Leg weakness and late onset pain post revision decompression

Tagged: Delayed onset pain and weakness, hypermobility

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LizzieJo
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December 22, 2020 at 2:12 pm

Post count: 5

#33491

I had a revision left l4/l5 decompression/discectomy (due to severe radiculopathy confirmed by MRI showing disc protrusion) 4 weeks ago. The previous revision was three years previously.
The nerve was stuck to the disc and bone etc with more scar tissue than the surgeon had ever seen and so the operation took a long time and the nerve was stretched quite a lot. Post op I had some weakness in left leg but that was improving over the first week. Pain was significantly reduced.
However, one week post op the leg weakness deteriorated significantly and I developed a Trendelenberg gait and needed to use crutches. A MRI at this point showed no issues that would explain this.
Two weeks post surgery I then developed increasing pain in virtually the same pattern as the previous L5 radiculopathy. The pain is now very severe. The surgeon think it is still post op nerve irritation causing the pain and neurapraxia causing the leg weakness. With both hopefully improving over time. It is possible that a previous left hip replacement, plus hypermobility EDS plus the neurological issues of pernicious anaemia may be contributing to this situation.
I am currently on gabapentin, cocodamol, naproxen, amitryptLine and diazepam for pain relief.
I wondered if you had any thoughts about the delayed onset weakness and pain, and also the contributions of the hypermobility and pernicious anaemia to the situation.
Many thanks

Donald Corenman, MD, DC
Moderator

December 24, 2020 at 7:47 am

Post count: 8660

#33496

I am a little worried about your statement “the nerve was stretched quite a lot” during surgery as nerves don’t tolerate significant retraction very well. The next statement “Post op I had some weakness in left leg but that was improving over the first week. Pain was significantly reduced” is also concerning if you did not have weakness in that leg prior to surgery. However, pain reduction is encouraging at least in the first week.

Your next statement is more discouraging “However, one week post op the leg weakness deteriorated significantly and I developed a Trendelenberg gait and needed to use crutches. A MRI at this point showed no issues that would explain this”. It would be helpful to have the MRI report copied here. Weakness which causes a Trendelenberg gait is loss of the L5 nerve supply to the gluteus medius muscle which is the nerve you had operated on.

I’m not sure what pernicious anemia has on the injured nerve root and I don’t notice anywhere in your report of hypermobility. Why did you bring up that term?

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.

LizzieJo
Participant

December 28, 2020 at 4:33 am

Post count: 5

#33506

I can’t copy the radiology report sadly. But it did say there was some soft tissue odema and scarring as expected and a mid line Sedona but no cause identified to explain new onset of weakness one week post op.
Pernicious anaemia causes damage to the myself not sheath of the nerve so I was wondering if this made the nerve damage more serious/healing slower?
Also I have Ehlers Danlos hypermobility so I was wondering if this makes the healing slower. I know it also makes pain experienced differently.
I know the left hip replacement would have cut through the gluteus medius so this muscle is already weak.
As you say it is concerning that both the pain and the weakness deteriorated some time post surgery.
I am now Four weeks post op and the weakness seems to be improving. The pain does too in that I don’t have the horrible leg pain. However I do have quite significant lower back pain and definite painful stiffness particularly on waking.

Do you think this is the nerve damage? Or muscle weakness in the area?
Your insight is much appreciated.

LizzieJo
Participant

December 28, 2020 at 11:26 am

Post count: 5

#33507

I should probably explain that the nerve was stretched more than normal and more than the surgeon would have liked as as he had to remove a considerable amount of scar and other tissue from the area to separate the nerve from the disc and the bone it was stuck to. There was so much scar tissue he said he had never seen so much and sent it to pathology, still waiting for results. Again I have been told that this amount of tissue around the nerve could be due to my EDS as it is a connective tissue disorder.

Sorry typo in MRI report…serona not Sedona..over the scar area.

LizzieJo
Participant

January 11, 2021 at 4:32 pm

Post count: 5

#33522

Week 7 I am still finding it difficult to walk and the pain is awful.
I would appreciate your thoughts to the extra information provided.
Many thanks

Donald Corenman, MD, DC
Moderator

January 13, 2021 at 8:41 am

Post count: 8660

#33529

With revision surgery with epidural scar revision, it is matter of time to determine how the root recovers. Even though seven weeks feels like a lifetime, in “nerve years” that is a very short period of time.

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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