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  • Rectal pain due to lumbar spine (serious issue)

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    Old 05-30-2011, 07:00 PM   #1
    Teacupforme
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    Rectal pain due to lumbar spine (serious issue)

    I have had a lumbar L5 discectomy this past Feb. The disc herniated to the left and caused foot drop. I had an emergency operation. I was going well until week 7 when I started experiencing bilateral nerve irritation in both legs and rectal nerve irritation/pain. A new MRI showed no nerve compression but the L5 disc has a slight poterior bulge. Nowhere near the cauda equina. I also have severe spinal athritis and wear and tear.

    In saying that I now have rectal irritation/pain and irritation in both legs from something irritating the nerves. No actual compression per say just irritation. My ortho said I don't have much L5 disc left and my disc herniation was fixed and this is NOT a reherniation in a different direction. He has pre-op films and the report and post-op films and report. The pre-op report says the disc had a herniation to the left compressing the L5 nerve root and a large fragment. (this is what he operated on). It makes no mention of a posterior bulge. The new report says that there is a 14mm posterior bulge not pressing on any neural matter, far away from cauda equina. He has examined both sets of films and has said the disc has NOT moved since my operation and I should have no issues now, and that my small posterior bulge was there even pre-op and that was left alone because he can't remove all my disc. Well why do I have butt pain then now? What can I do?? Any opinions here please?

    God Bless

    Last edited by Teacupforme; 05-30-2011 at 07:03 PM.

     
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    Old 05-31-2011, 05:39 AM   #2
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    Re: Rectal pain due to lumbar spine (serious issue)

    I don't know what to think about your situation. Nerve pain can continue well beyond the time of surgery and can cause symptoms similar or worse than pre-surgery pain. It may be when the surgeon freed up the nerve during surgery, it irritated the part that sends signals out to the rectal and buttock area. The other possibility I can think of would be that scar tissue is pressing on the nerve.

    I don't understand why the 14mm posterior bulge was not addressed, if it was present at the time of surgery. It is possible that the disc reherniated post surgery. It doesn't have to compress a nerve for there to be painful symptoms. Sometimes there is a chemical reaction that occurs when some tissue leaks out and it is irritating to the spinal nerve.

    MRIs do not show everything. It may be that something else is going on. If the pain persists and you aren't getting any better, you may need to have further testing.

    Sorry I can't be of more help. What seems to be nerve pain can be difficult to tract down. I spent the better part of two years trying to figure out why I had nerve pain...kept being told all the nerves were clear -- no signs of nerve compression, and yet the pain was clearly nerve pain. I had to be very persistent to get some answers. But it all worked out in the end...just took awhile and was very frustrating.

     
    Old 05-31-2011, 08:45 AM   #3
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    Re: Rectal pain due to lumbar spine (serious issue)

    A 14mm disc bulge is an awfully large bulge. If I were you, I would take the cd's or films and consult with a new surgeon. Something isn't right. The canal at that area is not much larger than 14 mm, so it may well be that it is compressing the entire canal and that is what is causing the buttock pain.
    Just so that you know, the cauda equina is the part of the spinal canal that contains the spinal nerves from below the conus medullaris at L1, to the end of the sacral nerves at S5. The cauda equina contains all of the spinal nerve roots from L2- down, it is not one area of the spine, but rather the entire lumbar area. Each pair of nerve roots innervates an area of the body- called dermatomes. If you do a search of dermatomes, you will see where each pair of nerve roots innervates each area of the body.
    I hope that you can get this straightened out. I wouldn't wait because if this is Cauda Equina syndrome, the longer you wait, the less likely that the nerves will recover.
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    Old 05-31-2011, 11:24 PM   #4
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    Re: Rectal pain due to lumbar spine (serious issue)

    [QUOTE=backhurtz;4767172]A 14mm disc bulge is an awfully large bulge. If I were you, I would take the cd's or films and consult with a new surgeon. Something isn't right. The canal at that area is not much larger than 14 mm, so it may well be that it is compressing the entire canal and that is what is causing the buttock pain.
    Just so that you know, the cauda equina is the part of the spinal canal that contains the spinal nerves from below the conus medullaris at L1, to the end of the sacral nerves at S5. The cauda equina contains all of the spinal nerve roots from L2- down, it is not one area of the spine, but rather the entire lumbar area. Each pair of nerve roots innervates an area of the body- called dermatomes. If you do a search of dermatomes, you will see where each pair of nerve roots innervates each area of the body.
    I hope that you can get this straightened out. I wouldn't wait because if this is Cauda Equina syndrome, the longer you wait, the less likely that the nerves will recover.
    Back[/QUOTE]


    Thats what I thought too, but the radiologist report and the films show that it is far away from the cauda and apparently genetically I have a very large spinal canal. I don't know why he didnt clean up the disc bulge in the back, he only fixed the fragment to the left which caused footdrop. I am not showing signs of scar tissue either from films. As stated that 14mm disc bulge is its width. It's 5mm AP. They call it broadbased. The surgeon said he couldn't do anymore to that disc. If the spine specialist and radiologist and the MRI show no nerve compression or cauda equina what can I do now?? Also may I The protrusion is 14mm in width and 5mm in AP. I am not sure if that is significant?? Is it better to be wider and less AP or opposite, because its being called a broad based protrusion. May I also mention that the report says I have SEVERE facet arthrosis in L4/L5 and L5/S1 and radiologist recommends facet blocks. Could this be also irritating nerves???Thank you for taking time to reply to my post I do appreciate it.

    Last edited by Teacupforme; 06-01-2011 at 12:08 AM.

     
    Old 05-31-2011, 11:26 PM   #5
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    Re: Rectal pain due to lumbar spine (serious issue)

    [QUOTE=tetonteri66;4767050]I don't know what to think about your situation. Nerve pain can continue well beyond the time of surgery and can cause symptoms similar or worse than pre-surgery pain. It may be when the surgeon freed up the nerve during surgery, it irritated the part that sends signals out to the rectal and buttock area. The other possibility I can think of would be that scar tissue is pressing on the nerve.

    I don't understand why the 14mm posterior bulge was not addressed, if it was present at the time of surgery. It is possible that the disc reherniated post surgery. It doesn't have to compress a nerve for there to be painful symptoms. Sometimes there is a chemical reaction that occurs when some tissue leaks out and it is irritating to the spinal nerve.

    MRIs do not show everything. It may be that something else is going on. If the pain persists and you aren't getting any better, you may need to have further testing.

    Sorry I can't be of more help. What seems to be nerve pain can be difficult to tract down. I spent the better part of two years trying to figure out why I had nerve pain...kept being told all the nerves were clear -- no signs of nerve compression, and yet the pain was clearly nerve pain. I had to be very persistent to get some answers. But it all worked out in the end...just took awhile and was very frustrating.[/QUOTE]

    Did your nerve pain finally clear up on it's own? What was the end prognosis of your nerve pain did they ever tell you? Yeah I am frustrated because I feel that there is no point in complaining about pain anymore. But my nerve is being niggled and irritated and it drives me nuts!! Thank you for your reply.

    Last edited by Teacupforme; 06-01-2011 at 12:09 AM.

     
    Old 06-01-2011, 06:40 AM   #6
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    Re: Rectal pain due to lumbar spine (serious issue)

    I had a three level fusion from L3 to S1 and it did resolve the nerve pain, much to everyone's surprise. I had been told the nerves were had sustained permanent damage and would not recover, so we all were surprised when the pain went away after about the 4th day post surgery. I still have some numbness in both toes, but other than that I'm doing great. I had a lot of instability in my spine that was not apparent from MRI imaging, both standing, sitting and prone.

    Facet joints can cause a great deal of pain. In my case, the facets at L3 had worn down to little nubs, which was allowing my spine to move in ways nature had not intended. This was trapping the nerves and causing all kinds of issues. They are synnovial joints just like any other fluid-filled joint in the body, like the knee. When there is too much wear and tear on these joints, they respond by trying to lay down more bone, which results in bone spurs or osteophytes. This sets up the arthritic condition that is so common with the facet joints.

    The facets can also become inflamed. In an attempt to protect the stability of the vertebral segment, the adjoining muscles go into guarding posture which usually results in muscle spasms along the spine.

    It is fairly easy to find out the extent of the pain this is causing by having a diagnostic facet joint block. The doctor will inject a numbing agent, along with a steroid into the suspected joint. If the patient's pain goes away immediately, you can be pretty sure, the joint is a source of the pain the patient is experiencing. (The patient is asked to keep a pain diary while the numbing agent is wearing away.) This is the diagnostic part of the injection. The steroid is included to help calm down the inflammation in the facet.

    Sometimes it is helpful to consult with a different doctor if you feel you are not getting any fresh ideas from your current surgeon or PM. If I had accepted what I was being told by several surgeons after my first fusion, I would have accepted my condition as it was, having been told "this is as good as it's going to get." By now I would be walking in the house, but using a wheel chair for all activities away from the house, because I could only stand on my feet for a minute or two before the pain become intolerable.

    I felt very strongly that mine was a mechanical problem because when I sat down, the pain would go away or was at least tolerable. So I kept looking for answers. I was willing to accept that there was an outside chance that those surgeons were right, but what they were telling me didn't explain why the pain went away when I changed position.

    While I saw many spine surgeons, my original surgeon ended up being convinced I had instability and did the surgery.

    I might add, we never suspected that I had facet joint "issues." None of the doctors ever mentioned facet joints to me....It was only near the end when my surgeon had decided to revise my first fusion and was trying to figure out if he was going to do one more level or two, he ordered facet joint blocks for more information. But it was not until he opened me up that he found the extent of the damage to my facets. He was completely taken by surprise, and ended up having to do spinal reconstruction at the L3-4 segment.


    Sorry this is long. I guess that's enough details about me! I'm happy to answer any questions you might have.

    TT.

     
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    Old 06-01-2011, 08:16 PM   #7
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    Re: Rectal pain due to lumbar spine (serious issue)

    [QUOTE=tetonteri66;4767890]I had a three level fusion from L3 to S1 and it did resolve the nerve pain, much to everyone's surprise. I had been told the nerves were had sustained permanent damage and would not recover, so we all were surprised when the pain went away after about the 4th day post surgery. I still have some numbness in both toes, but other than that I'm doing great. I had a lot of instability in my spine that was not apparent from MRI imaging, both standing, sitting and prone.

    Facet joints can cause a great deal of pain. In my case, the facets at L3 had worn down to little nubs, which was allowing my spine to move in ways nature had not intended. This was trapping the nerves and causing all kinds of issues. They are synnovial joints just like any other fluid-filled joint in the body, like the knee. When there is too much wear and tear on these joints, they respond by trying to lay down more bone, which results in bone spurs or osteophytes. This sets up the arthritic condition that is so common with the facet joints.

    The facets can also become inflamed. In an attempt to protect the stability of the vertebral segment, the adjoining muscles go into guarding posture which usually results in muscle spasms along the spine.

    It is fairly easy to find out the extent of the pain this is causing by having a diagnostic facet joint block. The doctor will inject a numbing agent, along with a steroid into the suspected joint. If the patient's pain goes away immediately, you can be pretty sure, the joint is a source of the pain the patient is experiencing. (The patient is asked to keep a pain diary while the numbing agent is wearing away.) This is the diagnostic part of the injection. The steroid is included to help calm down the inflammation in the facet.

    Sometimes it is helpful to consult with a different doctor if you feel you are not getting any fresh ideas from your current surgeon or PM. If I had accepted what I was being told by several surgeons after my first fusion, I would have accepted my condition as it was, having been told "this is as good as it's going to get." By now I would be walking in the house, but using a wheel chair for all activities away from the house, because I could only stand on my feet for a minute or two before the pain become intolerable.

    I felt very strongly that mine was a mechanical problem because when I sat down, the pain would go away or was at least tolerable. So I kept looking for answers. I was willing to accept that there was an outside chance that those surgeons were right, but what they were telling me didn't explain why the pain went away when I changed position.

    While I saw many spine surgeons, my original surgeon ended up being convinced I had instability and did the surgery.

    I might add, we never suspected that I had facet joint "issues." None of the doctors ever mentioned facet joints to me....It was only near the end when my surgeon had decided to revise my first fusion and was trying to figure out if he was going to do one more level or two, he ordered facet joint blocks for more information. But it was not until he opened me up that he found the extent of the damage to my facets. He was completely taken by surprise, and ended up having to do spinal reconstruction at the L3-4 segment.


    Sorry this is long. I guess that's enough details about me! I'm happy to answer any questions you might have.

    TT.[/QUOTE]


    On the contrary I appreciate you taking the time to write such a detailed post to help me. Since I have such a big spinal canal (genetically). The MRI with contrast shows no neural impingment in any direction. The radiologist said my problem is Facet joints and the spine surgeon said that I have the spine of a 60 year old. I am in my 30's. I have massive arthritis in these joints and recommended facet blocks.I see they are probably all rough and grainy scraping up against soft tissue. Thats how I imagine them to be. I have just started fishoil and glucosamine and trying to stay off the chemicals as much as I can if I am going to manage this longterm. he said I hardly have any disc left and anymore out would be a fusion and he refuses to fuse me at this satge so I better learn how to manage it. He said he operated on me due to footdrop and not pain. It's nice to get some opinions from people who experienec the same issues though. Aristotle said that in order for a doctor to cure a patient he himself must have been inflicted with the condition too.

    Last edited by Teacupforme; 06-01-2011 at 08:17 PM.

     
    Old 06-02-2011, 05:40 AM   #8
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    Re: Rectal pain due to lumbar spine (serious issue)

    Hmmm. Facet joint disease can be very painful, but, in and of itself, does not involve the spinal nerves that carry sensation out to the limbs...so I still think the rectal pain and leg pain is coming from that L5 segment, and probably that 14 mm bulge at L5. Even if the nerve is not compressed, there can be a chemical irritant stemming from the bulge. It just sounds to me like something is irritating those nerves.

    I gather you did not have these pain symptoms during the first seven weeks after surgery, right? And, of course, you had the same facet problems during this time -- that hasn't changed. So what is different?

     
    Old 06-02-2011, 06:09 PM   #9
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    Re: Rectal pain due to lumbar spine (serious issue)

    You are correct. You have made a very logical assessment of my situation. There is nothing that can be done now except conservative treatment or going under the knife again. I opt for conservative at this stage and strenghten my spine. I wasn't doing physio after my surgery and let me back get sooo weak that at weak 7 I went into severe muscle spasm and it was downhill since then. If I had strenghthened my back I wouldn't be in this situation. So now I am doing core exercises and all of that and things have gotten a bit better. I have a follow-up in 3 months with surgeon so all I can do is wait and see how my exercises go at this point. I am also doing alot of praying.

     
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