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What Causes Sharp Pain In Buttocks While Bending And Standing?
Question: Doctor, I visited with you last week and said I was going to get an MRI Saturday on my lumbar. I as you might recall,2 weeks ago I began severe sharp pain in my buttocks (both sides)(more than the back itself). I got a trigger point injection in the back but no help. I was given a 6 day prescription of methylprednisolone and just finished it. It helped some, but the pain is in the buttocks when I bend over and standing up. Actual Sitting is ok and actual standing is ok. Walking is ok.BUT if I bend over, it kills me getting back up...both sides of buttocks. Here are the results
L3-4
There is a minimal concentric disc bulge with a new superimposed small broad based right paracentral disc protrusion that does not cause nerve root impingement. Facet arthropathy is minimal . There is no spinal canal stenosis. No significant neural foraminal stenosis is seen
L4-5.. There is a mild concentric disc bulge with a superimposed small central disc protrusion. There is suggestion of a crescentric band of overlying extruded disc material. This measures 14x3x7 mm and there is indentation of the left ventral aspect of the thecal sac with probable impingement upon the descending left L5 nerve root. The lateral recesses are narrowed and spinal canal stenosis is moderate to severe with contribution from severe bilateral facet arthropathy and moderate ligamentum flavum thickening. Fluid is noted in the facet joints and there are bilateral extraspinal facet synovial cysts inferiorly. There is mild right and mile to moderate left neural foraminal stenosis.
L5-S1--There is minimal concentric disc bulge. Bilateral facet arthropathy is moderate to severe. No spinal canal stenosis is demonstrated. Proximal right neural foraminal stenosis is minimal...
Id like to know if this will require surgery and what you think I should DO and AVOID DOING to get this to calm down. I have to take care of my mom who is 91 and I need to be as healthy as I can be
L3-4
There is a minimal concentric disc bulge with a new superimposed small broad based right paracentral disc protrusion that does not cause nerve root impingement. Facet arthropathy is minimal . There is no spinal canal stenosis. No significant neural foraminal stenosis is seen
L4-5.. There is a mild concentric disc bulge with a superimposed small central disc protrusion. There is suggestion of a crescentric band of overlying extruded disc material. This measures 14x3x7 mm and there is indentation of the left ventral aspect of the thecal sac with probable impingement upon the descending left L5 nerve root. The lateral recesses are narrowed and spinal canal stenosis is moderate to severe with contribution from severe bilateral facet arthropathy and moderate ligamentum flavum thickening. Fluid is noted in the facet joints and there are bilateral extraspinal facet synovial cysts inferiorly. There is mild right and mile to moderate left neural foraminal stenosis.
L5-S1--There is minimal concentric disc bulge. Bilateral facet arthropathy is moderate to severe. No spinal canal stenosis is demonstrated. Proximal right neural foraminal stenosis is minimal...
Id like to know if this will require surgery and what you think I should DO and AVOID DOING to get this to calm down. I have to take care of my mom who is 91 and I need to be as healthy as I can be
Brief Answer:
At moment surgery not indicated.
Detailed Answer:
Hello again and thanks for asking directly.
Symptoms you describe actually (buttocks pain when bending and standing) with no other symptoms such distribution of pain to leg(s), no numbness in legs, no difficulty or restrict of walking are related to degenative changes, revealed by MRI too, of your lumbar column.
Foraminal stenosis at L5 manifests with sciatica, rather than low back pain.
Spinal stenosis produces difficulty walking, urination problems.
So, at present, foraminal stenosis and spinal cord stenosis are not responsible for your symptoms, degenative changes of spinal cord articulations are.
Surgery is reserved to cases with symptomatic stenosis, or severe herniated disc disease, so, at the moment, surgery is not the best option to improve your condition.
You should avoid lifting weights, if overweight you should loose some, avoid instant movements or turns of body, avoid excessive bending over or excessive stretching.
You should continue physical therapy with the aim of strengthening lumbosacral muscles, reducing joints loading and NSAID drugs.
Warm procedures in case of exacerbated pain helps.
Imaging follow up is needed also to assess stenosis of the spinal cord and foramina. (MRI in six months).
With proper treatment and measures is possible to maintain this status and postpone surgery or even avoid it.
Hope you found the answer helpful.
Best regards.
At moment surgery not indicated.
Detailed Answer:
Hello again and thanks for asking directly.
Symptoms you describe actually (buttocks pain when bending and standing) with no other symptoms such distribution of pain to leg(s), no numbness in legs, no difficulty or restrict of walking are related to degenative changes, revealed by MRI too, of your lumbar column.
Foraminal stenosis at L5 manifests with sciatica, rather than low back pain.
Spinal stenosis produces difficulty walking, urination problems.
So, at present, foraminal stenosis and spinal cord stenosis are not responsible for your symptoms, degenative changes of spinal cord articulations are.
Surgery is reserved to cases with symptomatic stenosis, or severe herniated disc disease, so, at the moment, surgery is not the best option to improve your condition.
You should avoid lifting weights, if overweight you should loose some, avoid instant movements or turns of body, avoid excessive bending over or excessive stretching.
You should continue physical therapy with the aim of strengthening lumbosacral muscles, reducing joints loading and NSAID drugs.
Warm procedures in case of exacerbated pain helps.
Imaging follow up is needed also to assess stenosis of the spinal cord and foramina. (MRI in six months).
With proper treatment and measures is possible to maintain this status and postpone surgery or even avoid it.
Hope you found the answer helpful.
Best regards.
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Doctor ---one follow up. If I am offerred an epidural steroid injection , do i have to do it now? Im inclined to let time pass a little and then see if i improve. Would it hurt me to hold off on getting this ESI? Or would it be better to go ahead and get this ESI. And... Do you like the idea of doing physical therapy niw??
Brief Answer:
Epidural injection could wait.
Detailed Answer:
Welcome back.
In my opinion, epidural injections could wait, since you are not experiencing moderate to severe symptoms.
If there will be worsening of symptoms, epidural injection is an alternative to improve symptoms, at least temporarily.
Physical therapy results more effective when it is carried out when no pain at all or minor symptoms, so I think this is a good moment to start physical therapy.
Rest and avoiding of physical activity is indicated when sudden and moderate to severe symptoms get back.
Hope I helped you. Take care.
Epidural injection could wait.
Detailed Answer:
Welcome back.
In my opinion, epidural injections could wait, since you are not experiencing moderate to severe symptoms.
If there will be worsening of symptoms, epidural injection is an alternative to improve symptoms, at least temporarily.
Physical therapy results more effective when it is carried out when no pain at all or minor symptoms, so I think this is a good moment to start physical therapy.
Rest and avoiding of physical activity is indicated when sudden and moderate to severe symptoms get back.
Hope I helped you. Take care.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
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