Back problems causing PN symptoms

[lindsayg]

I recently had pelvic and lumbar MRI's and several problems showed up regarding my lumbar spine. Mostly a lot of osteoarthritis and moderate spinal stenosis in L3-4 and L4-5. Has anyone had back surgery and found the PN symptoms went away? I've heard a lot of conversation about PN coming from back trouble and am lost as to what my next move should be.
Thank you.
Lindsay

[HerMajesty]

My PN arose from my sacrum at S2 and as I recover from surgery I am recovering from PN, although the S2 nerve roots were compressed for 8 years so I am not sure I will ever be totally asymptomatic. I'm not sure that compression of the lumbar nerve roots correlates at all with pudendal symptoms; but if there is stenosis of the spinal canal causing pressure on the spinal cord itself, I think anything below the level of the compression could potentially be affected. I would be surprised however if that would manifest as PN alone. I would expect it to cause general issues with the lower half of the body, such as leg pain or weakness in addition to PN. Even with a problem as low as S2, I had much more global issues than just PN.

[Violet M]

Lindsay, my understanding is that radiculopathies in the spine rather than the pudendal nerve can cause pudendal neuralgia symptoms and that it can be difficult to distinguish between a peripheral pudendal nerve injury as opposed to a spinal radiculopathy. In the abstract of Dr. Bautrant's article it states that 12 of the people were rejected for the study because it was deemed that they had spinal radiculopathy rather than peripheral nerve injury. You can find the article at this link: http://www.pudendalhope.info/sites/defa ... utrant.pdf Here is an excerpt from the article. (The original article was in French)

"The pudendal nerve (n.pudendus) may be
submitted to many forms of trauma along its
course either inside or outside the spine (fig.1)
If the medullary or radiculo-plexus conflict can
be at the origin of perineum neuralgia of the
pudendal type by neurological pathology or
lombo sacral [6], the progress and neurological
and physiological exploration of the perineum
allow us to distinguish from the impairment to
the pudendal nerve itself [7]."

Even with a peripheral PN injury as opposed to a spinal pathology, there can be many more symptoms than just in the distribution of the PN. At least there were in my case. The reason is that muscles of the pelvis such as the piriformis can go into spasm in response to the PN pain and cause sciatic-type symptoms clear into the foot and difficulty walking (which is what I had). Also, PN/PNE often does not occur in a vacuum as the only pathology. There may be other accompanying problems such as SI joint dysfunction, laxity in the ligaments, etc. that are contributing to a nerve entrapment. So, it's not an easy diagnosis especially since there are many variations of the disease in the PN patient population. It can be very difficult to determine whether your pain is due to a spinal radiculopathy or a peripheral pudendal nerve injury. Dr. Bautrant relies a lot on the pelvic exam where he presses along the course of the nerve to determine if two of the most common areas of PN entrapment (the area at the ischial spine and alcock's canal) are tender.

Violet

[lindsayg]

Thank you Her Majesty and Violet for responding. Her Majesty, I hope your surgery is successful and in time your PN issues resolve as well. Violet, why doesn't it show in "new messages" when someone has responded?
Lindsay

[HerMajesty]

Lindsay,
So far so good...I won't be posting a success story until I know the absolute final outcome which takes more time...but I am much better and doing tons more in terms of work and physical activity. So I am living proof that PN can originate in your back.

[bikelover]

The pudendal derives from the sacrum, not the lower spine. Unfortunately I don't think syrgery at the L's will fix the S's, though I'm no expert.

[HerMajesty]

The pudendal does derive from the sacrum (which is part of the lower spine: the vertebrae are simply fused at the lowest level). However, stenosis is a narrowing of the spinal canal, so it has the potential to impinge on nerve conduction from the point of compression on down. In that sense, lumbar stenosis can effect the sacral nerves - symptoms would be in similar distribution to cauda equina syndrome, although not as acute.