3 Weeks Post Microdiscectomy Pain

Tagged: Back pain symptoms after a microdiscectomy

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zzab
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October 13, 2020 at 4:49 pm

Post count: 23

#33144

Hi doctor I have been having a rough few weeks and wanted to get your input. My original surgeon reviewed my new MRI and said everything is fine, even though he refused to acknowledge the protrusion at L4/L5. He did not seem happy to see me to say the least. I saw a second surgeon who did acknowledge the protrusion but said it could be a recurrent herniation or swelling from the annulus as you have noted. The good news is the radiologist report indicates no nerve compression and I haven’t felt any nerve sensations since my fall. However I have been experiencing very strange symptoms since my fall 3 weeks ago, most of which I never had pre or post surgery. The new surgeon thinks it is due to inflammation.

I am experiencing muscle twitching on my legs but mostly my right leg, which is the non-operative leg. I had one day where my glute was sucked in and another day when I woke up to a charlie horse in my calf, both on the right leg. Today I’m experiencing random little twitches all over in both legs. I had numbness in both legs about a week after the fall but that was periodic and has since faded. My back pain seems to move all around. Sometimes it is around L1 or my mid back, other times it moves lower into the lumbar. Stiffening my core or doing any kind of core work seems to make my back “feel sick”. Same thing with swinging my arms by my side when I walk.

I did get on a medrol pack and days 3-5 I felt 80% but the pain came back as I tapered off. I am currently taking 15mg of meloxicam and it has provided some relief. By day 4 I felt 80% and this past Saturday felt almost 100% all day. Unfortunately these past two days I’ve regressed a bit and had some moderate discomfort later in the day to the point I needed to lay on the floor at work for a few minutes.

Prior to the fall at 4 months I felt 100% and was capable of doing 45 minutes of core work and 30 minutes of walking a day with zero pain. Sitting and standing were not an issues. It’s been over 3 weeks since the fall and while I have improved I am still dealing with a lot of issues which are concerning, many which I never had before my fall. Do these symptoms seem to be inline with inflammation or something else? If it is inflammation how long would you expect it to settle?

Donald Corenman, MD, DC
Moderator

October 14, 2020 at 8:15 am

Post count: 8660

#33147

You note “I am experiencing muscle twitching on my legs but mostly my right leg, which is the non-operative leg… another day when I woke up to a charlie horse in my calf, both on the right leg. Today I’m experiencing random little twitches all over in both legs”.

These symptoms are generally not related to your back. Twitches are small muscle contractions that can be associated with nerve injury but you never had an opposite side injury. Cramping is also generally not related to your injury. You might be deconditioned or developing a metabolic condition but I would not focus too much on your twitches or cramps.

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 26, 2020 at 3:42 pm

Post count: 23

#33270

Hi doc wanted to give you a quick update and get your thoughts on the current symptoms I am having. Will give a brief timeline of events as we have had quite a bit of back and forth. Thank again for all of your help.

Left L4/L5 laminontomy with microdisectomy on May 22, 2020. Post op back pain was pretty much gone and stayed away during my recovery. Had periodic numbness in my legs up until 8 weeks. Dealt with nerve inflammation until 3.5 month which was mostly centralized burning towards the top of my left glute. From 3.5 – 4 months I felt 100%, no back or nerve pain. Was also doing daily core work and walking throughout my recovery. Had my fall off the tree at the 4 month mark which really set me back. Post fall I had severe back pain and some numbness return but no nerve pain. I did have to take a round of medrol and mobin but am happy to say 5 weeks later my back feels like it did prior to the fall, basically pain free and I’m off all medications.

The back pain disappeared at the 4 week mark post fall but the day the back pain left I started experiencing numbness in my left leg again. Had a few moments of deep nerve pain that was different than anything I felt before. It wasn’t a burning sensation and can only describe it as a deep pain that traveled down the leg. Also had the deep sensation run across the front of my thigh which does not represent the L5 nerve root pathway. After a couple of days the numbness mostly faded and my L5 nerve root started “burning again”. Pain wise the burning is fairly low maybe 2-4 and there have been a few points during the day where it goes away but is mostly constant.

Essentially at the 5 month post op point I feel like I did at the 2.5-3 month mark. No back pain whatsoever but fairly constant burning of the root. The pain doesn’t really travel down my leg although I have felt it in my calf a few times. My new MRI post fall shows I have no compression of the nerve root but still a small protrusion. I’ve done the SLT along with nerve flossing and have no issues.

It seems like as soon as the back pain faded I started getting numbness and as soon as that faded the nerve started burning again even though I hadn’t had nerve pain since the 3.5 month mark. I know nerves can be finicky but just want to make sure I am not looking at permeant nerve damage here as I dealt with sciatica for close to a year before getting surgery. Is there a good chance my nerve pain will fully go away if given more time? If so what would a ballpark number be?

Donald Corenman, MD, DC
Moderator

October 28, 2020 at 7:29 am

Post count: 8660

#33277

I think based upon your recovery trajectory including the exacerbation from the fall out of the tree, you are doing OK. The new MRI supported no new herniation. You could consider another round of oral steroids or even an epidural steroid injection.

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

December 1, 2020 at 8:20 am

Post count: 23

#33426

Hi Doc,

After meeting with a few new surgeon’s they do believe I have a re-hernation based on my imaging and on going symptoms. MRI states 4.5mm protrusion but thankfully is not in contact with my nerve root. My symptoms are fairly constant back pain and periodic numbness in my foot. Again I was 100% pain free 2 months ago before my fall (4 months post op) and haven’t been able to turn a corner with this back pain yet. Do surgeons ever consider a revision surgery for individuals with only back pain from re-herniations? I am not really sure where to go from here.

Do I just wait it out and hope the protrusion shrinks over time?

If I do elect to have a revision are the risk higher than the first op? My main concern is scar tissue. I avoided the scar tissue attaching onto my nerve root from the first op and am worried about going back in a second time which would create more.

Donald Corenman, MD, DC
Moderator

December 2, 2020 at 5:14 am

Post count: 8660

#33427

Re-herniations can cause lower back pain without leg pain. The posterior annulus is full of pain nerve endings and a herniation can stretch these fibers causing pain. A redo microdiscectomy can relieve pressure and reduce pain, just not as effectively as reducing pain from a nerve root compression.

Risks are somewhat higher for a redo microdisc than a first surgery due to scar but not substantially higher. There is always the risk with further scar formation but again is not too high.

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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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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