I have been having severe buttock pain for the last 5 months radiating down my left leg to my foot and has been making my life hell.I have had an MRI (Lumbar Spine and Pelvis ) which shown a small annular bulge at L5 S1 which my consultant says he has seen a lot worse.At first my consultant did not want to do anything about this but after constant pressure from myself and Health care manager he decided to do a nerve root block. I did have relief,however short (10 days)now he says I need a disc decompression/discectomy which as he says is a pretty invasive operation with 3/4 days in hospital and 2 month recovery (btw I have no pain in my back and he can't guarantee I will be pain free after the op). I have visited a PT and following his assessment he says that I am suffering with a condition called Piriformis Syndrome.All indications point to this but my consultant has said it is very hard to diagnose and that the Piriformis muscle does not show up on scans and in itself is a very horrendous operation with months on crutches. I have gone for a 2nd opinion and that consultant also pointed to the L5 S1 being at fault. I have returned to my PT and he is adamant that the Piriformis is the problem although he does not have scans to prove this. To me it sounds like a process of elimination with the less severe op being the Discectomy. Anyone who can offer any advice which can help me would be greatly appreciated. My Discectomy op is scheduled for the 28th Jan so I have a few weeks to make my mind up.
Sorry to confuse you even more, but inability to sit is most often a sign your sacroiliac joint is shot. Do some research on SI joint fusions. There are very few surgeons who are knowledgeable on SI joint issues, so you'll really need to look for someone who has done at least several dozen SI joint fusions to be evaluated by. Most spine surgeons can't evaluate you as they have no training in this area.
I would suggest holding off on the discectomy until you have been evaluated for all possibilities and find a doctor you trust and click with. I ended up having several back surgeries which did not relieve my symptoms just to find out my SI joint was shot and then had an SI joint fusion.
Piriformis syndrome is very controversial - there are many in the medical field that don't even feel it causes major problems and that the symptoms can almost always be explained by other means.
The Following User Says Thank You to twohands For This Useful Post: Maddon (01-10-2011)
Hello Maddon, and welcome to the forum. It is always a bit difficult for me to give advise to someone in the UK, Australia, etc. as the insurance is so different. However, I am going to tell you what I would tell someone in the US.....if possible, get an opinion from an Orthopedic Spine Specialist or a neurosurgeon who limits his practice to the spine.
Though your PT might be a very good one, he is not qualified to make a diagnosis and shouldn't be giving advise counter to that of your physician, in my opinion. Having said that, he could be right, but as you stated, there are no tests to determine piriformis syndrome. However, your test shows bulging at L5-S1 and your symptoms fit for that level of the spine. The fact that you are having leg pain indicated that there may be some compression of the nerve root. A more definitive test might be a myelogram-ct which will more clearly show any kind of nerve impingment.
I would certainly try to get a second opinion; at the very least I would ask for the myelogram ct scan. It is possible that the MRI is just not showing the full extent of the problem.
Please stay in touch and let us know how it is going.
The Following User Says Thank You to maltluver For This Useful Post: Maddon (01-10-2011)
I can tell you from my own experience with this, is that sciatica can cause severe pain in the buttock area where the nerve runs through. The symptoms you describe are very similiar to what I had when I had left-sided sciatica from an issue at L4/L5. Keep in mind, though, that many nerves cross in this area, and it's not always exact as to where the pain is stemming from. Also, one person can have a huge herniation on MRI that would like to be painful, but have no pain at all, and another can have a lesser looking on MRI, but yet be in severe pain. Everyone is different.
When I had my sciatica, I had pain running from my lowback, through about the center of my left buttock, down the outside side of my left thigh and calf, in my outer left ankle, and most of my left foot was completely numb. If fact the whole foot was numb except for my left arch area. I had so much pain that I was not able to sit, stand, or lay down. No position whatsoever gave me any relief. Sitting was terrible, even going to the bathroom was awful b/c that area in my rear that was throbbing was right in the area that sits on the toilet seat. The pain I had all along from my rear to my ankle felt as if some one sliced me open all the way down and was pouring rubbing alcohol inside the open wound 24/7. It never let up and was just unbearable. It went on for 3 months until I was finally able to see my surgeon again. Had an MRI and found tissue stuck inside the left lateral foramen (its an area that runs off the spine where the nerve roots run away from the spine. It's like a tunnel that has a nerve root running through it. There was material jammed in there compressing the nerve root). They said it was either disc material or scar tissue, but most likely scar tissue. I ended up having a nerve block done at L4/L5 and when they did it, it flushed the jammed tissue out. Afterwards,all that nerve pain and such was gone. It does come back now & then, though, but I also have more new stenosis & disc herniations. That was my most severe case. I've also had sciatica on both sides before my lumbar surgery which was due to spinal stenosis and other things and it would come and go in different areas.
I can't diagnose you, but it sure sounds to me like your pain might be from your issue at L5/S1, especially since the nerve block helped the pain for a while. Many times they do those blocks using it as a diagnostic tool. I also can't say much to the procedure/surgery for it, but I had multi-level laminectomies, foramenotomies, and discectomies done at once from L3 thru L5 in '06. I think I was in the hospital for 2 1/2 days. Recovery took me about 3 months. They actually got me up walking the day after surgery. I don't know too much about discectomies, but if that's all they would have to do, it seems like the recovery time they told you might be a bit long for that, but again, I don't really know. If you end up also have total laminectomy done, that would definitely extend the recovery time.
The Following User Says Thank You to Baybreeze For This Useful Post: Maddon (01-10-2011)
I am having a nerve root block today and hoping that I have longer relief than the last. Regarding my surgery for a Discectomy, that is still on course for the 28th. I do not feel positive towards this surgery but I can't also put up with the pain and my immobility. Unfortunately I have to put my faith in the hands of my consultant who I am told is the main man in his field in my area. Fingers crossed that the nerve block works.
I would just like to add that problems stemming from the piriformis and a L5-S1 issue are not necessarily exclusive. In other words, it is not "either/or." You could have pain coming from both areas. The physical therapist feels a problem in the piriformis, probably where it is attached near the hip, but he cannot see what also is going on with the disc between the lumbar 5 and first sacral vertebra.
The sciatic nerve exits from the inside of the pelvis to the outside and branches into two nerve bundles at the sciatic notch. The piriformis muscle lays across the sciatic nerve as it runs across the buttock and starts down the back of the leg. In some people, the piriformis has "split" and the sciatic nerve actually can run THROUGH the muscle.
When the piriformis muscle is irritated in any way, it can swell or became taut, which can cause it to rub against the sciatic nerve. Tension or cramping of the muscle can cause sciatic pain, and if the muscle is over-developed, as in some athletes, it can also cause sciatic pain. Sciatic pain caused by the piriformis often becomes worse when sitting. Walking and standing will usually cause the pain to let up. This is the opposite of pain stemming from a disc problem at L4-5 or L5-S1 which is often relieved by sitting. Obviously these are generalities that are sufficiently common among sufferers that they are worth noting, but will not be the case for every person with this problem.
It is entirely possible that you have a disc problem between L5-S1 AND that your piriformis is irritating the sciatic nerve. The injection you are getting today may indicate that the L5-S1 is definitely involved, but it will not rule out whether there is also an issue with the piriformis.
However, at least in the US, it is very uncommon to surgically alter the piriformis. Just about everything else would be tried prior to severing the muscle attachment or cutting the muscle itself.
I hope you get relief from the procedure you are having today. Please let us know how it goes.
The Following User Says Thank You to teteri66 For This Useful Post: Maddon (01-12-2011)
Thx for all of your replys. I had the nerve root block and 4 facet joint injections on the 10/1/11. I asked the radiologist who read my MRI to explain the readings to me.She said it is highly unlikely that the L5/S1 disectomy will relieve my buttock pain if I was to go ahead with this operation. It may however relieve my leg pain. She said that the back being very intricate in its makeup is very hard to diagnose, which is why there is only a 75% chance of it working.This I am not really happy about and the consequences of having additional pain and months of recovery without success does not make me happy. Last night (11th) I had a piercing burning sensation on my left buttock (just like how this all started)and today I have again the same pain.With having been off work for so long without a proper diagnosis is very depressing.I can only hope it goes as quick as it came.I have spoken to my health care manager who is looking at other possible causes, but I take on board eveything you have all said.
Bear in mind that your radiologist that read your films is not a spinal specialist. My ortho spine surgeon used to kind of roll his eyes when I would tell him what my pain management doc had said...that I was unstable, or that all my problems were stemming from a certain segment. He would remind me he was very good at what he did, but diagnosing was NOT his thing. I would say the same to you about the radiologist.
Since they don't know what is causing your buttock pain, how can the radiologist even say that? She's just giving you the standard line that is based on statistics.
Not to downplay ANY spine procedure, including injections, BUT a laminectomy is not that big a deal. If you choose your surgeon very carefully, and there are no untoward incidences, it should not take you months and months to recover...and there is a chance you might just have immediate relief.
I am in no way trying to talk you in or out of having surgery....obviously, you're the only one who can make that decision. I just will tell you that sometimes people put it off and put it off and put up with pain for years and then end up having the surgery anyway. I always wonder if the problems would have been less if the surgery had been done sooner. I certainly put myself in this category of people who waited probably "too long."
One thing I would agree with the radiologist on is that the lower back, sacral area, pelvic area and all the supporting soft tissue, muscles and ligaments that attach in this area are all very tightly located and inter-related. When my piriformis muscle gets taut, either from some irritation or inflammation, it pulls on the attachment over by the hip, which causes my left pelvis to rotate slightly forward, which pulls my IT band that runs down the outside of my leg from hip to knee taut, and it causes pain. It also causes a spot on my lower calf that can hurt like crazy. It can feel just like the pain from a herniated disc...but I now know what causes it, and I am fused at that level and don't even have a disc there, plus I've had so much imaging lately that I know what is causing the pain. My PT has become VERY frustrated because he just can't seem to find the right combination of activities to give me that will build up my glutes without having this effect on the piriformis...so I have acupuncture and it helps keep things loose and to control the pain while the PT tries to figure out what is unique about my body.
I guess you need to keep looking for answers until you feel you can trust what the doctor recommends or you find another solution. I wish you all the best.
The Following User Says Thank You to teteri66 For This Useful Post: Maddon (01-13-2011)
I would look for someone who could do the surgery lyproscopicly. I know a friend who had it done like that and was walking with out pain with in a few hours...yes HOURS. He procedure was outpatient and she said she is go glad she went through it. She no longer has butt or leg pain. Good luck and I hope you get some relief.
The Following User Says Thank You to tmorgan813 For This Useful Post: Maddon (01-15-2011)