2 weeks Post MD/decompression, pain on 'good side'. What could this mean?

Tagged: atrophy, decompression, L5 S1, microdiscectomy, paresthesia

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LA_Frankie
Participant

June 14, 2020 at 11:49 am

Post count: 21

#32654

Hello.

17 days ago I had a microdiscectomy and decompression at L5/S1. Prior to surgery I exhausted conservative treatments starting with PT, NSAIDs, and my first epidural injection. The sciatic pain lasted for 3 months, each month getting worse, until after the injection I could no longer walk and was bedridden for 10 days before surgery.

Initial MRI was in March, the followup MRI in May reported the following, “At L5-S1 there has been slight increase in right subarticular disc protrusion resulting in severe right subarticular zone stenosis. The protruded disc contacts and posteriorly displaces the descending nerve roots, slightly worsened in comparison to prior examination.”

The first 10 days or so following surgery I felt great. 85% of the right leg pain was gone, no pain in the back (although my symptoms were never in the back per se.) I have slight calf weakness (cannot stand on my tippy toes for more than 5 seconds.) I had this symptom during the 2nd month but I regained the strength in my calf prior to surgery. Heel feels numb, or as if I am walking on rocks. But nothing major, or nothing unexpected I should say.

Suddenly, day 14 or so I began getting shooting pains in my ‘good side’, the left side which was unaffected prior to surgery. Shooting pains reminiscent of the nerve pain in the right (glute, hamstring area.) It is not persistent. It usually happens when transitioning my position, or when reaching for something.

At this time, the pain in the right leg also started to increase in intensity. Still NOWHERE near where it was before surgery. I can stand for 20 minutes now without pain, walk for almost 1.5 miles. Prior to surgery, like I said, I couldn’t walk 10 feet! My pain level was a 10/10 which landed me in ER one day after the epidural injection.

45 y.o. male, good health, normal BMI. Currently taking 220mg naproxen twice daily, 500mg Tylenol twice daily. Ice and heat as needed. Incision is pretty much healed. Experienced no complications following surgery.

My question and concern is this: why am I now getting pain on my ‘good side’? I asked the N.P. that works with my surgeon and she told me that it should resolve in ‘a few weeks’ and is typical. It sure doesn’t feel typical and I am looking for more of a medical explanation as to why my left side is now symptomatic.

Thank you for reading my story.

LA_Frankie
Participant

June 20, 2020 at 4:41 pm

Post count: 21

#32669

I guess I won’t get a reply with a Post count of 1. :(

Well, now it’s 2.

Donald Corenman, MD, DC
Moderator

June 21, 2020 at 7:50 am

Post count: 8660

#32671

Must of missed your first post-sorry.

Contralateral pain is not typical after a microdiscectomy but can occur due to inflammation of the opposite nerve root, a seroma (collection of post-operative fluid that somehow traverses to the opposite side) or discal settling that can trap the opposite nerve root in the lateral recess or foramen. A rare, unusual condition is a recurrent disc herniation that develops from the opposite side (seen that twice in 30 years).

There is an unusual crossover phenomenon that normally occurs with severe pain on one side that “transfers” to the opposite side due to the opposite nerve tracts that cross in the cord.

Since the symptoms have improved substantially post surgery, give this some time to resolve. If the symptoms are annoying, you can ask for an oral steroid. If they are progressive or impairing, a new MRI might be warranted.

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.

LA_Frankie
Participant

June 21, 2020 at 11:36 am

Post count: 21

#32676

Thank you, Dr. Corenman for your reply.

As it turns out the pain in the ‘good leg’ has disappeared since I started being more cognizant of my posture and balance. I had been favoring the affected right side for so long that I was using my left leg exclusively to stand, turn, push off, etc. I think the shooting pain might have been from overuse of those muscles — specifically the glute/hip area where the shooting pains were located.

This bring another question to mind, without posting a second thread hopefully you can provide your feedback.

I have developed atrophy in my right glute. There is noticeable shrinkage of the muscle. The entire leg is weaker as well. The calf still presents weakness but feels like it is slowly improving. (I can stand on my toes now for 5 seconds before it weakens. Last week was only 3 seconds.)

I have been injured a total of 4 months, and my question is will muscle atrophy related to nerve injury recover through exercise? Is muscle atrophy and nerve health directly related?

Sincerely,
F

Donald Corenman, MD, DC
Moderator

June 22, 2020 at 5:25 pm

Post count: 8660

#32681

The right gluteal muscle consists of 3 different groups; the minimus, medius and maximus. The medius is connected to the L5 nerve and causes a limp called a trendelenberg gait. The maximus pulls the hip backwards when you walk, propelling you forward and is typically an S1 nerve innervation. If either nerve is affected, the corresponding muscle will atrophy (lose volume). The good news is that since they are so close to the nerve source, they have a much better chance of regaining nerve supply and recovering when the nerve is decompressed.

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.

LA_Frankie
Participant

June 22, 2020 at 7:06 pm

Post count: 21

#32682

Thank you, Dr. Corenman.

My major concern is the lower part of the buttock which has flattened completely and will not activate when I try isometric exercises. Granted, it has only been 3 weeks since decompression.

Are there any exercises specifically that you would advise your patients with gluteal atrophy to bring up with their therapists?

Also could the atrophy be related to the piriformis? I did not have tightness before surgery but now I cannot stretch my piriformis without considerable tenderness/tightness.

Thanks again. You are a great asset to those of us dealing with these issues!
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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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2 weeks Post MD/decompression, pain on ‘good side’. What could this mean?