Reherniation after L5-S1 microdiscectomy after falling

Tagged: facet joint, Symptoms after a microdiscectomy

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seb_nied
Participant

January 25, 2021 at 2:17 am

Post count: 24

#33567

Hello Dr. Corenman,

many thanks for providing your feedback and for this great service you are doing for the community.

I had a microdiscectomy exactly 26 days ago and had an unfortunate accident yesterday during one of my walks. I did not notice an icy patch on the sidewalk and slipped on it. My feet slipped forward and I found myself on a horizontal position with my hands on the ground and my back facing downwards. The fall was very controlled, I managed to land on my hands and did not hit any part of my back on the ground.

I did not feel any aggravated pain in my back or leg right after the fall and managed to normally walk without issues.

My situation after the operation was that I still had some light nerve pain coming and going, mostly translating in a tightness feeling on the back of my leg from the tight going down to my calf. Before the fall it was getting better but yesterday during the evening the pain went back to what it was 2 weeks after the surgery. It is not a strong pain (maybe 3 or 4 out of 10), it doesn’t prevent me from walking, sitting or laying and I do not think it is worse than it was pre or after the operation. But i have to admit it increased since the day before the fall even though not very much.

Of course I’m worried that the fall caused a reherniation, however reading around the net I discovered that reherniation usually happens independendtly from how fast we go back to normal activities and usually ‘just happens’ due to factors are not within our control. I didn’t find any information about an unforseen event like a fall. I’m planning to have an MRI soon but I’m going crazy about this and was looking to have an feeback in the meantime.
I’d immensely aprreciate having an opinion from you.

Sincererly,
Sebastian

Donald Corenman, MD, DC
Moderator

January 26, 2021 at 1:03 pm

Post count: 8660

#33572

This sounds like a slight aggravation of symptoms but not to the intensity or longevity you had prior to the fall; “I still had some light nerve pain coming and going, mostly translating in a tightness feeling on the back of my leg from the tight going down to my calf. Before the fall it was getting better but yesterday during the evening the pain went back to what it was 2 weeks after the surgery. It is not a strong pain (maybe 3 or 4 out of 10), it doesn’t prevent me from walking, sitting or laying and I do not think it is worse than it was pre or after the operation”.

There is no doubt that a fall in the early postoperative period can induce a recurrent disc herniation but symptoms can vary from nothing (the herniation is in a location that does not compress the root) to severe preoperative pain return. Slight increase in symptoms can still be treated by the same postoperative course you are on.

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.

seb_nied
Participant

January 27, 2021 at 9:07 am

Post count: 24

#33576

Thank you very much Doctor for your answer.
A quick update on the development of my symptoms. After 48 hours from the accident my back muscles located in the lumbar zone started to feel soar, mostly when standing and sitting, a similar feeling of tiredness as I’ve been standing or bending for several hours. Usually this feeling is less severe when walking or laying.
The front thigh muscles of my original herniated side started to heat up and feel tired and muscles in my calf became stiff, similar to a feeling of a cramp. The power in my calf and leg is comparable to how it was before, it is reduced comparing to the good leg (I can do several repetitions pushing up on my toes but I feel less strength than on the other leg).
I have an MRI tomorrow to check what happened even though my symptoms suggest that something happened in my back.
I will report the results tomorrow.
Regards,
Sebastian

Donald Corenman, MD, DC
Moderator

January 27, 2021 at 11:45 am

Post count: 8660

#33577

You note:”48 hours from the accident my back muscles located in the lumbar zone started to feel” sore. This is normal for a fall post surgery even without a recurrent herniation. The new MRI will define your current situation. Paste the results here.

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.

seb_nied
Participant

January 28, 2021 at 7:18 am

Post count: 24

#33587

Hello Dr. Coleman,

the MRI showed indeed that there is a disc herniation, but much smaller than the previous one and more centrally localized. It was unclear for the doctor who examined the MRI whether the herniation might have been a residual from the surgery or perhaps a re-herniation after the accident, as it is central and in general hard to remove with a discectomy.
Additionally to the herniation, there is a sign of facet joint effusion at the same level (L5/S1) visible on the MRI as white substance filling the facet joint. The doctor said that this is creating a swelling of the joint and the pressure applied from both sides (one side from the joint and the other side from the centrally herniating disc) is causing the sciatic pain.
I was advised to treat this in a conservative way with cortisone injections in the facet joint. If this does not help, discuss about a revision surgery.
About my current symptoms, in addition to the lumbar back pain I was experiencing there is still a feeling of discomfort in my posterior and anterior thigh area and a warmth feeling in my anterior thigh very close to the knee. Calf and foot/toes feel relatively the same as after the surgery.
Do you see a greater risk coming from the inflammation of the facet joint and a high chance that a discectomy/laminectomy will need to be performed?

Best regards,
Sebastian
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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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