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.

 

Removing Piriformis Muscle Heals Sciatica Pain

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Dr. Tollestrup Doubles Up on Successful Surgeries To Heal Sciatica Pain

We recently shared this video story about Spencer Hawkins, a patient of Dr. Tollestrup’s who battled severe sciatica pain for years. Dr. Tollestrup was able to eliminate Spencer’s pain by surgically removing his piriformis muscle. Now Spencer is back playing the sports he loves.

Click Here to Watch Spencer Get Back in the Game

Ironically, Spencer’s softball buddy David Sherman was suffering from a very similar pain problem. The two researched online together and discovered they both had piriformis syndrome. David came to see Dr. Tollestrup first but opted to wait until Spencer had surgery. After seeing Spencer’s results, David decided to go for it too. This is his story.

Decade of Chronic Pain

David’s original problem was severe low back pain and bilateral sciatica pain. The sciatica pain in the left leg was much worse than the right leg. David suffered for more than ten years. He endured 11 epidural injections with varying degrees of relief.

Eventually, David decided to undergo spine surgery. His spine surgeon confidently told him that surgery would fix both his low back pain and his sciatica pain. He had a fusion of the lumbar spine from L4 to S1.

The results of the spine surgery were mixed. While the fusion fixed his low back pain, it did nothing for the severe sciatica pain in the left leg. The pain eventually got so bad that it limited David to walking no more than a couple of blocks at a time. This resulted in David having to give up tennis and softball, two sports that he loved to play.

David came to see Dr. Tollestrup after researching online. After an evaluation, Dr. Tollestrup diagnosed David with piriformis syndrome. A follow-up diagnostic injection of the left piriformis muscle resulted in two weeks of almost complete relief from his usual pain.

Bye Bye Piriformis Muscle

Based on his excellent response to the piriformis injection, David opted to undergo surgery with Dr. Tollestrup to remove the piriformis muscle pinching his sciatic nerve. A piriformis muscle is a spare part – like an appendix – that most people don’t need.

By the time David came back to see Dr. Tollestrup for his one-week postop appointment, his original sciatica pain was essentially completely gone.

Cautiously optimistic, David is back playing softball in two different leagues 3 to 4 times a week with his friend and fellow success story Spencer.

Here is what David had to say after his successful surgery.

“After suffering from sciatica pain for more than 10 years, one week after surgery to remove my piriformis muscle my pain is gone. I am now back to enjoying my life again.”

If you or someone you know has sciatica pain, the problem could be piriformis syndrome. Dr. Tollestrup can help. Fill out a form on the right or call 702-666-0463.

 

Sharon is back to long walks and sleeping through the night thanks to surgery from Dr. Tollestrup to remove her Piriformis Muscle.

Severe Nerve Compression Goes Undiagnosed for Ten Years

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Nerve Compression at Multiple Sites Causes Ten Years of Chronic Pain

Carrie is a patient of mine who needlessly suffered for ten years because no one could properly diagnose nerve compression as the source of her pain. I am sharing her story in hopes of reaching others who may be dealing with the same problem.

Spine Surgery

Carrie started her chronic pain journey more than a decade ago with severe sciatica pain in both legs. She underwent decompression of the spinal cord with a fusion of the L4-L5 vertebrae.

This surgery resolved her right leg pain but left her with numbness in both feet and shooting pain in her left leg radiating into the top of the left foot.

Through the years, Carrie tried dozens of therapeutic interventions. Sadly, one treatment she tried involved a charlatan chiropractor who charged her $5000 for powdered drink supplements and two small, ultimately useless machines. Neither of these offered her any relief.

Spinal Injections

Last year Carrie underwent multiple spinal injections by her pain management doctor. These spinal injections resolved most of the sciatica pain from the low back/buttock area down the posterior thigh to about the level of the knee.

However, again she was only able to achieve partial relief. The injections did not help any of the symptoms from the knee down. The more active she would be, the more pain she would experience in the lower leg and foot. She also started to have weakness in the left leg.

Correct Diagnosis

Carrie’s podiatrist referred her to me. Upon examination, I diagnosed her with serious nerve compression syndrome which involved entrapment of multiple nerves at various locations throughout the left leg. The problem started with a compression of the left sciatic nerve deep in the left buttock called piriformis syndrome. She also had a simultaneous compression of other nerves in the lower leg and top of the foot at three additional locations.

I performed surgery on Carrie, releasing the pressure on four different nerves at four different sites in the left pelvis and leg.

Nerve Decompression Surgery with Dr. Tollestrup can help eliminate migraine headaches.

Dr. Tollestrup performs nerve decompression surgery

 

 

 

 

 

 

Two months later Carrie has complete relief from the pain in her left leg! She continues to have some numbness and weakness on the top of her foot. With these types of nerve injuries, especially ones that have been present for many years, recovery can take a year.

For most patients, the thing that really affects their quality of life is the pain. They usually do very well dealing with numbness or weakness as these problems do not occupy the mind every waking moment and rob the patient of sleep at night.

If you have been unable to achieve relief from chronic pain, I might be able to help. Please fill out a form on the right or call my office at 702-666-0643.

Tim Tollestrup MD

Denervation surgery helps patient with chronic knee pain

Knee Replacement Surgery Fails to Heal Pain

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Pain Increases After Knee Replacement Surgery

Wanda had a left total knee replacement done by her orthopedic surgeon.

Unfortunately, after surgery, she still suffered from terrible pain. In fact, physical therapy made her pain worse. During physical therapy, she was using a Continuous Passive Motion machine. The more Wanda used the CPM machine, the more she started experiencing numbness and tingling involving the skin over the inside of her lower leg and pain on the inside of her ankle.

In addition, she started having severe, radiating pain starting near the inside of her knee and traveling up her inner thigh into the groin area.

Orthopedic Surgeon Denies Pain

Baffled by the cause of her persistent knee pain, Wanda’s orthopedic doctor just continued to send her to physical therapy. In total, Wanda participated in three rounds of physical therapy. Despite extensive therapy, Wanda’s symptoms never improved.

Wanda’s orthopedic surgeon told her many times that he didn’t understand how she could still be having pain and that everything was perfect with her knee replacement. Eventually, her surgeon started to intimate that the problem was all in Wanda’s head. Unfortunately for patients suffering from peripheral nerve damage, this is not an uncommon experience.

Finding Relief

Luckily for Wanda, her husband researched constantly on the internet and found Dr. Tollestrup. Wanda then came to see Dr. Tollestrup for an evaluation.

After learning about her arthroplasty, Dr. Tollestrup knew that Wanda had most likely undergone an unnecessary surgery because her knee pain before surgery was exactly the same as after the knee replacement. He also suspected that the source of her ongoing pain stems from the small sensory nerves that give sensation to the soft tissue around the knee joint itself.

Based on the description of the location of the new pain and numbness from the groin down to the inside of the ankle that Wanda started to experience after the knee surgery, Dr. Tollestrup also knew that there was a problem with Wanda’s saphenous nerve. A brief physical exam confirmed that the saphenous nerve was being compressed or pinched deep in the inner thigh in a tight space called the adductor canal. Using local anesthetic, Dr. Tollestrup put to sleep the small sensory nerves causing the pain in the area of the left knee. This gave Wanda immediate, temporary relief from her left knee pain, thus confirming Dr. Tollestrup’s diagnosis.

Disconnecting Damaged Nerves

With the accurate diagnosis made, Dr. Tollestrup took Wanda to the operating room.

Through a single incision just above the knee on the inside of the thigh, he was able to find and disconnect all of the damaged nerves to the knee. He also relieved the pressure on the main saphenous nerve in the adductor canal.

Click here to watch this video from the operating room showing exactly what Dr. Tollestrup did in surgery.

By the time Wanda came back to see Dr. Tollestrup for her one-week post-op visit, all of the original pain in the left knee was gone. The sensation on the inside part of the lower leg had returned to normal. She was no longer experiencing the shooting pain up the inside of her left thigh into the groin or the pain on the inside of her ankle.

“I don’t have any pain at all,” Wanda said. “I am so happy I found Dr. Tollestrup.”

If you or someone you know has persistent knee pain before or after a knee arthroplasty, Dr. Tollestrup may be able to help. Please fill out the form on the right or call the office at 702.666.0463.

A Tragic Tale of Unnecessary Knee Replacement and Amputation

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A Tragic Tale of Unnecessary Knee Replacement and Amputation

Kathy’s story is a tragic tale of a misdiagnosis leading to unnecessary knee replacement and amputation. We are sharing her experience in hopes of reaching other patients like her who may be able to avoid the mistakes made by her doctors.

An injury at work left Kathy with chronic knee pain. An orthopedic surgeon suggested a total knee arthroplasty. Kathy agreed.

But after surgery, she continued to have severe pain. Unfortunately, the only solution her surgeon could think of was to replace the prosthetic knee.

This vicious cycle continued and Kathy endured two additional knee arthroplasties. Complications following the third knee arthroplasty left Kathy with no alternative but an above-knee amputation (AKA).

Following the amputation, Kathy developed horrible phantom pain as well as severe residual limb pain in the end of her stump. While the phantom pain was bad, the residual limb pain was more debilitating because it prevented Kathy from being able to wear a prosthetic leg, thus confining her to a wheelchair.

True Source of Pain: Damage to Peripheral Nerves

The real tragedy of Kathy’s story is that it could have almost certainly been prevented had she found Dr. Tollestrup earlier.

In Dr. Tollestrup’s opinion, the most likely cause of Kathy’s original knee pain was damaged peripheral nerves. Sadly, with a knee denervation surgery by Dr. Tollestrup, the knee replacement surgeries and subsequent amputation could have been avoided.

Kathy finally found Dr. Tollestrup. He diagnosed the source of her pain as coming from the multiple neuromas which had formed on the ends of all the nerves that were cut through when the leg was amputated.

Dr. Tollestrup performed two cutting-edge surgical procedures involving a combination of disconnecting the smaller damaged nerves and sewing cadaveric nerve grafts to the larger damaged nerves to prevent re-formation of the painful neuromas. This is a highly complex surgery that Dr. Tollestrup is uniquely qualified to do.

Second Chance: Out of the Wheelchair and Back to Active Life

It has now been about a year and a half since Kathy’s first surgery. Her phantom pain is almost completely gone. The residual limb pain is also drastically improved. It is not completely gone but is down to such a mild level that she is no longer taking pain medication. She is now able to wear her prosthetic leg as much as she wants to without experiencing the horrible pain that she used to. This has freed her from the confines of her wheelchair which has been life-changing for her.

Kathy is looking forward to getting back to a much more active lifestyle again.

If you or someone you know has a peripheral nerve injury or pain of an undiagnosed peripheral nerve origin, Dr. Tollestrup may be able to help. Please fill out a form on the right or call the office at 702-666-0463.

Schwannoma Removed During Complex Peripheral Nerve Surgery

By | Dr. Tollestrup Blog, failed morton's neuroma surgery, nerve decompression surgery, Nerve Surgery, news and events, success stories | No Comments

Complex Peripheral Nerve Surgery Solves Chronic Pain Problem

Marilyn came to see Dr. Tollestrup for a complicated peripheral nerve pain problem. Dr. Tollestrup performed a tedious peripheral nerve surgery which fixed her issue permanently. This is her story,

For many years, Marilyn’s ankle was swollen. When she bumped her ankle, she would feel a painful electric shock sensation radiating down into her foot. A CT scan showed a tumor involving the right posterior tibial nerve.

The preliminary diagnosis was a schwannoma, a tumor found in peripheral nerves. Schwannomas are usually benign. But because they are located in peripheral nerves, schwannomas can cause significant nerve pain and weakness.

When a schwannoma grows inside a nerve, the rest of the nerve fibers end up plastered to the outside of the tumor kind of like spaghetti stuck to the outside of a balloon. This can make surgery to remove the tumor difficult.

With this diagnosis in mind, Dr. Tollestrup brought Marilyn to the operating room.

First, he decompressed nerves in the medial ankle area. Using an overhead operating microscope, he then carefully dissected the tumor out of Marilyn’s tibial nerve without injuring any of the other important nerve fibers.

The surgery was a complete success! Marilyn no longer has to endure the sharp, shooting pains in her ankle. Additionally, Dr. Tollestrup was also able to preserve normal sensation to the bottom of Marylin’s right foot.

Here is what Marilyn had to say about her experience. Take a listen here.

If you or someone you know has a peripheral nerve injury or pain of an undiagnosed peripheral nerve origin, Dr. Tollestrup may be able to help. Please fill out a form on the right or call the office at 702-666-0463.

Choir Teacher’s Sciatica Pain Gone After Piriformis Syndrome Surgery

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Choir Teacher Overcomes Chronic Sciatica Pain

After more than two years of debilitating sciatica pain, Deborah found Dr. Tollestrup. Deborah agreed to share her story in hopes of reaching others like her still suffering.

Deborah is a school teacher who teaches choir at a local middle school. Two years ago, she was injured sliding down a ride at a water park. As she was sliding down, she became airborne and landed very hard on the right buttock. Right away, Deborah felt like something had torn or ripped deep in the right buttock and there was a radiating pain which traveled down into the back of her thigh.

Over time, the pain increased causing her to walk with a noticeable limp. Sitting became almost impossible. She also started to have pain in her right foot. Sleeping was problematic because the pain kept her up at night.

Deborah was unable to find a doctor to give her any insight into the source of her pain or recommend any solution. Many doctors are not aware of piriformis syndrome. Very often doctors will recommend physical therapy, spine surgery, and narcotic pain medication. Unfortunately, none of these options offer long-term relief.

“The Tollestrup Procedure”

After hearing Deborah’s story and performing a careful peripheral nerve examination, Dr. Tollestrup diagnosed the source of the pain in Deborah’s right buttock, leg, and foot as Piriformis Syndrome. Piriformis Syndrome occurs when the large sciatic nerve becomes entrapped by the overlying piriformis muscle.

Dr. Tollestrup performed an operation he created to remove the piriformis muscle and relieve the pressure on the sciatic nerve.  A colleague calls this surgery the “Tollestrup Procedure.” This is done as an outpatient procedure and the patient is able to walk immediately.

By the time Deborah came back to see Dr. Tollestrup at the two-week post-op mark the debilitating pain in the right leg was completely gone.

Walking on the Beach

It is now two months since Deborah had the pressure on her sciatic nerve relieved. She continues to be pain-free. At her most recent follow-up visit, she remarked that her students noticed that she is no longer walking with a limp. One of them even came up to her and said, “Mrs. Fleischer, you look different since surgery, you can see it in your face.”

A fitting finish to this story is the text Deborah recently sent to Dr. Tollestrup when she was in San Diego. For Dr. Tollestrup, this is the most gratifying part of the job!

If you or someone you know suffers from chronic sciatica pain, fill out the form on the right or call Dr. Tollestrup at 702-666-0463.