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Dr. David
Dr. David, Board Certified Physician
Category: Orthopedics
Satisfied Customers: 46381
Experience:  Experienced Physician trained in New York City. I'm ready to help.
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H Doctor, I am 68. 5'7" 186. I have some back pain but the

Customer Question

For Doctor Scott H
Doctor, I am 68. 5'7" 186. I have some back pain but the main pain is in my buttocks. It especially hurts when I stand up straight from a sitting position ...and sit down from a standing position,and also when I bend from the waist over to pick up something (and dont bend knee). Sitting itself and standing itself is ok.This has lasted 14 days. Prior to that I was not having pain. I was walking and had even started playing golf A LITTLE after staying off it for 10 months. I cant say a certain event caused this. 2 weeks ago I had received a back massage and then walked inside for 45 minutes and then stretched for 15 minutes. Tuesday, Aug 25 I had some "trigger point" injections into the spine area from a pain doc who treats my neck and upper back) and she gave a steriod dose pack 6 day supply. ...and Meloxicam 7.5 mg. 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 of an MRI 4 days ago:
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. What would say is causing this buttock pain. can it get better with time??I have to take care of my mom who is 91 and I need to be as healthy as I can be
Submitted: 1 year ago.
Category: Orthopedics
Expert:  Dr. David replied 1 year ago.

This is Dr. David

there looks like indention of the left ventral thecal sac and impingement of the L5 nerve root is most likely what is causing your pain in your buttocks and sacral area.

you might need a steroid injection into the Left L4/5 disk space to see if the steroid injection helps decrease inflammation so the disk go back into place.

it sounds like you have gotten an injection already which didn't really help.

it sounds like that disk at L45 being out of position is what is causing your pain.

physical therapy could help.

a TENs unit on your back could help distract your back and decrease pain.

if the pain continues, you might have to see a neurosurgeon to talk about options for spine surgery.

hopefully that won't be the case

let me know if you have questions.