Michaelrch

Dear Dr Corenman

Many thanks for you quick response.
In answer to your question about my symptoms before this last surgery, I had both leg pain, especially after standing for a while or sitting for relatively short periods, and I also had central Back pain if I did anything that required “shock absorbing” in my lower back e.g. walking downhill and a certain gym machine where you stand on elastic bands that are free to move up and down and you have to stabilise yourself on them.

Re the herniated disc, from the consults I have had, yes the surgeon says he does not see any further herniation though it has to be said that a) any previous herniation was not much evident on previous MRIs and
B) he did not see much of a herniation when he actually operated and opened my up.

The reasons for believing that some of the pain I have now is Si joint pain are
– that it gets worse after walking (not the case before this surgery)
– I have pain on the outside of the thigh and sometimes into the hip as well as in the back of the leg,
– I have had injections into the joint and they do work a bit, albeit nothing amazing.
– I cannot lie on my left side at all without causing pain.
– some of the physical movements to provoke SI joint pain are positive though not all
– the first steroid injection I had in the joint (about 3 months ago) caused a very strong immediate reaction in the local area – actually it felt like someone had just taken a big hammer to my backside but I figured that was a reaction to the injection into a highly inflamed joint

Reasons to believe it might not be are
– I had an RFA and it did not fully clear up the pain in the joint
– I have had several steroid injections and continue to get buttock and leg pain after walking too much or doing the wrong exercises

Other symptoms right now are
– I cannot stretch my hamstring without causing an instant and long lasting painful reaction in my S1 nerve
– I can’t sit for more than 5-10 minutes without first getting back pain then getting long lasting leg pain afterwards
– I can’t lie on my back without getting pain in my back (I think my L5S1 facet joint) and also almost instant tingling then pain in my buttock and leg (so I have to lie on my right side, without exception which is infuriating)

Those last symptoms do suggest that something is pressing the nerve directly rather than the nerve pain being the result of an inflammatory problem in the SI joint. The problem with lying on my back only appeared after doing some exercises to strengthen my glutes and hip abducttors and adductors (to stabilise the SI joint) which involved a slight twisting of the hips. I put (past tense) it down to further irritation of the SI joints or facet joints but, in hindsight, I guess the sheering motion could have caused further deterioration of the disc…

Do you have any thoughts regarding the stiffness if the rest of my lumbar spine? I have a feeling that if I don’t remedy that, anything else I try will be futile as so much load is currently being put on the bottom segment and the SI joint.

Also, should I not be worried that if the existing stiffness and stabilisation is already causing SI joint dysfunction then actually fusing the L5S1 would not make that dysfunction even worse?

Re your study, how did you conclude that the SI joint pain was actually caused by the lumbar spine?
My surgeon said that a problem with the L5S1 disc could “entertain” a problem in the SI joint but I had no idea what he meant. It sounds akin to what you are suggesting.

Thanks very much again
Michael

Ps I have tons of images that I could send you. I know you charge for looking at those. How could I arrange a consultation on that basis and get an idea of costs etc?

Many thanks again Dr Corenman

Re the gel barrier, as I had the microdiscectomy 9 months ago I hope that the tear in the annulus should have scarred over now. The main aim of this next op is to clear the nerve of scar tissue and any debris that is in there but is not clear in the MRI. That said I suppose if the surgeon thinks that he needs to trim a few millimetres of the disc he might do. He does think that the problem is the combination of the fixed nerve and a very small bulge in the disc.

Re the neurolysis, in your experience is there a significant chance that the symptoms of the scarring after this op will be worse than what I have now?

I know it’s not a good reference source given the bias and self selecting group of people, but I have read reports on forums of people having an op to remove scar tissue and being in worse pain afterwards. I am hoping that they are not representative and that the gel or barrier can reduce these risks to an acceptable level.

Thanks again for your advice Dr Corenman. I will bear that in mind.

Re the Neurolysis which I am scheduled for in April, I understand the chances of success are 50-60%. I asked my surgeon if the op could result in worse pain afterwards if the scar comes back worse. He said that it is not likely. He also intends to use Medtronic Medishield (marketed in the US as Oxiplex) and this has a good track record of reducing incindence of adhesions.

In your experience with your patients, if the neurolysis op does not work, is there a serious chance of the symptoms being significantly worse? Also do you use gel barriers in your practice and if so, how do they work?

Many thanks again as always
Michael