Significant leg/calf pain post-discectomy L4/5

Tagged: Leg Pain

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Michelle j
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December 9, 2023 at 5:59 am

Post count: 5

#35894

Dear Dr Corenman, I want to first of all say thank you for providing this service, I am really down and quite scared right now but reading some of the answers you’ve given people has given me some hope. Apologies if this has posted twice, I tried to edit due to an incorrect autocorrect but then the post seemed to disappear.

I am currently 2.5 weeks out from having a discectomy or microdiscectomy (I’m not sure which it was). I ended up in hospital for about six nights instead of 1 to 2, which was caused a combination of nausea and liggtheadedness that impacted on my ability to get up and around post-surgery.

Prior to surgery I had really severe sciatic pain (at times 10/10 pain) due to a significant disc rupture L4/5 right side – the pain was both shooting and deep within the calf and side of calf in particular. It began about 8 weeks ago but was preceded by several months of terrible back pain that preceded the rupture.

I chose surgery as I’m a mum with a young toddler and haven’t been able to pick him up for almost six months and the pain was just getting worse and worse.

I had some nerve pain post surgery still but my doctor wasn’t tooo worried. It was starting to improve but then last week my toddler leant on my stomach and I felt a sense of my spine bulging. I had a lot of shooting pain for a day or two later and spoke to my doctor who wasn’t too worried. The shooting pain is gone now but I am having terrible aching in my sciatic nerve mostly in the side of my calf but also sometimes in my buttocks. This pain is very bad when I am laying down/at rest, is there sometimes when I’m sitting but not as much, and is often non-existent when I’m walking (until I tire and then I think it’s there a bit – but not sure on this)

I am hoping you might be able to let me know whether this kind of nerve pain would usually be due to a reherniation (potentially when my Bub pressed on me) or if it could be a sign of my nerve healing/still being sore/inflamed because it was compressed badly prior to surgery.

The leg pain is sometimes not too bad when laying but is particularly bad tonight (a deep ache thats difficult to shift). I was up and about quite a bit more today than I have been since the surgery because I had noticed moving generally meant no pain, but I may have been on my feet a little too long this afternoon at the shops.

Thanks so much for your time.

Take care
Michelle

Michelle j
Participant

December 9, 2023 at 6:07 am

Post count: 5

#35895

Just a bit of extra info Dr Corenman that might help. With my rupture that led to surgery, I had foot drop fairly quickly which then became partial foot drop. This issue has been completely resolved and while I sometimes have a little numbness and tingling, my muscles seem to be working properly again.

Donald Corenman, MD, DC
Moderator

December 9, 2023 at 12:41 pm

Post count: 8660

#35896

The possible causes of increased leg pain after a period of relief post-microdiscectomy surgery are inflammation of the nerve, seroma, recurrent herniation and infection with much more rare conditions like facet fracture.

Inflammation is common after decompression of the root. A compressed structure that was injured will “swell” and become congested. Oral steroids and time are the best treatment.

Seroma is a common condition. Fluid exudes from surgical sites and can build up and congest and compresses the nerve root. Seromas typically resorb after some time but occasionally need to be aspirated by needle. This is diagnosed by MRI and treated by needle aspiration.

Recurrent herniation occurs in 15% of patients and normally increase pain significantly. Recurrent weakness and a “tighter” leg (SLR) are common. If the recurrence is not too large, sometimes an epidural injection can be helpful. A redo microdiscectomy is not uncommon in the face of a recurrent herniation.

Infection should be rare at less than 1% of all surgeries. Interestingly, many patients do not have fevers or chills but have increased back pain that translates to leg pain eventually. Lab tests are the beginning for diagnosis. Diagnosis is by lab tests and patient symptoms.

The fact that your muscle strength returned quickly is a good sign. Maybe an oral steroid might 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.

Michelle j
Participant

December 9, 2023 at 4:25 pm

Post count: 5

#35897

Thank you so much Dr Corenman, I really appreciate your help!

Michelle j
Participant

December 9, 2023 at 4:27 pm

Post count: 5

#35898

Thank you so much Dr Corenman, I really appreciate your help! Michelle

Donald Corenman, MD, DC
Moderator

December 9, 2023 at 5:26 pm

Post count: 8660

#35899

Please keep in touch with your progress.

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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