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Dr. Corenman, thank you for providing this open online spine information resource. Your website has been very instructional. It has helped me during my self education and decision making process to proceed with an microdiskectomy on a very herniated rupture L5-S1 disc.
I am 16 days post surgery with really good post surgery results. The later I have measured by my lack of pain.
I have started PT and am very positive for the immediate future. However, I still have questions regarding long term implications, ei life post surgery.
The post surgery follow up with surgeon and surgeon assistant revealed that a very large amount of the nucleus was degenerative and thus removed. This was not reflected in the MRI. Like an iceberg, the MRI showed the extend damage outside of the disc which was pretty large. However, there was more damaged nucleus inside and it had to be removed.
As I understand it I probably have no nucleus left inside the disc. It was explicitly explained to me that I need to focus on trunk/core strengthening, stretching etc. to help minimize future pain. Regardless I have been given a window of maybe 2-5 years before an eventual fusion due to pain as the vertebra space collapses.
I have researched the topic and understand the mechanical implications of the “fluid” nucleus removal. In my simple engineering mind I modeled the disc as a complex loaded pressure vessel were the nucleus is the incompressible fluid and the annulus the vessel walls not only loaded via hoop tensile stress but Also torsionally.
In your experience how long does the annulus last under the “non design” load condition were the annulus fibers are now experiencing compression vs the “hoop” tension generated by the reaction to the nucleus pressure on the annulus walls. It is almost as if the annulus would delaminate analogous to a composite structural panel with the exterior lamina being pushed radially out and the interior lamina being forced inward into what’s left of the nucleus cavity.
Is it possible to strengthen the core enough to supplement the now compromised local load bearing ability and prevent the vertebra spacing collapse? Is life without a fusion possible after vertebra spacing narrowing due to annulus degeneration?
I understand every patient is different and am just looking for additional data / sampling to help myself prepare mentally and physycally for the coming futures.
My biggest regret, if I can call it that, is a future without cycling… I am an avid cyclist both road and mountain and am having a hard time trying to wrap my head around not being able to ride in order to preserve what “shelf life” I have left on that disc.
Thank you for making this website available. It has truly been a resource for me in helping understand what has occurred to my spine.
You have developed a very good understanding of the mechanics of the disc. Your explanation of the disc is well thought out. There is a caveat however.
In my experience, patients are “wired” to have or not have lower back pain. This means I can place two identical MRIs side by side with the same findings of IDR (isolated disc resorption-the disc literally disappears and the patient has bone-on-bone findings). There is no one individual who can predict which patient is asymptomatic and which has incapacitating lower back pain.
The difference is the neurological “wiring” that connects the disc with the brain (thalamus). Some patients have a PhD in “back pain” and some patients have not finished grade school with their neurological connections to the brain. I hope you have an uneducated spine and never develop significant lower back pain.
The prediction that you will need fusion for your lower back is not accurate in my opinion. You certainly might need surgery but the chances are probably less than 50%.
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.Thank you for the prompt reply Dr. Corenman. Time will tell the level of education achieved by my spine.
Hello Dr. I am at 5 months post surgery and feeling pretty decent except for nagging low intensity left side lower back discomfort and a very tender sacrum area. The later specially after sitting down for 1hr to 1:30 which is the most I have brave to do at work. I been lucky enough to obtain a sit stand desk and actually have been standing more than sitting.
My question regards activities post subtotal discectomy given the fact there is little or no nucleus. I have waited on starting any heavy aerobic based excercises but truthfully I am craving for those types of workouts.
In your opinion is swimming a safe excercises given the surgery? How about biking? I was an avid and aggressive freeride mnt biker as well as road cyclists. I really miss these activities. Is mnt biking not recommended due to the vibration / shock nature? How about road cycling or maybe even a 700c highly recline recumbent for road cycling. The later are odd machines but maybe ok for my back?
Just seeking opinions… I am feeling better and stronger every month. I continue my core work and stretches as prepared by my PT. on that note… Is yoga or Pilates an ok activity given my spine surgery?
I really appreciate ur feedback. In the end I can accept no riding if it means preserving the disc I have left.
It is my practice to slowly increased the stress on the operated level to allow the body to accommodate the change in biomechanics. I like to use the 20% per week rule for recovery.
Think of a shot-putter who throws a 16 lb ball 75 feet and does it 100 times a day. After recovery from spine surgery, I would have him start throwing an 8 lb ball 40 feet and do this about 40 times a day (about 1/2 of his previous peak). He could increase any one parameter by 20% each week.
For example, he could throw a 10 pound ball 40 feet, 40 times a day. The next week, he could choose to increase the throw to 48 feet keeping a 10 pound ball at 40 attempts. Every week he can choose to increase one parameter by 20%.
This protocol tends to allow the body to adapt without injury. You can speed up the protocol but that tends to create more risk. This 20% rule can be adapted to skiing, mtn biking, tennis, baseball, basketball, football and many other sports.
Swimming is a very safe sport (other than the flip turns). Biking is relatively safe with road biking safer than mountain biking. You would have to put on a shorter, higher stem to reduce the flexion required in the drops.
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.Thank you doctor. I have started low intensity road rides on a 25deg laid back recumbent. 10miles easy gears. Felt good and really could off gone further but figure 10 miles is a good starting distance. Kept heart rate in the low 130s. Will follow your incremental recommendations and build base miles first then increment intensity.
Will pick up swimming once our aquatic center opens in May. Figure this will be good for the core as well.
Do you have recommendations for lumbar support cushions or chairs?
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