13 days post-microdiscectomy

Tagged: microdiscectomy

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ajdoganier
Participant

December 27, 2023 at 12:12 pm

Post count: 3

#35914

Hi Dr. Corenman,

I’m 13 days post-microdiscectomy at my L5-S1 level. Below are the findings from my related MRI. Before the microdiscectomy, I had occasional pain in my left hip, left calf twitches, and tingling/burning sensations at times on my side/back of leg (hamstring) and in my foot (side and bottom). I have next to no symptoms on my right side, although every now and then when I’m lying down, my right toes will twitch (otherwise no real symptoms on this side thankfully). Since I had no symptoms on my right side, my surgeon told me he would not touch the L4-L5 level and we’d only address L5-S1, since my symptoms aligned with foraminal stenosis identified on my MRI. This made sense to me.

When I woke up from surgery, my surgeon told me he removed a ton of bone spurs that we’re pressing on my nerves at the L5-S1 level (he said 2 in particular were compressing the nerve from both sides). He said I had a disc bulge at the L5-S1 level, which is consistent with my MRI, but that it was calcified (he said that means it had been there a long time) and that it wasn’t anywhere close to touching my nerves so he left it alone. He said he also felt around in my L5-S1 disc space and said there isn’t much disc material left and that the disc is really thin (he gave me the impression this might actually be a good thing at this stage – less material to risk herniating).

When I woke up from surgery, I had no glute/leg/calf/foot pain at all. 13 days post surgery, I have transient nerve feelings (mostly tightness and burning) in my left glute, leg (side of thigh), and foot (sometimes outside part of foot, sometimes underneath). The calf twitching stopped for a few days after surgery, but is now back. I still have some tenderness in my back at the incision site, but it’s much less. At times, I have nerve symptoms in my right side (where I had nothing before surgery), but they don’t last long.

Does this sound like a “normal” recovery experience at the 13 day mark? I’m nervous that the surgery didn’t actually fix the issue given similar symptoms have come back. Is it possible that I still have inflammation that is causing these nerves to react the way they are? How long does post-microdiscectomy surgery inflammation typically last? Anything else you’d mention that might help calm my anxiousness?

MRI REPORT BELOW
____________________________
FINDINGS: 5 lumbar vertebra as labeled on series 5 image 8.
Height: Within normal limits.
Alignment: Mild left convex curve and reduced lordosis in the scanned position. Mild approximately 2-3 mm of degenerative retrolisthesis at L4-L5 and LS-Sl.
Marrow: Minimal edematous Modic type I degenerative endplate change posteriorly at L4-L5. Mild fatty Modic type II degenerative endplate changes at LS-Sl. No facet edema.
Conus: The conus medullaris shows normal position, contour, and signal content. The tip ends at L1.
Disc levels: There is congenital canal stenosis below the Ll level. Normal disc signal/height at Tll-Tl2 through L2-L3. Mild L3-L4, diffuse L4-L5 and diffuse LS-S1 disc degeneration. Mild L3-L4, mild L4-L5 and severe LS-Sl disc height loss. Anterior endplate spurring at LS-S1.

LS-S1: Retrolisthesis, disc bulge/osteophyte eccentric to the left, moderate/severe left foraminal stenosis, moderate right foraminal stenosis and posterior displacement of the left S1 nerve root. No significant central canal stenosis.

L4-L5: Retrolisthesis, broad-based disc bulge and right paracentral/subarticular inferior disc extrusion with an associated annular fissure. Mild canal stenosis with right lateral recess narrowing. Mild foraminal stenosis.

L3-L4: Minimal disc bulging toward the foramina. Mild facet degeneration. No degenerative canal/foraminal stenosis

T11-T12 through L2-L3: Minimal disc bulging at L1-L2. Mild facet degeneration at T11-T12 and L2-L3. No canal or foraminal stenosis.

IMPRESSION:
1. Congenital lumbar canal stenosis and multilevel degenerative changes.
2. L4-L5 degenerative changes including a right inferior disc extrusion causing mild canal stenosis with right lateral recess narrowing.
3. L5-Sl degenerative changes resulting in moderate/severe left foraminal stenosis (left L5 nerve root), posterior displacement of the left Sl nerve root and moderate right foraminal stenosis.

Donald Corenman, MD, DC
Moderator

December 27, 2023 at 2:48 pm

Post count: 8660

#35915

Your symptoms “When I woke up from surgery, I had no glute/leg/calf/foot pain at all. 13 days post surgery, I have transient nerve feelings (mostly tightness and burning) in my left glute, leg (side of thigh), and foot (sometimes outside part of foot, sometimes underneath)” are all normal for recovery, When a nerve root is decompressed, it can swell for as much as 6 weeks leading to “echo symptoms”. As long as they are much reduced in intensity from the initial symptoms, be patient. It is possible that you have a seroma (a small collection of fluid) that should resorb. 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.

ajdoganier
Participant

December 27, 2023 at 6:30 pm

Post count: 3

#35917

Thanks for the quick reply, Dr. Corenman. Very helpful to hear that what I’m experiencing is normal. I will definitely keep you in the loop on my progress.

Related, have you ever heard the L5-S1 disc fusing naturally? I can’t help but think about what might be down the road for me at this level in my spine (I know I should be focused on the recovery that’s in front of me). For reasons I can’t quite articulate, the idea of having a spinal fusion at 40 years old (current age) scares me quite a bit. My surgeon thinks that I likely won’t need a fusion in the future given my spine is stable and so much disc has already disappeared. Curious on your thoughts on a vertebrae “naturally” fusing and if that’s something you’ve ever seen or if it’s even likely given my circumstances.

Donald Corenman, MD, DC
Moderator

December 28, 2023 at 2:30 pm

Post count: 8660

#35918

I have seen 2 discs autofuse in my career so it is very rare (other than some rare diseases). Many individuals with severe degenerative discs don’t even know they have that. Live your life and just don’t overload your back.

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.

ajdoganier
Participant

January 23, 2024 at 4:52 pm

Post count: 3

#35955

Hi Dr. Corenman,

I’m almost 6 weeks post-MD (L5-S1 left side) and am having some new sensations that have me worried. My left glute/hip feel extremely tight, my left calf has almost constant fasciculations, and at times the bottom of my left foot is tingly. None of it is pain per se, but there are quite a bit of sensations. Is it common for calf fasciculations after a surgery like this? Will they fade with time?

Also, I had an MRI done on Saturday that appears to be worse than my MRI pre-op. My MD only involved the removal of bone spurs at the L5-S1 level (apparently there were osteophytes pretty entangled with the nerve). That said, the report looks worse than my pre-op MRI (which you can see above). Does anything seem odd to you? I’m nervous the surgery didn’t work.

_____

TECHNIQUE: Multiplanar and multisequence imaging of the lumbar spine was performed.
COMPARISON: None
FINDINGS:
CONUS: Terminates in normal position and demonstrates normal signal characteristics.
CAUDA EQUINA: Unremarkable.
OSSEOUS STRUCTURES: Vertebral bodies are normal height without fractures.
ALIGNMENT: No vertebral body listhesis is present.
BONE MARROW: Normal bone marrow signal. No focal osseous lesion is seen.
PARASPINAL SOFT TISSUES: Paraspinal soft tissues are unremarkable.
L1-L2: There is no disc bulge. There is no neural foraminal narrowing. There is no spinal canal stenosis.
L2-L3: There is no disc bulge. There is no neural foraminal narrowing. There is no spinal canal stenosis.
L3-L4: There is no disc bulge. There is no neural foraminal narrowing. There is spinal canal stenosis
measuring 9 mm in AP dimension. There is bilateral facet joint arthrosis.
L4-L5: There is a 4 mm posterior disc protrusion with a central annular fissure. There is bilateral neural
foraminal narrowing. There is spinal canal stenosis measuring 6 mm in AP dimension. There is impingement
on bilateral transiting nerve roots. There is bilateral facet joint arthrosis.
L5-S1: There is a 4 mm posterior disc protrusion. There is bilateral neural foraminal narrowing. There is
impingement on bilateral exiting nerve roots. There is no spinal canal stenosis. There is bilateral facet joint arthrosis. There is a left hemilaminectomy at L5.
The paraspinal soft tissues are unremarkable.
IMPRESSION:
Multilevel disc pathology with neural foraminal narrowing and spinal canal stenosis as detailed above.
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Donald Corenman, MD, DC

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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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