Still having leg pain and is getting worse when I don't move.

Tagged: Chronic nerve/leg pain after 2 microdiscectomies

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ftkm92
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February 7, 2015 at 11:17 am

Post count: 28

#12159

Hi,

I had a discectomy and laminectomy in August 2014. After 2 months from the surgery I was in great pain and I had another MRI Done with cotrast. The report says lordosis abnormal lumbar may due to spasm. L4-L5 minor paracentral disc herniation indenting the theca.L5Si left paracentral disc herniaion with annular tear, narrowing the left neura foramen causing impingement of the left S1 nerve root. This a further compromised by scarring and granulation tissue inflammatory changes at the site of surgery but no obvious abscess.

I The month of octorber 16 2014 I had revision discectomy done and remove the scar tissues and rhizolysis done too.

In January My Dr called for a MRI with contrast and EMG and NCV. The nerve test shows normal.

The Latest MRI Report
Recent surgery has been performed at the L5S1 level. A discectomy was done.The surgical tract is visible as a tract of T2 prologation. There is enhancement along the tract.
The left posterolateral aspect of the disc also enhances. There is enhancement around the left S1 root. However there is no residual or any compressive lesion.

At the L4L5 level there is a central buldge of the disc whichmidly indents the ventral theca.

comment.
Recent discectomy at the L5S1 level via left hemilaminotomy.
Signal abnormality and enhancement along the surgical tract , and enhancement adjacent to the S1 root
Granulation tissue?
No residual disc herniation at this level
central buldge of the L4L5 disc.

Currently i have difficulty sitting and laying on the bed. When I sit or laying on the bed I feel a pulling sensation at the back of buttock all the way to my toes. The side of the ankle feels tight. I been able to push all my 5 toes downwards and I find it difficult to fush all my five toes towards me. Most of time i drag my left leg and sometimes I walk like climbing staircase. occasionally my left leg twitches.

From your experience what is causing the problem? Is it the question mark granulation tissue giving in the problem.

In fact those leg discomfort only started in the month of december. In the month of January it became worse. Now February still the same and the leg gets very tight and pulling all the time when I don’t walk.

Hopefully You can help me what is giving me the problem. My surgeon says I should not have pain and he wants to see me walk normally by the next visit.

Donald Corenman, MD, DC
Moderator

February 8, 2015 at 11:35 pm

Post count: 8660

#12162

By your report of symptoms, it seems you have a chronic radiculopathy (see website) and motor weakness of the tibialis anterior (foot drop). This is reenforced by your report of toe dorsiflexor weakness (“I find it difficult to push all my five toes towards me”). You also report a steppage gait associated with weakness of the tibialis anterior muscle called foot drop (“Most of time i drag my left leg and sometimes I walk like climbing staircase”).

What is somewhat perplexing is that the surgery was performed at L5-S1 to decompress the S1 nerve root (“Recent surgery has been performed at the L5S1 level”) and the S1 nerve root supplies the calf muscles causing weakness of push-off, not of foot drop (normally mediated by the L5 nerve).

The EMG findings you do not report and these could be valuable to help differentiate the nerves involved (with the understanding that not all investigators who do these studies are as accurate as they can be).

Your surgeon should have performed motor strength testing in the office as part of his physical examination and reported to you the results. See “symptoms of lumbar nerve injuries” to fully understand these disorders. If you have weakness generated from injury to the nerve root, the motor tests should be obvious and you will not be capable of “walking normally” as your surgeon requests.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

ftkm92
Participant

February 9, 2015 at 9:28 pm

Post count: 28

#12170

Hi.

Is it possible to have a footdrop? From the previous MRI it shows a paracentral. Herniated at L4L5 but it did not compress the L5 nerve root. Another issue is Paracenteral at L5S1 level with compression in the S1 nerve root.

I not sure what’s going on? According to the physiotherapist I have problem with the L5 and S1 nerve root.

Previously had an enormous about of scarring of the S1 nerve root from the first surgery.

current mri show granulation tissue and a bulging disc at L4L5 level.

According to my surgeon he says my ankle is weak. He ask me to push up his hand using my toes and I fail most off the time. The big toe does not go up.

Latest MRI shows granulation tissue.
.
Dr says I should not have pain and should be walking normally. I have been limping for 8 months already. Had two surgery done.

Is it those problem cause by the granulation tissue surround the nerve root? Is it possible the herniated disc at the L4L5 level without compression causing the problem?

My surgeon says he not sure because Nerve test shows normal.

ftkm92
Participant

February 9, 2015 at 9:39 pm

Post count: 28

#12171

I could not bear the pain and i am taking targin, arcoxia 120, neurontin 900mg and ultracet to manage the pain.

I also went for treatment under pain management doctor. She says I am having foot drop.

Is it normal that I feel the discomfort when i sit, laying on the bed. Walking no pain just weak and slow. Standing slight pulling feeling.?

The granulation tissue surround the S1 nerve root only.

Donald Corenman, MD, DC
Moderator

February 9, 2015 at 10:58 pm

Post count: 8660

#12172

There are two places the L5 nerve could be compressed. One is the foramen at L5-S1 which would be the most likley area of compression and the other is L4-5 in the lateral recess.

There has been no comment regarding foraminal stenosis or a big enough compression at the L4-5 area. There is a very small possibility that you have a lumbarization of L5 (the L5 vertebra congenitally is part of the sacrum) and the root with scar is really the L5 nerve and not S1.

What were the results of the EMG/NCV testing?

If the nerve has scar (granulation tissue) without compression, then there is a probability of this nerve having a chronic injury (chronic radiculopathy-see website).

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

ftkm92
Participant

February 10, 2015 at 10:57 am

Post count: 28

#12185

On 26/6/14

1st MRI report.
L4/L5 There is a disc prolapse with mild central canal and bilateral lateral canal stenosis.

L5S1 There is disc prolapse and left parasagittal disc extrusion causing moderate central canal, left lateral canal stenosis and mild right lateral canal stenosis, it results compression onto the traversing nerve root of left S1 in later canal.

Did surgery in 10/8/14

2nd mri report on 8/10/14
L4/L5 The prolapse disc result in mild central canal and left lateral canal stenosis.

L5S1 The prolapse disc results in left sided moderate central canal and left lateral canal stenosis. ITcompressing onto the traversing nerve root of left S1 in lateral canal.
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Donald Corenman, MD, DC

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Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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