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back pain

Low Back Pain Involving Superior Cluneal Nerve Compression

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Low Back Pain Not Coming from the Spine

Low back pain stemming from superior cluneal nerve entrapment is an underdiagnosed condition. Dr. Tollestrup has developed a surgical approach to help alleviate low back that does not emanate from the spine. He has many patients who have had success with this procedure. Marty is one of them. He is sharing his story in hopes of reaching others still struggling with chronic low back pain.

Marty’s First Nerve Surgery

Marty first came to see Dr. Tollestrup for groin pain after an inguinal hernia repair. Dr. Tollestrup eliminated the nerve pain by removing several damaged nerves in the right lower abdominal and groin area.

After nerve surgery, Marty continued to have some deep right groin pain due to severe arthritis in the right hip joint. After undergoing a right hip replacement, Marty’s right groin pain was finally completely gone.

New Low Back Pain

Unfortunately, during the time it took to resolve the orthopedic hip problem, Marty developed severe right-sided low back pain with radiation of the pain into the hip area. This pain became constant and debilitating. Lying on his back intensified the pain, making it impossible to sleep.

CT imaging of the spine did not show any reason for the low back pain and hip pain. With imaging clear, Marty tried pain management but was not able to get any relief.

Back to Dr. Tollestrup

Marty returned to see Dr. Tollestrup in hopes that he might be able to do something for his low back pain. After listening to Marty describe the location of the pain, Dr. Tollestrup suspected that Marty might be suffering from compression of the superior cluneal nerves.

The superior cluneal nerves are a cluster of nerves that branch off the main L1, L2, and L3 nerve roots and travel along the lumbar spine. These nerves pass through tight tunnels made up of fascia and bone and can become entrapped.

Entrapment of the superior cluneal nerves can cause severe low back pain which is usually off to the side slightly rather than in the middle, directly over the spine. There can also be a radiation of pain into the buttocks or hip. It is a common problem that is rarely diagnosed correctly. Many patients with this problem will undergo unnecessary spine surgery. Undergoing spine surgery when the low back pain is actually due to superior cluneal nerve entrapment will have no effect on the original pain at best, and at worst, can make the original low back pain become much worse.

Superior Cluneal Nerve Entrapment

Dr. Tollestrup sent Marty for a diagnostic block of the right superior cluneal nerves. Once the nerves were anesthetized Marty’s low back pain was instantly relieved. This let Dr. Tollestrup know that the real source of the low back pain was entrapment of the superior cluneal nerves and not some type of problem with the spine itself.

In this photo the green circle is around the superior cluneal nerves.

With this knowledge, Dr. Tollestrup was able to take Marty to the operating room and remove these small, unimportant sensory nerves to permanently relieve his low back pain.

Low Back Pain Gone

A week after surgery Marty is once again pain-free thanks to Dr. Tollestrup.

Superior cluneal nerve entrapment usually goes undiagnosed by orthopedic surgeons simply because they do not have comprehensive knowledge of the peripheral nervous system.

If you have unresolved low back pain, Dr. Tollestrup can help. Please fill out the form on the right or call the office at 702-666-0463.

 

Nerve Surgery Success After Six Failed Back Surgeries

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Failed Back Surgery Leads to Nerve Surgery Success

Thomas came to see Dr. Tollestrup after he endured failed back surgery six times. His chief complaint is pain and paresthesia involving the left lower extremity.

Pain and Numbness

Thomas’s pain starts in the left knee and radiates down into the lateral leg and over the dorsum of the foot. He also has pain in the calf muscle and the plantar surface of the foot. He states that he gets a lot of cramping in the toes and the arch of the foot.

Sitting makes the pain worse. When he sits, he also has pain in the left buttock and thigh.

He has a strange sensation that is kind of like a tingling from the knee down into the foot. He describes his pain as a “hard ache” most of the time with occasional intermittent painful electric shocks.

Thomas takes a sleeping aid otherwise he doesn’t sleep very well due to the pain. His wife says that he tries to sleep most of the day just to try to get away from the pain.

He has had a thorough workup with imaging of the spine from both his spine surgeon and his pain management physician. Neither of them can find any ongoing pathology at the spine level.

Sciatic Nerve Compression

On physical examination, Thomas shows evidence of compression of the large sciatic nerve at the level of the piriformis muscle in the deep buttock. This is called piriformis syndrome.

He also has compression of the common peroneal nerve just below the outside of the knee.

To confirm this, Thomas had a diagnostic injection of the left piriformis muscle which totally relieved his usual sciatica pain for about 48 hours.

With the diagnosis confirmed, Dr. Tollestrup took Thomas to the operating room and performed a surgery he developed where the piriformis muscle is removed and the pressure on the sciatic nerve completely relieved.

Surgical Success Times Two

After this surgery, Thomas has complete relief of the sciatic pain from the buttock to the knee level but persisted in having radiating pain down the outside of the lower leg and over the top of the left foot.

He went back to the operating room a second time for surgical decompression of the common peroneal nerve, a nerve that can become pinched just below the outside of the knee. After this procedure, Thomas is now completely pain-free of the original pain in his left leg.

Thomas is not being evaluated by Dr. Tollestrup for his chronic low back pain. Back surgery was supposed to relieve this pain but only made it worse.

Stay tuned for an update on Thomas’s low back pain.

“He has provided me with a quality of life that I thought I lost forever. I now have absolutely no pain in my legs. I am able to walk without pain again.”

Patient's Husband urges friends and family to see Dr. Tollestrup who helped his wife overcome chronic nerve pain

Removing Nerves Relieves Low Back Pain

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Low Back Pain Eliminated by Surgically Removing Damaged Nerves

I want to share the story of a patient suffering from low back pain for more than 20 years. His story is applicable to many people dealing with low back pain still searching for relief.

In this particular case, the patient’s low back pain is alleviated when he is sitting or lying down. As soon as he would stand or start walking, he would start experiencing severe low back pain. This low back pain prevents him from walking long distances at a time.

Interestingly, the patient notes that the pain is always located on either side of the spine rather than directly over the spine.

Failed Back Surgeries

Over the years, this patient underwent two separate spinal decompression procedures at different levels in the lumbar spine. Neither surgery gave him any relief.

Luckily, this patient came to see me. After giving him a comprehensive peripheral nerve evaluation, I knew the cause of his long-standing low back pain. My hypothesis is that the pain stems from compression of a series of small nerves on either side of the spine. These nerves are called the superior cluneal nerves.  referred the patient for a diagnostic block of these nerves. This procedure involved putting both the left and the right superior cluneal nerves to sleep by injecting local anesthetic around them. This gave the patient 95% relief from his usual low back pain for almost 10 hours.

Nerve Surgery Offers Solution

Based on the excellent block results, I surgically remove the superior cluneal nerves on both sides. These nerves are relatively unimportant, small sensory nerves, that do not affect the ability to walk or move the back muscles or leg muscle.

By the three-month post-op mark, the patient reports the following:

  •  No pain at all about 75% of the time,
  • The other 25 % of the time, some low back pain when walking but instead of the 8/10 level it had been before, it would be down around a 2-3/10 level.

The difference was life-changing.

Physical therapy may help this patient to further improve. His core muscles are weak due to inability to exercise for the last 20 years. Weak core muscles are a very common cause of mild to moderate low back pain that will usually resolve with exercises targeting these muscles.

If you or someone you know has persistent low back pain I might be able to help them find relief. Please fill out the form on the right or call my office at 702-666-0463.

Tim Tollestrup MD

Nerve Compression Causes Severe Sciatica Pain

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Nerve Compression Compromises Quality of Life

Christine suffers from multiple chronic pain issues stemming from nerve compression. These cover the range from severe low back pain and sciatica pain to bladder pain to pain in multiple joints. We will tell her story in segments. Readers can follow her journey back to health with the help of Dr. Tollestrup and his innovative surgeries.

Severe Sciatica Pain

Christine has an aggressive form of osteoarthritis. Eventually, the arthritis pain in the right hip progresses to the point where Christine elects to have the right hip replacement surgery.

After surgery, Christine begins experiencing severe, right-sided sciatica pain. With a history of low back surgery, her doctors assume the problem stems from her back. This despite the fact that MRI imaging of the lumbar spine does not show a problem.

With medication failing to control her pain, she elects to have a newer type of spinal cord stimulator implanted. This is effective for three years. Then the pain in the right leg  comes back with a vengeance.

Pinpointing the Pain

It was at this point that Christine is referred to Dr. Tollestrup by her primary care physician. After completing a comprehensive peripheral nerve evaluation, Dr. Tollestrup concludes that her pain comes from two different pinched nerves in the right leg.

The first location is compression of the sciatic nerve in the deep buttock, a very common cause of sciatica pain called piriformis syndrome. The sciatica pain caused by piriformis syndrome is often missed or attributed to be due to some type of problem at the spine level.

In addition, Christine also has compression of a different nerve near the outside of the knee called the common peroneal nerve.

Rare Find

In the operating room, Dr. Tim Tollestrup finds a very interesting and rare set of circumstances. In Christine’s case, she has an anatomic variation in her piriformis muscle where she effectively has two separate muscle bellies medially joined together into one common tendon.

Understanding this particular anatomic variation of the piriformis muscle is key to understanding why Christine’s previously mild sciatica pain in the right leg became so severe right after the hip replacement. Often when the hip is replaced, the top part of the femur bone, where the piriformis tendon is attached, is removed to accommodate the prosthetic hip joint. Because the piriformis muscle is relatively unimportant in moving the leg, there is often no effort made by the orthopedic surgeon to reconstruct it.

In Christine’s case, however, this had serious consequences because as soon as the piriformis tendon was released, it retracted away from the hip and towards the spine, effectively strangling the part of the sciatic nerve passing through it in the crotch of the two tendons where they joined together.

Sciatica Pain Gone

By the one-week post-op, Christine tells Dr. Tollestrup that 95% of her original sciatica pain was already gone. At the 6-week post-op visit, she notes that her original sciatica pain was 100% gone.

Christine’s sciatica pain is 100% gone after nerve compression surgery*.

Christine has other chronic pain issues, including fairly severe left-sided sciatica pain, which she is continuing to work with Dr. Tollestrup to solve.

If you or someone you love has chronic pain, Dr. Tollestrup can help. Fill out the form on the right side of this page or call the office at 702-666-0463.

*Disclaimer

We do not guarantee any specific results or outcomes for surgery, should our practice work on your behalf. Information on this website may be used as a reference for successes we’ve achieved for our patients, and not as an assurance or guarantee for similar results in all instances.

Nerve Compression Causes Severe Sciatica Pain

Peripheral Nerve Surgery Offers Hope After Failed Back Surgery

By | back pain, Dr. Tollestrup Blog, Nerve Surgery, persistent pain after spine surgery, piriformis syndrome, success stories | No Comments

Nerve Surgery Heals Patient After Failed Back Surgery

Shelley is a woman who came to see Dr. Tollestrup after she failed back surgery multiple times.  She had pain complaints involving her low back, pelvis, and legs. Before meeting Dr. Tollestrup, Shelly endured failed surgeries and ineffective treatments.

Her story is painful reminder of how getting the right doctor to perform the right surgery is the key to relieving chronic pain.

Painful History

Shelly had three spine surgeries before to coming to see Dr. Tollestrup. After the third surgery, Shelly became aware of severe pain and buzzing in her left leg.

As time progressed the pain in her left foot became worse. Eventually Shelly was given a diagnosis of Chronic Regional Pain Syndrome Type 2 (CRPS II). The assumption was that there had been some type of injury to one or more nerves during the disc replacement surgery.

Shelly tried everything – spine injections, ketamine infusions, various medications, physical therapy and finally a spine stimulator. None of these options gave her relief.

By this time, Shelly’s worst pain was the skin of her left thigh. Shelly’s pain management doctor referred her to a local spine surgeon, who ordered a discogram which was positive at the L3 level. Based on that finding, the spine surgeon recommended a fourth spine surgery which was scheduled for May 1, 2017.

Social Media Leads to a New Option

While waiting to undergo her fourth spine surgery, Shelly discovered Dr. Tollestrup through social media. She made an appointment to see him a month before she was scheduled to have back surgery again.

After putting Shelly through a comprehensive peripheral nerve evaluation, Dr. Tollestrup was able to break down Shelly’s various pain complaints.

Based on his detailed understanding of peripheral nerve anatomy, Dr. Tollestrup knew that the pain in Shelly’s left thigh was not coming from a problem involving her L3 intervertebral disc. The simple reason for this is that Shelly was experiencing pain in an anatomic distribution rather than a dermatomal distribution. When a nerve root is pinched at the spine level, it produces pain in a dermatomal distribution (see dermatome picture).

Shelly was experiencing pain in an “anatomic” distribution rather than a “dermatomal” distribution. When a nerve root is pinched at the spine level, it produces pain in a dermatomal distribution

Shelly’s pain clearly conformed to an anatomic distribution. Anatomic distribution describes the actual part of the body that a specific nerve innervates. In the case of Shelly’s left thigh pain, the pain perfectly approximated the anatomic distribution of a nerve called the “lateral femoral cutaneous nerve”, or LFCN for short.

One of Shelly’s secondary complaints was left sciatica pain. Based on her physical exam, Dr. Tollestrup diagnosed her with a left piriformis syndrome which is compression of the big sciatic nerve in the posterior pelvis by the piriformis muscle.

In order to confirm both diagnoses, Dr. Tollestrup sent Shelly for two diagnostic blocks which gave her temporary relief.

Peripheral Nerve Surgeries Successful

The next step for Shelly was surgery. Dr. Tollestrup performed two outpatient surgeries on Shelly the same day.

To address the severe, burning nerve pain in the left thigh, Dr. Tollestrup located the damaged nerve and disconnected it. He then removed a long segment of the nerve and buried the upstream end in the muscle deep in the pelvis.

For the sciatica pain, Dr. Tollestrup removed almost the entire piriformis muscle.

One week later, Dr. Tollestrup saw Shelly back in clinic for her first post-op checkup. She was happy to inform him that the horrible, life-altering pain in the left thigh was completely gone. Surgery also eliminated the left sciatica pain. Shelly’s countenance actually looked different. She looked brighter, happier, and more alive. Dr. Tollestrup refers to this as removing the pain mask.

Shelly feels great after peripheral nerve surgeries.*

Shelly’s story is a cautionary tale. Her spine surgeon misdiagnosed the true cause of her left thigh pain. A fusion of the L3 and L4 vertebrae would not have given her any relief from her pain. In fact, it probably would have made it even worse. It also would not have fixed her left sciatica pain which was due to compression of the sciatic nerve by the piriformis muscle.

If you or someone you love has failed spine surgeries, injured peripheral nerves might be the problem.

Call the office at 702-666-0463 to schedule an appointment with Dr. Tollestrup. Or you can fill out a form on the right hand side of the page.

*Disclaimer

We do not guarantee any specific results or outcomes for surgery, should our practice work on your behalf. Information on this website may be used as a reference for successes we’ve achieved for our patients, and not as an assurance or guarantee for similar results in all instances.

New Life for Husband and Wife Thanks to Peripheral Nerve Surgery

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Two for One Success Stories

Patsy and Michael Slate both had successful peripheral nerve surgery for two very different pain problems. Treating spouses is a common occurrence in Dr. Tim Tollestrup’s practice.

Patsy suffered from terrible back pain for years. Despite trying many different treatments, she was still in constant pain. She thought she would have to live with the pain until a chance encounter changed her fate.

Michael had successful peripheral nerve surgery to relieve constant, searing migraine headaches. In this post, you can read how Dr. Tollestrup treated his problem through peripheral nerve surgery.

In one of Michael’s follow up appointments, Patsy began discussing her back pain with Dr. Tollestrup. Both patient and doctor realized that peripheral nerve surgery might also be a solution for her.

Persistent Low Back Pain

Patsy’s low back pain was on the left side. The pain started about two weeks after the uncomplicated delivery of her fourth child in 2004. This pain became constant, although it would wax and wane in severity.

Patsy noted that if the pain on the left side became very severe, she would also start to feel some pain in the same location on the right side. Her usual low back pain was not centered over the spine but rather located to the left of the spine. Any type of activity involving sitting or standing for prolonged periods would make the low back pain worse. Bending or twisting at the waist would also tend to increase the level of her back pain.

What made the back pain even more of a mystery was that MRI imaging of her lumbar spine showed absolutely no evidence of any abnormality. For Dr. Tollestrup, this is a sure sign that the pain was caused by peripheral nerve damage.

Desperate for relief from the pain, Patsy finally agreed to her pain management doctor’s recommendation to have a spinal cord stimulator implanted. Although the trial stimulator seemed to work well, the permanent stimulator never really gave Patsy effective relief from her pain.

Disconnecting Nerves Offers Solution

After performing an exam focused on the peripheral nerves in the low back area, Dr. Tollestrup suspected that Patsy was suffering from entrapment of the superior cluneal nerves on the left side. The diagnosis was confirmed through a diagnostic block of the superior cluneal nerves. This involves injecting some local anesthetic around the nerves and putting them to sleep. This diagnostic procedure gave Patsy complete, temporary relief of her normally constant low back pain.

With the diagnosis confirmed, Dr. Tollestrup scheduled Patsy for surgery. Intraoperatively, Dr. Tollestrup, made an incision lateral to the spine and found the injured superior cluneal nerves. These nerves were then disconnected shutting off the constant pain signal to Patsy’s brain.

When Patsy came back to the office to see Dr. Tollestrup for the one week post-op wound check, she told him that her original, severe, left-sided low back pain was gone.

It has now been over two months since surgery and Patsy is in the process of arranging to have her spinal cord stimulator removed since she hasn’t needed it since surgery.

If you or someone you know has low back pain that doesn’t respond to standard treatment call Dr. Tollestrup’s office to schedule a consultation. His office number is 702-666-0463. He can help you and possibly your spouse if he/she has a mystifying pain problem too.

Back Pain Not Stemming from the Spine

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Why Spine Surgery Fails

In a recent post on Facebook, Dr. Tollestrup shared his thoughts on why lingering back pain may not originate from the spine but from damage to peripheral nerves around the spine, The post attracted so much attention that he decided to respond and elaborate in further detail. 

Chronic back pain is a condition that affects millions of Americans. The traditional approach to chronic back pain – spine surgery or pain management – has a mixed record of success at best. A big part of the problem is that spine surgeons, pain management doctors, neurologists and other specialists are essentially blind to the peripheral nervous system.

Doctors who treat patients with spine pain believe that all neck or back pain originates from the spine. This has led to a system where back pain tends to be treated with physical therapy at first. If that fails, then the next step is spine surgery if anything suspicious pops up on imaging. If that fails, the patient is then shuffled off to pain management where they are offered spinal injections, narcotics, and possibly a spinal cord stimulator. If imaging of the spine is totally normal, then the patient may bypass surgery and be sent straight to pain management.

Peripheral Nerve Injury

In this photo, you can see the many peripheral nerves around the spine.

But here is the rub. If the patient’s persistent back pain is due to a serious injury to peripheral nerves, like the ones in the picture, no amount of physical therapy, spine surgery, narcotics or spinal cord stimulators will ever provide the patient with effective pain relief.

All too often, spine surgeons and pain management doctors end up treating the imaging study (X-ray or MRI) rather than the patient. Very little if any effort is made to correlate the patient’s clinical symptoms with the findings on the imaging studies.

I’ve had many patients tell me that their initial evaluation by their spine surgeon consisted of a brief five-minute meeting where an MRI is thrown up against a light box and the spine surgeon proceeds to list the problems. Unfortunately, the patient undergoes a surgical procedure on their spine for a problem identified on imaging that is not even anatomically capable of producing the type of clinical symptoms the patient is suffering from!

The problem is so common that there is even a term for patients who undergo spine surgery without any improvement or even worsening of their pain. It’s called “Failed Back Surgery Syndrome.”

Simple Surgical Fix

Certainly not all, but probably the majority of patients who experience severe back pain really have some type of peripheral nerve injury. In most cases, physical examination combined with targeted nerve blocks done with local anesthetic can definitively confirm peripheral nerves as the true source of the patient’s ongoing pain. Once the correct diagnosis is arrived at, a relatively simple outpatient surgical procedure can then be performed to remove the small damaged nerves which generally results in complete relief for the patient.

If you or someone you know suffers from chronic back pain that significantly affects quality of life, there is little drawback to undergoing a peripheral nerve evaluation. You may have a problem that can actually be fixed resulting in elimination of your debilitating pain. What do you have to lose?

Dr. Tim Tollestrup

To schedule a consultation with Dr. Tollestrup please call the office at 702-666-0463 or use the web form on the righthand side of the page.