I am looking for people who have L4/5 disc injuries but symptoms in their sacral nerves that don't correspond to any normal pattern for that level.
I have a Grade V tear at L4/5, with some posterior bulging but no evidence of nerve compression anywhere. Concurrent with the onset of some acute lower back pain in this area, I lost a lot of sensation, initially in the penis but now in areas of the perineum corresponding to S3 4 5 dermatomes, including areas above the pudendal nerve area. Some altered bowel and urination sensation is noted but nothing critical yet. Right side is worse but is bilateral, and erectile dysfunction/numbness is the primary complaint.
I have herpes genital simplex, which DOESN'T do this, but may account for some sacral nerve damage contributing to a 'double-crush' neuropathy. I can alter pinprick sensitivity just moving my back around. Prolonged sitting makes things much worse.
Pudendal EMG at 5 months was 4.2Right 2.7Left. I am at 22 months now and am in gradual decline, far worse functionally than at the time of the EMG.
I have had probably every test/study in existence (Multiple MRI's of all parts of spine, CT Myelogram, Discogram (with NO test for increased numbness, darn it), MR Neurogram of sacral plexus, a couple of injections), and have found doctors generally don't want to attribute to the torn disc this sacral radiculopathy. Some in person (never in writing, for obvious reasons) will agree that it might be that even though it is completely out of the area it should affect, but taking out the disc (i.e. fusion or prodisc) out on a 'best guess' is nearly as scary as doing nothing and losing all sexual sensation permanently, and possibly facing bladder/bowel issues more serious ahead. While I have some lower back pain, it is low on the visual scale usually, maybe 2-4. If I weren't functionally impotent and numb in the penis I wouldn't be pursuing this yet, probably.
Has anyone run into a situation like this, and if so, what did you do, what was found, how did any surgeries impact this, etc.
I have had some doctors simply deny the disc could be involved, some say maybe it is but you cannot do anything about it, and a few say it may be the disc and you should take it out. The disc is the only known lesion in my spine from my brain to the coccyx.
Has anyone ever mentioned caudia equina to you? These symptoms you report sound alot like this. A disc herniation that is pressing on the end of the spinal cord called the caudia equina can cause genital numbness and bowel and bladder problems. This is usually cause for an emergency microdiscectomy.
One note, fusion and prodisc are not the only surgical options for a herniated disc. Are these the only options your dotors have presented you?
Thanks for your reply. Probably 10 radiologists and many more pain/spine specialists of various disciplines have looked at the L4/5 disc MRI film, from several different lumbar MRI's, CT;s, etc. Virtually all state that there is no compression of the cauda equina at L4/5. As much as I would like for that to be the problem (believe me, I would) I am forced to conclude that it must not be.
As far as my comment on fusion/prodisc, I have been told that *IF* the disc itself is the cause of the sacral radiculopathies, then I would need to take the entire disc out as just a micro-discectomy or IDET, etc., is not as certain to end the problem.
It is hard, since many doctors simply don't believe a torn disc can refer symptoms, and even those that do are puzzled by the referral pattern my symptoms are have. My experience so far suggests my presentation is very unusual.
Last edited by Woofdog123; 01-14-2005 at 07:16 PM.