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persistent pain after spine surgery

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.

 

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

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

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

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.

Persistent Back Pain Post Surgery

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When Back Pain Isn’t Caused by a Problem with the Spine

When a patient suffers from back pain that does not respond to physical therapy, general consensus is that the pain must originate from some type of problem involving the spine itself.  However, another more likely cause may stem from peripheral nerve damage.

Just like many other parts of the body, there are many peripheral nerves in the back sacral area that can be the source of chronic pain. Sometimes these nerves can be damaged directly due to traumatic injury. Sometimes they can become irritated or damaged as a result of spine surgery itself.

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

Peripheral nerve damage in the back/sacral area can be the explanation for chronic back pain where no cause can be identified on MRI imaging or it can be the source of lingering pain even after a spine surgery.

If the source of chronic back pain is one or more damaged peripheral nerves, then no amount of spine surgery will fix the problem. Conversely, spine surgery likely will make the pain worse. I know this because many of my patients endure back pain of undiagnosed origin for years. Very often they undergo multiple surgeries, none of which help and sometimes cause an increase in their pain by surgically injuring peripheral nerves.

Patients who suffer from chronic back pain where no cause can be identified or who experience persistent back pain even after spine surgery should undergo a peripheral nerve evaluation to see if peripheral nerve damage might be the source of their pain. If it is, then the pain can usually be eliminated altogether via an outpatient surgical procedure.

Here are a few patients of mine who presented with lingering or persistent back pain. I was able to eliminate their pain through surgical procedures I have created.

Robert – Persistent Pain After Spine Surgery

Frederick’s Story – Sciatica Pain Gone

Barry’s Story – Low Back Pain Gone After Two Innovative Surgeries by Dr. Tollestrup

The blue bands pictured here are called Vessel Loops. They are soft elastic rubber bands that you can place around delicate structures like blood vessels or nerves to hold and manipulate them so you don’t have to touch them with metal instruments that could otherwise damage them. So each of those blue vessel loops are placed around a damaged peripheral nerve in the picture.

If you are suffering from back pain where no cause can be found through an MRI or if you have lingering back pain after surgery, call my office at 702-666-0463. I hope I can help you like I have helped these patients.

Tim Tollestrup MD

 

Low Back Pain Gone Thanks to Innovative Surgeries

By | Dr. Tollestrup Blog, news and events, persistent pain after spine surgery, piriformis syndrome, success stories | No Comments

Low Back Pain Finally Gone Thanks to Innovative Surgeries by Dr. Tollestrup

Barry is a patient with a  history of low back pain. Like many patients with chronic pain, Barry experienced a number of failed treatments until he finally found Dr. Tim Tollestrup.

Several years ago Barry went on a long vacation to Australia. Prior to going on that trip he had an epidural which gave him total relief of his low back pain for almost three months. About 3 days before coming home from Australia he started to experience numbness in the left leg. The plane ride home really exacerbated the symptoms in the left leg producing severe radiating pain down the leg as well as increased numbness.

Upon returning to the United States he underwent a lumbar spine fusion which relieved most of the radiating pain in the left leg. He continued to have tingling and numbness in the left leg and foot, however, along with significant pain in the left calf muscle. The cramping pain in the left calf muscle would get especially bad with any kind of exercise. The left calf would also tend to ache all night long, making sleep difficult. Sitting for extended periods of time would produce pain in both buttocks with radiation of the pain into the posterior thighs.

Unfortunately for Barry, the lumbar spine fusion did not relieve his original back pain.

Dr. Tollestrup’s Approach

Barry was referred to Dr. Tollestrup by his primary care physician. Dr. Tollestrup evaluated Barry and identified a compression of the left sciatic nerve in the deep buttock, a condition known as piriformis syndrome as the primary cause of the residual numbness in the left leg and the pain in the left calf muscle.

Barry underwent surgery to remove the piriformis muscle and decompress the sciatic nerve. By 8 weeks post-op, the numbness and pain in the left leg was gone!

Next, Dr. Tollestrup investigated the cause of Barry’s chronic low back pain which had not been relieved by his low back surgery. Physical examination showed that the likely source of the low back pain was compression of several small nerves on either side of the spine called the superior cluneal nerves. In order to confirm this diagnosis, Dr. Tollestrup referred Barry for a block of these nerves where the nerves were put to sleep using a long-acting local anesthetic. This gave Barry complete relief from his usual, constant low back pain for about 48 hours.

Based on the positive result from the block, Barry went back to the OR where Dr. Tollestrup performed an operation he developed to remove these superior cluneal nerves.

Barry just checked in for his three month post-op visit after having the superior cluneal nerves removed and he has had complete relief from his original lower back pain. Barry joked with Dr. Tollestrup that now that his low back pain is gone, he has been much more active, working in his garden, etc. Now he is experiencing soreness in muscles that he has not used for a very long time due to the fact that he was so limited by his original back pain.

Two successful, innovative surgeries by Dr. Tollestrup have given Barry complete relief*.

Low Back Pain Gone

*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.

Dr. Tollestrup removes Jackson's piriformis muscle and decompresses superior cluneal nerves

Dr. Tollestrup Helps Patient After Failed Back Surgery

By | chronic pain after surgery, Dr. Tollestrup Blog, Patient Stories, persistent pain after spine surgery, success stories, Uncategorized | No Comments

Lingering Pain After Back Surgery – What Does It Mean?

Robert Jackson’s story illustrates the problem of failed back surgery and why patients still have pain even after the surgical procedure. In Robert’s case, spine surgery did not help him at all. After the surgery he still had low back and sciatica pain. He agreed to let us share his story in hopes of reaching other patients like him.


As a result of a wakeboard accident, Robert Jackson had some nondisplaced vertebral body fractures at L2 and L3. After this injury, he had upper back pain at the site of the fractures as well as low back pain on both sides. Before the wakeboard accident, he was already dealing with right sciatica pain.  After he accident, this pain was much worse.

To understand Robert’s case, it is important to note that he had back pain in three places:

  1. Pain at the site of the injury in his upper back.
  2. Low back pain as a result pf the wakeboard accident.
  3. Right sciatica pain which predates the accident.

After about three months, the upper back pain went away because the fractures had completely healed. However, the severe lower back pain and right sciatica pain persisted. Eventually he underwent spine surgery with the assurance from the spine surgeon that it would relieve his low back and sciatica pain. Unfortunately for Robert, spine surgery did not relieve his low back or right sciatica pain.

Enter Dr. Tim Tollestrup whom he met in an unusual way. Dr. Tollestrup operated on Robert’s wife after she suffered a traumatic peripheral nerve injury.

Robert mentioned to Dr. Tollestrup that he had residual back pain after spine surgery. The pain was so bad that Robert was heavily dependent on pain medication to get through the day.

Upon physical examination Dr. Tollestrup diagnosed Robert with piriformis syndrome and superior cluneal nerve compression. Dr. Tollestrup surgically removed his piriformis muscle and decompressed his sciatica nerve. One week post op Jackson shared that his sciatica was pain gone.

Dr. Tollestrup performed a second surgery removing his superior cluneal nerves. Removing the superior cluneal nerves relieved the persistent low back pain.

Thanks to the surgeries by Dr. Tollestrup, Robert is now sleeping 6-7 hours straight at night (formerly he was unable to sleep more than 1-2 hours at a time) and wakes up feeling refreshed. He described his results so far as “life changing.”

Robert did not need spine surgery. After spine surgery he still had pain. But nerve surgery finally gave him relief.

Robert did not need spine surgery. After spine surgery he still had pain. But nerve surgery finally gave him relief.*

However an important distinction must be made about failed back surgery syndrome. Dr. Tollestrup cannot help all patients who have pain after spine surgery. If you have a traditional spine problem, you still need spine surgery.

However, in some instances, like Robert’s case, Dr. Tollestrup’s surgeries can provide relief for patients with pain after spine surgery. If you are unsure of which category you fall in, Dr. Tollestrup can examine you and offer his opinion.  His office can be reached 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.