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-   -   S1 Radiculopathy ... Piriformis ... SIJD??? (https://www.healthboards.com/boards/back-problems/991454-s1-radiculopathy-piriformis-sijd.html)

Tinaz79 10-19-2014 10:20 PM

S1 Radiculopathy ... Piriformis ... SIJD???
 
Sorry in advance for the long post....

I've been battling bilateral scaitica from butt down to all toes for 7 months. My first thought was piriformis since mine is always in spasm even though I've gotten it stretched out to 80-90% of what I used to (I was able to do Pigeon Pose easily but no longer). Anyway, I had a Provocative EMG done, but they didn't do my piriformis and other hip/pelvic muscles as my Dr requested. But what they did find was S1 radiculopathy. Not surprising since I was dx'd with a central extrusion at L5/S1 in '08 but had no problems except after my L4/5 fusion when I complained of S1 nerve pain, but that only lasted a few months and I chalked it up to my back readjusting to being back "in place".

I had no problems for years and was getting off my meds when I started having bilateral sciatica after Breast surgery and needing to sit/sleep upright for a week. After the 3rd day that's when all hell broke loose.

Ive had a piriformis injection that gave 6+ hours of pain relief, due to leg being numb, but although I could feel the muscle was still relaxed after pain came back I became scared that wasn't it. My NS said my l5/S1 disc bulge with fissure isn't the problem but my PT says it is. But now suddenly says it is but still nothing he can do (he's a top U.S. neurosurgeon at Wash U/Barnes Jewish in St Louis and the only one I'd trust to touch my spine).

I have all these symptoms of severe piriformis (all 5 toes affected, red swollen feet if things are aggravated, tailbone aches, pudendal pain (easily aroused for no reason, tingling, burning, etc). The only things I come up with for those symptoms to occur together is PS, or SI Joint.

My questions to my fellow sufferers are these: I can only find that S1 can cause a tight piriformis but no spasming. For those with S1, do you find it spasms your piri ulimately causing pudendal issues? I'm also concerned about SIJD but don't have obvious "oh my aching si joints". I can "pop" them by bending backwards forcefully but there's never pain when the do. Can you have SIJD that causes this type of sciatica without joint pain? I've been tested, a year ago, for things like RA and other inflammatory issues but all neg. Sometimes I think I have an occasional pain here or there but my PM tested me with 3 or 4 tests and nothing created pain.

i feel hopeless because I feel it's turned into nothing but "hide the pain" without finding a dx. My PM is talking caudal injections so all nerve roots can be addressed all the way to a cord stimulator! My insurance won't even consider piriformis surgery or si joint.

i can't be on my feet for more than an hour, sometimes less, or my toes and bottom of feet go numb and then later they turn red. I'm stuck in bed, on the floor lying on my right side etc. it's been this way for months now. Neurontin helps very little but already had a bad reaction to where I just felt weird in my entire body, and when hubby went to wake me before he left for work to have me take my pain meds he couldn't wake me. He was about to call 911. I normally sleep light and never sleep well because of it. When he finally woke me I told him I still felt really weird. I hadn't changed my dose or anything. And still, only on 600mg total. No other meds agree with me...Topamax, antidepressants, etc due to bad side effects or they affect my SVT and kick up my heartrate.

i pray someone can help me as it seems i always have to tell the Drs what is wrong. 😟

my gut still tells me it's PS but all PT has failed and next course would be piriformis surgery which my insurance, and most, won't cover. However, if you know of an insurance that will please let me know as hubby can get additional insurance through work. We currently have TriCare Prime as he's retired AF.

thanks for reading and any help!
tina

teteri66 10-21-2014 10:40 PM

Re: S1 Radiculopathy ... Piriformis ... SIJD???
 
At least in my case, I found that things are not so neatly categorized as what you describe in your post. You probably have a combination of things that are causing your symptoms.

After I was fused from L3 to S1, as I started to become more active, I developed what I thought was hip pain. It took me a good year to work through all these issues. I was looking into having a *** injection or some type of prolotherapy and was going for treatment once per week to a guy that does body work and acupuncture. In my case, my left SI joint would pop out of place, which pulled the piriformis muscle taut and put pressure on its attachment over by the left hip. My pelvis was almost always rotated forward, etc. it was impossible to tell what was causing my symptoms, but was probably a bit of everything.

Do you know if you have instability at L5-S1? The fact that you have pain in both legs might indicate some sort of instability. Do you know if your fusion has completely fused and that hardware is intact?

Have you had a diagnostic nerve block at this level or for the SI joints? It is fairly unusual to have the piriformis as the major cause of symptoms. Problems with it often develop from another issue. I would tend to think your lower lumbar problems are causing issues with SI joints and piriformis.


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