also dream of being able to do something more than elliptical again (like easy tennis?) and am wondering if I’m letting too much time go by. Seems like even elliptical gets the back of my legs super stiff and adds pressure to lower back. Does the extrusion calcify and become harder to remove via micro discectomy over time? Should I count my blessings it’s not worse and try to change my mindset about the chance of a full fix to these manageable but uncomfortable and work-impacting symptoms? I read about these active people that get the surgery and are back out skiing or whatever they were doing before and wonder if I’m toughing this out, impacting my quality of life too much due to fear?

Thank you in advance for any opinions here.

Donald Corenman, MD, DC
Moderator

July 29, 2017 at 8:49 am

Post count: 8660

#25769

You don’t note any significant lower back pain. Nerve pain can cause unilateral upper pelvis pain (sometimes called sacroiliac pain) and can be confused with “lower back pain”. Most of your symptoms are likely nerve root originating pain (“pain of intermittent tingling in outer 2 toes on right side, mini-spasm to dull ache occasionally in right piriformis and general flexion intolerance” “can’t sit due to tailbone and inner buttock muscle discomfort/tightness”).

Part of what I rely on for diagnosis is the temporary results of an epidural steroid injection (the 3 hour window of lidocaine or marcaine relief called the “pain diary”). If you had good relief (only for the first 2-3 hours) of your symptoms, a strong correlation can be made between the disc herniation and your current pain. A microdiscectomy would be appropriate to try and reduce your symptoms.

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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