Revision L5S1 Disctomy with foramanotmy

Tagged: symptoms after recurrent disc herniation surgical removal

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Jnoga
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July 7, 2017 at 6:19 pm

Post count: 6

#25434

Hi Dr. I’m having some troubles that no one can seem to figure out. I recently had a microdiscectomy on Oct 12th. I was feeling good but reherniated I believe Jan 1. Or at least that’s when I noticed it. My Dr thought it was a flare up but after I told them I’m sure it wasn’t mri showed a large herniation. My surgeon suggested conservative treatment but with 60 days it completely popped and all my pain left my but and back and went to my hamstring and right foot. I lost strenght within 24 hours in my foot. Couldn’t support my weight on my toes at all. Well March 7th I had a revision discectomy. I noticed about a month after surgery i had a few numb spots in my left foot and toes (good side) i asked my dr about it at my 7.5 week check up. He told me its probabaly me being over sensative and my spine looked stable. Start exercising. I was so tight i couldnt bend in my back and he said its totally normal and because i had a revision it would take much longer to recover. He said i should be exercing and at leaste long walks. We would wait until 3 months for pt to be careful. I was extremely careful this time but at 8.5 weeks I felt a twinge in the left side of my spine. (My good side) Very clear nerve pain. I got an oral steroid pack which worked amazing. Afterwards I noticed my left shin felt like it had icee hot on it. Well the numb spots and cold spots started to go away but as I started walking more 3 miles a day and I felt it again. This time I was 90 days out from the 2nd surgery. Again saw the dr and the assistant ordered an mri. And another steroid pack. Again steroid pack got the major pain to go down but now my left calf keeps twitching and slight pain down the back of leg like a 1 or 2. Mean while my right foot issue is 90% resolved although heel is still numb at times. My Dr assistant says nothing in mri shows impingement and thinks it could be inflamation. I’ve started pt but I’m so sore I had to start in the pool. I’ve been going 2 weeks and it’s helping me move better. Reading my mri it says bilateral Formanal narrowing l5 S1 mild to moderate nerve contact can’t be excluded at L5. The pain dr and my Dr both say do PT and the mri doesn’t show anything for the symptoms. Let it calm down. So my questions my back is really sore on both sides. Is that from lack bending etc for 8 months, am I really weak from 2 surgeries? Also any ideas on the left side could it still be inflamation? My dr assistant again told me nothing in mri it probabaly is inflamation since steroid pack worked. Am I really far behind in recovery or is my Dr right abut revisions being much longer recovery. My PT guy is the best in the business I’m told by many sources. I’m beyond frustrated and scared. Please help!

Jnoga
Participant

July 7, 2017 at 6:40 pm

Post count: 6

#25435

I should also add my pt guy is very hopefull that with posture and muscle work he thinks I could relieve pressure. He feels muscles are in a protect mode causing more pressure

Jnoga
Participant

July 7, 2017 at 7:16 pm

Post count: 6

#25436

I’m a 38 year old male who was physically fit and in perfect health prior to Oct. I’m 5ft 8″ 160lbs

Donald Corenman, MD, DC
Moderator

July 8, 2017 at 6:02 am

Post count: 8660

#25437

Your history is consistent with the problems you have had. It appears your care has been good. Just one question though. Do your left leg symptoms occur with standing and walking vs. sitting down?

The disc height at L5-S1 most likely has diminished significantly after having two disc hernations with surgical removal. The height loss can be significant as the foramen (the exit hole for the nerve root) is made up 60% by the height of the disc. Not only do you lose foraminal height but the annulus (the outside of the disc) will bulge into the foramen just as a car tire that goes flat will push out sideways. The nerve root can be compressed with standing and walking as these actions will narrow the foramen while bending forward (crouching, leaning on a counter or sitting in a recliner) will open the foramen.

If the leg symptoms are not related to position, then you are on the correct path with pool work then eventually graduating to dry-land training. I agree it will take some time to feel”normal” again.

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.

Jnoga
Participant

July 8, 2017 at 8:56 am

Post count: 6

#25442

The left leg issues seem to be tingly all the time. I can lay on my back and still feel them. The 1st flare up on my left side of spine happened reaching for my right shoe off the edge of my bed after stretching. 8.5 weeks. My 2nd flare up happened after walking and doing light excercise in the pool 90 days. It seemed like if I reached back it got worse. Like to wash my lower back in shower. I didnt try to bend forward for fear of herniation. But also hurt when sitting.
Sitting on the toilet and reaching back with my right hand seems to be an issue with the left side of spine when I have flare ups. My back pain and tightness is equal on both sides. The back pain does get better after pt or heat. So i think that could be muscular? So if my mri report says can’t exclude nerve contact but my dr says they see no nerve contact on the left side. Is this something a dr would easily see on an mri? Also if it’s just mild to moderate narrowing that’s causing the issue will it get better with time and pt? Can PT really make a big difference? Ive been doing exercises at home and pool and monday I start real land pt. Can the tingles be lingering from my last flare up 30 days ago? The tingles do seem to be more noticable when i do my pt excercises. Could the dr really be right that it’s inflamation?

Jnoga
Participant

July 8, 2017 at 8:58 am

Post count: 6

#25443

Also do tingles mean there is contact or can tingles be lingering from a past flare up?
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Donald Corenman, MD, DC

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81 reviews

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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