[mikeosia]

#28825

Firstly, I have been constantly browsing these forums since my surgery. I can’t express the amount of admiration and respect I have for you. All the valuable information and support you have given me and so many other people both directly and indirectly, all selflessly. It’s truly exemplary. I truly wish you were my doctor. My insurance doesn’t cover anything outside of NY state. Thank you so very much for what you do!

My story,
I sprained my back late Nov 2017 and a few days later halfway in recovery, I stupidly lifted some heavy furniture with my legs bent but head down and felt a pop in my back. I forgot how long after that I had pain, but it wasn’t right away.

I had extreme pain mostly in buttock area radiating down my right leg. Pain from my right calf and to the toes started around a month or so after initial pain symptoms in my buttock and thigh. No numbness or tingling , I had perceived weakness because of pain but I don’t think it really was weakness, mild bowel problems I think also due to pain. Mostly extreme debilitating pain. In the beginning laying down helped, later on I couldn’t stand sit or move in any position without pain. Woke up frequently middle of night as well. I was on Aleve and ibuprofen basically every day/ every other day since it started.

3 epidural shots, two of the same and one different one, none worked. I tried PT and chiropractic care for weeks mild relief for a day or two after each session and it all came back the same, didn’t get progressively better. One visit to the chiro made me almost pain free for an hour or two felt like a miracle. Then it all came back again. Next visit to the chiro made everything even worse for a few days.

I got an MRI L spine sent by my primary care doctor on Jan 9th 2018 that showed a large herniation at L4-L5 and facet hypotrophy at the same level, Hypotrophy was definitely asymptomatic. Ive never had back pain or sciatica prior to this injury.

I went to a surgeon in February, he told me to wait 3 more months. My surgeon was very conservative and told me to wait it out. He didn’t seem to take my concerns or pain seriously… I just assumed because I had bad insurance?.. I am in NYC.. more profit driven than most places.

I went back and the surgeon scheduled surgery 4/20/18. I could barely walk after surgery but after a day or two(anesthesia wore off) my pain was 10 times worse than before surgery. I couldn’t stand. Unbearable, I was losing my mind.
Oxycontin didn’t even help me very much. I called the surgeon and he told me to take 800mg of Asprin and that worked to reduce my pain in half. I called again the next day and they gave me a steroid dose pack. That steroid pack changed everything for me. I was able to walk half steps a day after the first dose.

I didn’t have buttock pain or sciatica since the steroid pack just severe pain in the back and I couldn’t make full steps without severe pain, still cant. I can make full steps now but I limp and lean forward every step to avoid pain. I have mild/mod pain with every step. Stabbing feeling if I do anything too suddenly while standing.

6 days after surgery I thought I reherniated. I sneezed and felt a pop or crack. I asked my primary doctor for a contrast MRI 4/26/2018 and the results said this :
Impression:
Postsurgical changes at L4-L5 right laminotomy. Residual disc protrusion abuts the thecal sac.
Enhancement right lateral recess and right-sided neural canal concordant with granulation reaction.
Enhancement also seen surrounding the right and left L4 exiting nerve roots.

My surgeon said the results are incorrect since it was so close to surgery but… I am guessing he didnt want to acknowledge the residual herniation.

I got another post surgical MRI on June 9th 2018 and results say this:
COMPARISON: No prior MRI study is available for comparison.
FINDINGS:
The alignment of the lumbar veebral
bodies is normal in the sagial
plane. There is no pathologic bone marrow
replacement. No acute compression fracture is observed. There is slight disc space narrowing noted at L4-5.
L4 – L5: There is demonstration of a right hemilaminectomy defect. Small volume of enhancing epidural soft
tissue representing postoperative fibrosis is noted along the right lateral aspect of the spinal canal and the ventral epidural space. Enhancement along the posterior annular margin is presumably post surgical. No disc herniation is observed. Minimal annular bulge is identied.
Neural foramina are patent.
There is no disc herniation, foraminal stenosis, nor signicant
central canal stenosis at the other lumbar disc space
levels.
The conus medullaris is normal in position and signal characteristics. No pathologic intradural enhancement is
observed. There is no central clumping nor peripheral adherence of nerve roots to suggest adhesive arachnoiditis.
IMPRESSION:
Postoperative changes at L4-5 without disc herniation.

My current symptoms: When I sit I am mostly pain free. Sitting, I always feel something in my butt area and very mild radiating. very tolerable when sitting.

Sometimes not very often, I get up and there is zero pain in my back, Other times its 4/10. But all times if I stand for longer than 30 seconds is starts to hurt mild then it gets worse and worse until the one min mark and then I need to sit down for the pain to die down again. If i push through it the longer, the longer I hold the pain the longer it takes to recover when finally sit down.(10-15 min usually). I can sleep with no pain. I wake up pain free 85 percent of the time. But once I get up it starts again. If I put all my weight on my left side I can last a bit longer. Also if I alternate between each leg..

The surgery made this far more livable but I am still very limited in mobility and its extremely depressing. I am only 27.

My surgeon told me no pt or chiro for the first 3 months.. so I haven’t done anything since. I will be starting that soon.

I can lay down flat on my back and lift my right leg only half way up before severe pain.

Back pain is far less than before but still very much there, buttock pain is what really debilitates me.

My main concern was epidural fibrosis and scar tissue. I’m also worried about spinal instability. I still cant get a definitive answer from my surgeon as to whether or not my narrowing of l4-l5 and my pain is due to the protrusion. He is very vague. He said I might need a fusion down the line as well. that scares me.

My surgeon also did not bath my nerve in a steroid before he ended the surgery, I assume thats why I had so much pain after the anesthesia? Possibly developed even more scar tissue due to the extra inflammation?

Last note, I asked him if he thought it was wise, in order to avoid future problems and since its the same level, if he could shave down the arthritis on my facet joint. He said he would see when he opens me up… he did perform a facetectomy. here are the operative notes
“A high-speed
drill was used to perform a hemilaminotomy at the L4-5 level on
the right, partial medial facetectomy, ensuring not to
destabilize the joint. Ligamentum flavum was carefully resected.
The traversing root of L5 was under pressure. We gently
medialized it and found a sizable disk herniation. We opened the
annulus and removed the disk herniation in 1 piece.”

What do you think? If I was your patient, would you do a redo procedure or would you have me do pain management like my surgeon recommended last visit? Considering images if you do have the time to look, Should I be concerned about scar tissue?
whats causing all my pain?

missed fragment? reherniation? nerve damage not healed yet? My guess is that its structural since im relatively pain free when sitting and sleeping…

I can lift my son without struggle or pain if its within that minute, its just the prolonged standing, weight does not make it worse, which is weird. Also, if I lean forward with legs close together while sitting I recover from the pain faster. Majority of my pain 70 percent of it is in my buttock area. 20 percent very low back only the right side and 10 percent radiating to my thigh/calf and my ankle, It doesn’t get to the toes.

All of my MRI images and reports are viewable easily through a professional online viewer at

Dr. Corenman, I’m sorry this is such a long post. I tried to include as much detail as I could so you can accurately assess my case.

If this is too much, please let me know how much you’d like me pay you for your medical advice.

Thank you so very much,
Mike

[Donald Corenman, MD, DC]

#28833

“I had extreme pain mostly in buttock area radiating down my right leg…Mostly extreme debilitating pain…3 epidural shots, two of the same and one different one, none worked. I tried PT and chiropractic care for weeks mild relief for a day or two after each session and it all came back the same, didn’t get progressively better…I went to a surgeon in February, he told me to wait 3 more months”.

Huh? Why make you suffer? You had every indication for surgery, failed all appropriate non-surgical treatment and were miserable. Why you needed to wait 3 more months seems to be somewhat cruel to me.

“I could barely walk after surgery but after a day or two(anesthesia wore off) my pain was 10 times worse than before surgery”. This also makes no sense as you should have been singing his praises after surgery to have your pain relieved. It is possible that the nerve became extremely inflamed after surgery but that is 1 in 200 cases so highly unusual. The post-operative MRI notes he did remove the herniation.

“My surgeon told me no pt or chiro for the first 3 months.. so I haven’t done anything since”. Every surgeon has a different protocol so I cannot comment on his rehabilitation but I send my patients to PT after 7-10 days to gently stretch the root and start core strengthening exercises.

“Sometimes not very often, I get up and there is zero pain in my back, Other times its 4/10. But all times if I stand for longer than 30 seconds is starts to hurt mild then it gets worse and worse until the one min mark and then I need to sit down for the pain to die down again. If i push through it the longer, the longer I hold the pain the longer it takes to recover when finally sit down”. This sounds like either degenerative disc disease or lateral recess/foraminal stenosis. See https://neckandback.com/conditions/isolated-disc-resorption-lumbar-spine-idr/, https://neckandback.com/conditions/lumbar-foraminal-stenosis-collapse/ and https://neckandback.com/conditions/lateral-recess-stenosis/.

“My surgeon also did not bath my nerve in a steroid before he ended the surgery, I assume thats why I had so much pain after the anesthesia”? Possibly but placing steroid on the root after surgery is not universal and has some risks in itself so you cant throw stones for not doing that.

I think X-rays with flexion-extension, a new physical examination, possible CT scan of the area to look for a facet fracture (unusual but can happen) and a new careful assessment are in order.

Sorry but cant leave your email or hyperlinks on this site to keep it sterile.

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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