1 week post extraforaminal MIS decompression for L3-4 disc herniation

Tagged: MIS post-op pain extraforaminal discectomy lumbar

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jayd10033
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March 26, 2021 at 5:59 am

Post count: 79

#33820

Hello Doctor, one week ago I underwent MIS for a right L3-4 extraforaminal disc herniation. The MRI showed a clear herniation. I had been having sciatica and low back, buttock and searing leg pen on and off for 4 months. Activity modification and a cycle of pain management (3 epidurals, 2 weeks apart) with only moderate relief, I decided to have the aforementioned surgery given the size of the herniation. Prior to the surgery the MOST severe symptoms had subsided, but my experience is they had come and gone over 4 months. At the point of surgery I was having a little weakness in the front thigh hip (no foot drop) and some low back ache that persisted.

I have a 4 month old daughter, and so I thought it best to nip this in the bud.

This question is about post-op pain. I’ve read some of the other threads, but posting for peace of mind since everyone thinks their situation is unique ;)

I’m mobile, I’m walking. I wear a lumbar belt (Aspen Horizon 637) when moving.

Incision soreness minimal, low back discomfort as expected post surgery. I can’t say I’m not doing ANY BLT, given I do care for an infant, but I try move properly, etc.

I’m concerned about a persistent burning feeling, or sometimes bruised feeling localized to my right buttock. It feels bruised to the touch and is sensitive to clothing over it etc. It hurts to lie down on that side. Very slight other nerves sensation on my thigh, but the “painful” feeling is localized to my right buttock. I’m having no shooting pains, no radiating pain that I can perceive. I was put on a Medrol dose-pack, but hasn’t had any effect.

Is this burning/bruised feeling in my buttock “normal” ?

Thank you for this wonderful forum!

Donald Corenman, MD, DC
Moderator

March 27, 2021 at 11:11 am

Post count: 8660

#33824

A far lateral herniation at L3-4 will compress the L3 nerve root which goes to the quadriceps muscle which explains your knee weakness (“was having a little weakness in the front thigh hip (no foot drop”). That, in my opinion would be an indication for surgery at the beginning of symptom presentation. Nonetheless, you chose to try conservative treatment for 4 months before surgery which is acceptable, especially since you were about to deliver your child.

You are only 1-2 weeks out from surgery which requires root retraction for clear the herniation. Give it 6 weeks but if symptoms are really disagreeable, consider some oral steroids to reduce the inflammation.

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.

jayd10033
Participant

March 27, 2021 at 1:41 pm

Post count: 79

#33825

Thank you,Doctor. They did put me
on a dose pak. Today was the last dose – still no change in level of pain in buttock. I guess it’s just too soon after surgery.

jayd10033
Participant

March 28, 2021 at 11:00 am

Post count: 79

#33826

Hi Doctor, I see other people have posted MRI results, which I didn’t do but will put here for posterity. Let me know your thoughts. Again, 1.75 weeks post-op. Pretty persistent right buttock pain standing, sitting or laying down. No shooting pain, no pain in back. Minor tingling that comes and goes on lower back/thigh. Course of oral steroids is over with no change in buttock pain.

PS – I find your site fascinating, I’ve read a ton of posts, which are really helpful, even if from just a therapeutic point of view as I recover (hopefully!)

Below is pre-op findings.

EXAM: MRI LUMBAR SPINE WITHOUT CONTRAST
HISTORY: Lower back pain.
TECHNIQUE: Multiplanar, multi-sequential MRI of the lumbar spine was obtained on a 1.5T scanner using a standard protocol.
COMPARISON: Lumbar spine MRI 11/24/2020.
FINDINGS:
Bones: Five lumbar bodies are assumed. No evidence of acute fracture or pars defect. Vertebral body heights are preserved. No areas of bone destruction or abnormal marrow replacement.
Alignment: Unchanged mild retrolisthesis at L2-L3.
Disc spaces, spinal canal, and neural foramina: Disc desiccation unchanged moderate disc height loss at L2-L3. Partial disc desiccation at L1-L2 and L3-L4 with mild disc height loss at the latter. Evaluation of the individual motion segments demonstrates the following:

— T12-L1 and L1-L2 levels: No disc herniation, canal narrowing, or foraminal narrowing.

— L2-3 level: Mild retrolisthesis. Mild disc bulge with mild compression of the ventral thecal sac. Mild canal narrowing. Mild bilateral foraminal narrowing.

— L3-4 level: Mild disc bulge and worsened superimposed large right foraminal/extra foraminal disc protrusion, with worsened moderate-severe right foraminal stenosis and disc contact on the exiting right L3 nerve root. Mild canal and mild left foraminal narrowing.
Small 3 mm synovial cysts at the posterior margin of the left facet joint and the inferior margin of the right facet joint. Neither cyst indents the thecal sac.

— L4-5 patent L5-S1 levels: No disc herniation, canal narrowing, or foraminal narrowing. Mild right facet arthropathy at L5-S1.

Spinal cord: The spinal cord terminates at the level of T12-L1. The visualized segment of the cord is unremarkable.
Paraspinal musculature: Unremarkable.

Retroperitoneum: Visualized portions of the retroperitoneum are unremarkable.

IMPRESSION: MRI of the lumbar spine demonstrates:
1. At L3-L4: Mild disc bulge and increased large right foraminal/extraforaminal disc protrusion, with worsened moderate-severe right foraminal stenosis and disc contact on the exiting right L3 nerve root. Unchanged mild canal and left foraminal narrowing. Small 3 mm facet cysts bilaterally.

2. At L2-L3: Unchanged mild retrolisthesis and mild disc bulge. Mild canal and bilateral foraminal narrowing.

Donald Corenman, MD, DC
Moderator

March 28, 2021 at 11:19 am

Post count: 8660

#33827

The radiological report notes the large L3-4 right far-lateral herniation causing compression of the L3 nerve root which fits with your preoperative symptoms.

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.

jayd10033
Participant

March 31, 2021 at 5:17 am

Post count: 79

#33869

Thank you. I had my 2 week follow up. Doc said pain in buttock should subside and did not think another MRI was warranted yet. So far is is plateaued at pretty consistent discomfort. I wonder if it is nerve or piriformis- not sure how to tell.

What is your recommendation for lumbar belt wearing duration post far lateral MIS?

Do you suggest any type of easy range of motion I can do now?

Current guidance I have is 4 weeks belt when moving and zero PT or ROM exercises. Just walking, upright bike.

Lower back is getting super tweaked I think from no flexion.

Thank you,
Jay
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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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