Why should the lumbar be checked on mri?

Many physical activites such as sports, pelvic surgery, etc can all contribute to PN
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monty999
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Why should the lumbar be checked on mri?

Post by monty999 »

New to this so lots of questions.
Many posts say get back checked out as a possible culprit. Why is this?
I do have a problem with my back. My problem actually started after a fall onto the back.
l5-S1 and L4-S5 abutting but not compressing the sciatic nerve. 6 months of severe back pain and sciatica which was relieved by epidural into the L5. Sitbone pain started at around month 5 of back problem. Just a niggle. Now 15 months on a 7 out of 10. Debilitating.
2 back consultants said lumbar spine could not cause discomfort at the sitbone.
Any thoughts?
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Violet M
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Re: Why should the lumbar be checked on mri?

Post by Violet M »

The pudendal nerve originates from sacral nerves (S2,3,4) so if there is damage or compression at those areas it can cause symptoms similar to pudendal neuralgia. It would be considered a spinal radiculopathy rather than a peripheral neuropathy. For this reason, you should have a lumbosacral MRI and my PN physician also wanted me to have an MRI of the lumbosacral plexus.
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
monty999
Posts: 12
Joined: Fri Aug 16, 2024 11:51 am

Re: Why should the lumbar be checked on mri?

Post by monty999 »

Thanks for this violet. So this would differ from a lumbar mri which showed my L5-S1 and L4-S5 bulges. Does the sacrum mri look at nerves or just the bone? Will order MRIs. Funnily enough I had another fall onto my back onto concrete 6 weeks ago and now have bone marrow oedema of the sacrum. They call me ‘lucky’
One last question. Posted in another section but no answers. Pelvic mri showed Subtle soft tissue oedema in the distal and lateral aspect of the left obturator internus muscle and tendon, suggesting mild insertional tendinopathy and/or mild sprain.
Just a coincidence or could this be relevant? Thanks. You are so helpful.
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Violet M
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Re: Why should the lumbar be checked on mri?

Post by Violet M »

I think the lumbosacral plexus MRI would show a little more detail lower down than just the lumbar MRI. The lumbosacral plexus MRI should include the pudendal plexus. The picture at this link might help to make it more clear. https://www.researchgate.net/figure/Ana ... _318085947
It would depend on the software settings of the MRI as to how much enhancement there is of the nerves but an MRI would include soft tissue as well as bone.

Edema along the obturator internus could be significant since the pudendal nerve travels between the obturator internus and levator ani in the Alcock's canal. But I don't know how close to the nerve the edema on your MRI is. Can your physician give you more details as to whether it is along the Alcock's canal?

Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
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