Post Lumbar MicrodiskectomyL3-L4 8 weeks

Tagged: Lumbar Microdiskecomy, Pain 8 Weeks Post Op surgery

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BLA113
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July 17, 2024 at 10:05 am

Post count: 1

#36262

Hello Dr. Corenman,

I am 8 weeks out post op. I am a 51 yo active woman. Prior to surgery, I was experiencing horrible left sided pain; buttock, thigh, knee, numbness in feet/toes/ankle, sciatica pain, down my left leg. Pain was worse while seated, and increasingly got worse, as I have a seated job. I couldn’t sit without my thigh/knee throbbing. As the pain got worse in my knee, I went for an X-ray, and it showed I had water on my knee. I could no longer work, due to the pain.

Prior to this exacerbation, I had been dealing with this issue previously, but wasn’t suggested for surgery yet. I did the cortisone/steroid shots, PT, and Chiropractor. When I went for the latest MRI, it showed I had a pinched nerve (which was just bulging on the prior MRI). When I went for this second MRI (seen below). That is when the doctor suggested the microdiskectomy, and that my back has worsened. I have been dealing with sciatica pain for a few years now.

Had the surgery on 5/28/2024. Unfortunately, I feel I haven’t really seen an improvement yet. I went for my first post op approx 4 weeks after surgery. Told my concerns to the doctor. At that point I was getting a lot of nerve pain down my legs, still very stiff, to bend/twist. Still numbness and tingling down my feet. Though the doctor told me prior to surgery, bc where the pinched nerve was, it might not help the numbness/tingling in the left foot.
As far as the nerve pain, bc of how long I was dealing with the back pain, he felt it was normal, and the nerves are just working itself out. He said on my next visit, which is Aug 5, he will send me for PT at that time. He also told me to walk walk walk. Which I have been doing. I have no problem walking. Other than feeling very stiff, some muscle spasms, but nothing as to where I can’t walk. I try to walk 3 days a week, sometimes 4. Anywhere from 3-4 miles.

He said, don’t sit for more than a half hour. Which is where the problem comes in. I can’t sit for more than 5-10 min without feeling excruciating sharp pain in my left hip area. I constantly have to readjust myself to relieve the hip pain. Put foot up/sit on my right side more, and extend my left leg. Hip pain probably reared its ugly head maybe 2.5 weeks ago. It feels like it’s right in the ball/joint (7-8 on pain scale). I also continue to have horrible left buttocks pain, esp in seated position/it’s a cramping/muscle spasm (6-7 pain scale). I have bilateral lower back pain in standing/seated (3-5). Which is mainly NEW since surgery. That never goes away, makes it worse by any twisting or slight bending. If I sit too long, I still continue to have nerve pain going down through buttocks, thigh, into front of knee, and still numbness in foot. I have to constantly readjust myself for the pain to subside. Though it’s not as bad as before surgery, but I also am not allowing myself to sit as long, for it to act up as much either.

The only relief I really have for the hip, is when I’m standing, and resting with my legs out straight. I still have bilateral back pain, and buttocks pain, but it relieves the hip pain for the most part, unless I’m in a position it doesn’t like, and then it will be hurt again, until I move my position. Or if I’m sitting/laying to long, then the buttocks will start hurting.. Flexing forward irritates the hip. Even resting has its limits, and I have to get up and move eventually, but SITTING is by far the worse for me.

Also, just to note, I have control over my bowels, but I do feel (prior too and after surgery), whenever I have a bowel movement I do feel more pain in my bilateral lower back/hip area.

I do ice my back when I’m resting. I’m just very frustrated, and I was such an active person. I just feel I am not getting closer to where I should be. I hope I am wrong, and maybe I just need more time. Your insight would be most helpful. THANK YOU!

Pre-surgery MRI

Procedure: MRI LUMBAR SPINE WO CONTRAST
Ordering Diagnosis: Spinal stenosis of lumbar region without neurogenic claudication [M48.061 (ICD-10-CM)]
Chronic left-sided low back pain with left-sided sciatica [M54.42, G89.29 (ICD-10-CM)]
Accession #: PRMS240742467

Study Result
Narrative & Impression
EXAM: MRI LUMBAR SPINE WO CONTRAST

HISTORY: Low back and left leg pain.

COMPARISON: There are no studies available for comparison at this time.

TECHNIQUE: MRI of the lumbar spine was performed without intravenous contrast utilizing sagittal inversion recovery, sagittal T1, as well as axial, sagittal, and coronal T2 weighted sequences.

FINDINGS:

5 nonrib-bearing lumbar type vertebral bodies are identified. With the patient laying supine, there is no scoliosis. There is no acute fracture. Vertebral body heights are maintained. The visualized distal segment of the spinal cord demonstrates normal signal and morphology. The conus medullaris terminates at the level of T12-L1.

T12-L1: Normal posterior disc contour. No canal or foraminal stenosis. Facet joints are intact.

L1-L2: Normal posterior disc contour. No canal or foraminal stenosis. Facet joints are intact.

L2-L3: Left subarticular – foraminal disc protrusion results in left subarticular zone stenosis with contact/impingement of the traversing left L3 nerve root between the disc and the left facet joint. Mild canal stenosis. No right foraminal stenosis. Mild left foraminal stenosis. Facet joints are intact.

L3-L4: Small left-sided posterior endplate osteophytes are associated with a left foraminal – extraforaminal disc protrusion. Mild canal stenosis. No right foraminal stenosis. Mild left foraminal stenosis. Mild right facet joint arthrosis. The left facet joint is intact.

L4-L5: Mild disc bulge with mild left foraminal protrusion and associated annular fissure is noted. Mild canal stenosis. No right foraminal stenosis. Mild left foraminal stenosis. Mild bilateral facet joint arthrosis.

L5-S1: Small left foraminal disc protrusion has associated annular fissure, with mild left foraminal stenosis. No canal or right foraminal stenosis. Minimal facet joint arthrosis.

The sacroiliac joints are intact. The lumbar paraspinal musculature is maintained. No suspicious retroperitoneal lymphadenopathy is identified.

IMPRESSION:

MRI of the lumbar spine demonstrates multilevel degenerative disc disease.

L2-L3: Left subarticular – foraminal disc protrusion results in left subarticular zone stenosis with contact/impingement of the traversing left L3 nerve root between the disc and the left facet joint.

L3-L4: Left foraminal – extraforaminal disc protrusion.

L4-L5: Mild disc bulge with mild left foraminal protrusion and associated annular fissure.

L5-S1: Small left foraminal disc protrusion has associated annular fissure.
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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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