3 Weeks Post Microdiscectomy Pain

Tagged: Back pain symptoms after a microdiscectomy

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zzab
Participant

October 1, 2020 at 6:03 am

Post count: 23

#33077

Hi Doctor. I had a followup MRI and am still awaiting the radiologist report but wanted to reach out to you asap as I had a very scary day yesterday. I am 12 days from my fall and a little over 4 months post op from on my L4/L5 (left side). Again prior to the fall I felt 100%. I took a medrol pack about 8 days ago and I’d say by day 3 or 4 I felt 80% better but as soon as I finished the back a scary onset of symptoms occurred. Both legs went numb yesterday and I am now having muscle atrophy in my right glute. I never had any atrophy issues during my first 4 months of healing or during the period of my injury. My back surprisingly feels somewhat okay but I do still have that “sick in the back” feeling a bit and overall my body just feels bad. I am not eating much either. No nerve pain thankfully.

Why am I now having muscle atrophy on my non surgical side? The numbness in my legs comes and goes as well. I have posted a few images of pre and post surgery. The side view looks to be better post surgery but the ariel view looks like the protrusion is the same? What are your thoughts on all this? Do you think this is a reherniation or something else?

zzab
Participant

October 1, 2020 at 7:06 am

Post count: 23

#33079

Hi Doctor. I wanted to clarify the “atrophy” I mentioned above. Not sure if I am correctly using the term. Part of my gluteus minimus is being “sucked” into my body. Maybe this is something else? This started about 3 days ago. Sometimes it gets noticeably sucked in other times its only a little bit.

Donald Corenman, MD, DC
Moderator

October 1, 2020 at 7:42 am

Post count: 8660

#33080

Atrophy of the gluteus muscles takes some time (months) so it would be unlikely that this “just occurred”. I had to delete your images (after viewing them) due to site anonymity. Limited and “hand picked” views of images makes understanding the images more difficult and incomplete. You images you choose make the herniation appear less compressive. All-in-all considering limitations, you don’t appear to have a recurrent herniation.

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.

zzab
Participant

October 1, 2020 at 8:15 am

Post count: 23

#33082

Hi doctor sorry for the upload I wasn’t aware of the rules. Do you have any insight on why my non surgical side glute is being sucked in? Is it possible it is atrophy and I just didn’t notice before or something else?

Donald Corenman, MD, DC
Moderator

October 1, 2020 at 8:56 am

Post count: 8660

#33084

Why you might have atrophy of your non-involved (non-compressed) side does not fit with your compression injured nerve root as there is no cross-over in the lumbar level of these motor tracts.

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.

zzab
Participant

October 2, 2020 at 8:18 am

Post count: 23

#33090

Hi Doctor. I have received my pre surgery and post surgery MRI reports. Can you please assist with interpreting these for me? The good news is my back is starting to settle back down. I’m not feeling 100% as I did before my fall 2 weeks ago but things are starting to normalize.

1. What is your overall takeaway from the pre and post surgery findings?

2. Does it appear I have reherniated?

3. I see that I still have a protrusion at L4/L5 post surgery. Is this normal? If so and if I practice proper spinal movements going forward, is it likely for the protrusion to shrink in size over the next few years?

4. The fall I had off the tree 2 weeks ago made me feel “sick in the back” along with over symptoms like numbness in the legs. You noted this might be due to annular torque that I caused when landing. Is this possibly the “annular fissure” noted on the post surgery report? If so will the annular fissure repair itself over time assuming I practice proper spine hygiene?

5. Should I be concerned regarding the thoracolumbar levoscoliosis?

PRE SURGERY

FINDINGS:

Mild partial disc desiccation from T10-T11 through L3-L4 and to a greater degree at L4-L5.

At the L4-L5 Leve mild posterior bulging and 4mm broad posterior left paracentral protrusion is seen. Moderate ligamentum flavum hypertrophy noted. Mild to moderate compression of the thecal sac to a more marked degree in the subarticular lateral recess on the left at the origin of the left L5 nerve root sleeve.

Slight annular bulging at L2-L3 and L3-L4

2mm left posterior protrusion mildly indents the anterior margin of the thecal sac at L1-L2

IMPRESSION:

At L4-5 minimal bulging and moderate broad left posterior protrusion as well as some ligamentum flavum hypertrophy bilaterally. Mild to moderate compression of the thecal sac to a more marked degree in the subarticular lateral recess on the left at the origin of the left L5 nerve root sleeve.

POST SURGERY

FINDINGS:

Mild long segment thoracolumbar levoscoliosis is seen with a Cobb angle at 10 degrees and leftward apex about L3-L4.
Straightening of the normal lumbar lordosis without significant listhesis.
No acute fracture, compression deformity, or frank aggressive osseous lesion.

The conus medullaris terminates normally at T12-L1.
A 5mm T2 hyperintensity in the right kidney is too small to characterize but generally lacks enhancement favors a small renal cyst.

Disc desiccation L4-L5 with mild disc height loss. Small Schmorl’s nodes are present centrally in the endplates throughout the lumbar region.
Evaluation of the individual lumbar demonstrates:
L1-L2 Left paracentral annular fissue up to 9mm with a left paracentral disc protrusion to 3.5mm. This encroaches on the left lateral recess without nerve root contact. No overall thecal sac stenosis. No neural foraminal stenosis.

L2-L3: Unremarkable

L3-L4: Unremarkable

L4-L5: Prior L4 hemilanminectomy since 4/3/2020 for disc resection L4-L5. Disc encroachment on the central zone and lateral recesses has significantly improved since the prior exam. There is a posterior central/left paracentral annular fissure identified up to 12mm in with associated with a 4.5mm posterior central/left paracentral disc protrusion. Disc material encroaches on the left greater than right subarticular zones near the descending L5 nerve roots but without clear contract or mass effect. The thecal sac is narrowed to 9mm at the AP midline with prior caliber 6mm. Mild bilateral foraminal stenosis without exiting nerve root contact.

L5-S1: Unremarkable.

IMPRESSION:

1. L4-L5: Interval L4 hemilaminectomy since 4/3/2020 for disc resection L4-L5. Disc encroachment on the central zone and lateral recesses has significantly improved since the prior exam.
There is a posterior central/left paracentral annular fissure identified up to 12mm in with associated with a 4.5mm posterior central/left paracentral disc protrusion. Disc material encroaches on the left greater than right subarticular zones near the descending L4 nerve roots but without clear contact or mass effect. The thecal sac is narrowed to 9mm at the AP midline with prior caliber 6mm.
Mild bilateral neural foraminal stenosis without exiting nerve root contact.
2. L1-L2: Left paracentral annular fissure up to 8.5-0mm with a left paracentral disc protrusion to 3.5mm. This encroaches on the left lateral recess without nerve root contact or thecal sac stenosis.
3. Mild thoracolumbar levoscoliosis with straightening of the normal lumbar lordosis noted.
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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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