Keith Puri, DC
36 yo is pretty young to already have a degenerative spondylolisthesis. These are more commonly seen in the 6th or 7th decade of life causing more central or lateral canal stenosis. At 36 I would certainly look into flex/ext XR to assess for instability. If the spondy is unstable something in the lumbar spine or pelvis has to work more in a protective response to stabilize the spine and prevent the disc from shearing. My question was could the anterior core or pubic symphysis compensate for this? Like Carl mentioned, is the pubic symphysis the pain generator or is it the victim?
2 years of relief post cortisone injection in the pubic symphysis is fantastic. However, with his return of symptoms is the primary generator still the pubic symphysis or it is something else.
As for your patient’s perineum pain, I would have him try to identify his exact pain location and see if there is any overlap with any of the cutaneous nerves in the pelvis and perineum, spinal dermatomes or pubic symphysis pain referral pattern.