Numbness after microdiscectomy

Tagged: Infection after lumbar herniated disc

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Sailormoon
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September 22, 2020 at 11:44 am

Post count: 29

#33024

Hi Doctor

I have 2 microdiscectomy for L5S1, suspect cauda equina. Before 1st surgery the red flag is only saddle anaesthesia on my right buttock and bottom calf. I have pain in the right buttock radiating to my bottom calf. No numbness at all.

After 1st microdiscectomy, wake up from surgery i feel pin n needles in the bottom of my feet,right leg. But the surgeon told me it will heal within 6 months. Is it normal that i have pin n needles while i dont have it before surgery?

Then a week after surgery, i woke up feeling sharp pain at the same place just like before surgery. But this time no radiating pain. It lasts for 3 days then disappear. But i’m afraid it recurrent disc. Therefore 3 weeks later, i had MRI that stated:
– Bone defect at Lamina posterior L5 right side with edema and subcutaneous fluid collection
– L4-L5 protrusio
– L5-S1 compare to previous MRI (before surgery) decreasing extrusio right and left.
– Lesion 6-8mm at the right canalis spinalis suspect arachnoid cyst post op dd inflamasi.

Then the surgeon told me there is recurrent, then 4 weeks after 1st surgery, i had the 2nd one.

Woke up from 2nd surgery, i have pin n needles at my bottom leg, this time at my left leg. And also tingling sensation on left leg. I confused, because i never had problem with my left. And also my left hip and buttock was hurt until now. And if i lay flat, some minutes later i feel stabbing pain not far from incision site.

The doctor told me, he perform exploration on surgery and found no arachnoid cyst, only wound/scar. No fluid when opening incision site.

For reherniation, he said, he do manouver and took the disc from left side because its too risky to take the disc from right side because of narrowing spinal canal. Then i ask, the reherniation happen in left or right side? He said in the middle. He also perform curettage because degenerated disc and he said he make space for the right side

My question is, can the disc goes to the middle? Why i have stabbing pain? Im almost 3 weeks after 2nd surgery is possible i have dura tears?

Now im afraid to lay flat because of stabbing pain.

Thank you for your answer

Donald Corenman, MD, DC
Moderator

September 23, 2020 at 7:45 am

Post count: 8660

#33027

Paresthesias (“pins and needles”) are not uncommon after microdiscectomies. Many individuals have “numbness” and paresthesias that are present but unnoticed prior to surgery due to pain covering up those symptoms. The microdiscectomy relieves the pain, uncovering the previously unnoticed numbness. However, manipulation of the nerve root (required to perform a surgery) can stimulate these symptoms too.

I am a little confused as your surgeon surgically approached the opposite side. “For reherniation, he said, he do manouver and took the disc from left side because its too risky to take the disc from right side because of narrowing spinal canal”. Maybe due to the prior operation on the right, he was afraid of scar tissue and approached from the left side.

If you had a dural tear, you would have a headache when upright that would less with lying down and your incision would be “puffy”.

It takes some time (6 weeks-3 months) for the disc to “settle down” before your back will feel better. Try some physical therapy if see if this improves your discomfort.

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.

Sailormoon
Participant

September 24, 2020 at 12:45 am

Post count: 29

#33033

Hi Dr Corenman,

Thank you for your reply.
It help alot.

I dont have postural headache and my incision site looks good after 1st op and until now. Just corious why there is fluid collection seen on MRI around 3 weeks after 1st surgery?

Thank you.

Donald Corenman, MD, DC
Moderator

September 24, 2020 at 7:18 am

Post count: 8660

#33039

Fluid collection pockets (seromas) are quite common and might take as long as 6 months to absorb over time. Occasionally, there can remain but most cause no problem.

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.

Sailormoon
Participant

September 28, 2020 at 1:53 am

Post count: 29

#33051

Hi Dr Corenman.

Thank you for your explanation.
During surgery, the doctor told me to prevent reherniation again, he took all the disc so probably my back left with an empty disc for L5S1 and in the future i will have fusion.

Lately my back hurt so much when i try to sit and walk. My back feels like broken and unable to hold my leg. I know it needs 3 months for back to settle. But this pain is worst i barely able to walk and sit.
Does it because empty disc?

Donald Corenman, MD, DC
Moderator

September 28, 2020 at 6:37 am

Post count: 8660

#33052

Removing most of the nucleus will probably increase the chance of back pain. I would assume that he or she left the cartilaginous endplate intact which affords some shock absorption. You must give your back some time to accommodate. If no improvement in 3 months, reimaging would be helpful.

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.
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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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