1 Month Post-Op Microdiscectomy- Continuing Nerve Pain

Tagged: Microdiscectomy Surgery

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ta1124
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May 1, 2018 at 3:30 am

Post count: 1

#28201

Dr. Corenman-
I am a 35 year old male who suffered a herniated disc at the l5/s1 level approximately 2 years ago. I have had bouts of bad back pain and nerve pain (tingling/burning/occasional numbness) on the bottoms of both feet on and off during those 2 years. I was functional, but uncomfortable, working and living my life but any time I increased my activity level to a certain point the pain would come back, and sometimes come back after not increasing activity level. I had tried all conservative measures (physical therapy, epidural steroid injections, exercise, massage therapy, etc. etc) that were only short term fixes..the pain always came back. So after a few bad months of pain November-January of the past year I started going for surgery consultations. My main complete of my pain is the nerve pain in my feet. I do not feel pain in my butt, legs…just the bottoms of both feet, with low back pain on/off.
My 3 MRI Reports-
3/18/16
At L5-S1 there is a central disc herniation abutting the exiting right S1 nerve root with
mild central stenosis.

11/16/2016-
L5-S1: Disc desiccation with posterior disc herniation impinging on the descending right
S1 nerve roots in the lateral recesses. Mild spinal canal stenosis is present. There is
also a diffuse disc bulge, encroachment inferior aspects of neural foramina bilaterally.
Mild degeneration of the apophyseal joints is present.
IMPRESSION:
Disc desiccation at L5-S1 level with associated posterior disc herniation impinging on the
descending right S1 nerve roots in lateral recess, causing mild spinal canal stenosis.

1/26/18-
L5-S1: There has been mild interval regression of the paracentral disc herniation, now
only abutting the traversing right S1 nerve root.
IMPRESSION:
Mild improvement of the overall size of the central disc herniation at L5-S1, now only
abutting the right S1 nerve root.

I ended up deciding to get a microdiskectomy done by a top neurosurgeon in the NYC area. He made the incision on the left side as my pain in a little worse on my left than my right side. He told me there was a lot of scar tissue that he had to clean out along with the disc fragment and that he basically “roto-rootered” the whole area. From his surgeon’s report: Procedure: Left L5/S1 medial facetectomy and microdiskectomy and foramenotomies of left L5 and S1 using microsurgical dissection techniques.

Its now 2 days short of being 4 weeks post op- and unfortunately, I’m still experiencing a lot of the nerve pain in both feet. Its a tingling burning and I would have to say its more consistent throughout the day/night than it was before the surgery. I do not feel I reherniated, but I guess it is possible. I am doing my walking as told by my doctor. Probably walking close to 2 miles a day at this point. I saw my surgeon 2 weeks post op and told him about my pain and he basically said that its normal what I’m experiencing but soon the pain should start to trend downward not upward. I’ve had good days and bad days since the surgery and at this point I’m not sure it’s trending downward, I would have to say its about the same if not worse. So my questions to you are, this pain I’m experiencing is this normal? Are my symptoms of bilateral nerve pain on the bottoms of my feet from the s1 nerve irritation? (I never had an emg/nerve test as both neurosurgeons I saw dismissed their value in my case) At what point should I push for another MRI to rule out reherniation? I am going back to see him on May 25th- and he is supposed to clear me to start PT at that point..any advice you can offer I would greatly appreciate.
Thank You- Thomas

Donald Corenman, MD, DC
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May 1, 2018 at 1:25 pm

Post count: 8660

#28204

Your first complaint gathers my attention “My main complete of my pain is the nerve pain in my feet. I do not feel pain in my butt, legs…just the bottoms of both feet, with low back pain on/off”.

“Nerve pain” in the bottom of the feet, especially not connected to any radiating leg pains makes me think of peripheral neuropathy (https://neckandback.com/conditions/peripheral-neuropathy/). Rarely, these pains can be related to central spinal stenosis (https://neckandback.com/conditions/lumbar-spinal-stenosis-central-stenosis/). Are the foot pains equal or is one side substantially greater than the other side?

Before you fully assume that these symptoms are from nerve compression, it might behoove you to get a consultation from a neurologist (maybe not associated with your surgeon) with an EMG/NCV test. Generally, if foot symptoms are equal and you have no severe central stenosis, this is not going to be a nerve compression type syndrome.

In addition, you could consider a selective nerve root block at L5-S1, looking for a diagnostic response (see https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections/). If you have a poor or non-diagnostic response to the injection, this is probably not a nerve compression syndrome which would explain why you received no relief from surgery.

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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