4 months post L5-S1 hip/back pain soreness

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nooraulc
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April 21, 2014 at 8:07 am

Post count: 7

#10791

Hi,

I had a microdiscectomy on a large herniation at L5-S1 (left side) and although recovery has been progressing well (no leg pain), I have this pain/soreness in my back (at about the height level of the hip/pelvis but in the side and back, just above the glute). It has been there for a couple months now and is usually worse with exercise. Is this normal? My last follow up was last month and they gave me the all-clear to resume normal activity but this is holding me back quite a bit. If you push down on the on the pelvis bone in the back, it is sore.

Also, I have a area on my back where they did the microdiscectomy where if I push down on it, it sends an “electric shock” feeling down my back. Is this normal? It is just left of the incision. It is quite sensitive even 4 months after surgery.

nooraulc
Member

April 21, 2014 at 8:09 am

Post count: 7

#10792

I should note that I’m hesitant to contact my doctor about these issues right now because it takes forever for them to get back to me. I haven’t noticed these symptoms in anybody, which is why I am asking.

Donald Corenman, MD, DC
Moderator

April 21, 2014 at 10:08 am

Post count: 8660

#10793

The disc herniation itself is caused by a tear in the back wall of the disc which can be a pain generator. Some of the nucleus (jelly) has been lost by the very fact that this jelly extruded out of the disc. This causes the disc space to settle and the side walls of the disc to bulge somewhat. The nerve also was injured by the herniation.

Hopefully, all these symptoms will resolve with time. It does in most individuals. The disc walls have to accommodate. The nerve has to heal. The disc will get somewhat more stiff.

You might find it helpful to consider an epidural steroid injection or even a short course of oral steroid. This medication can be helpful in many patients.

I hope you are also engaging in a good physical therapy program. Core strength is very helpful to stabilize the spine after surgery.

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.

nooraulc
Member

April 21, 2014 at 12:45 pm

Post count: 7

#10794

Thanks for the quick reply Dr! Interesting. So by what mechanism does the sideways bulge cause pain (whether or not that is what is happening with me)? Does it press against certain nerves?

I am hesitant about oral steroids because last time they made me weaker, sicker, and didn’t really help. An epidural injection might be an option down the road, but I don’t think I’m there yet.

As far as physical therapy, I am working hard in rehab, maybe even overdoing it at times but always careful. I have done a ton of research on the subject (Dr. Stuart McGill’s book Ultimate Back Fitness and Performance is highly recommended reading).

nooraulc
Member

April 21, 2014 at 12:51 pm

Post count: 7

#10795

Also, I’ve been told I have a slight lordosis in my spine. I ‘ve noticed this since I was young and it never caused any problems before but post-surgery I think it may have gotten worse and I am now working on fixing it. Is this a problem that can be completely correcting even if you have a natural lordosis or will I always have a slightly lordotic spine?

Donald Corenman, MD, DC
Moderator

April 21, 2014 at 1:17 pm

Post count: 8660

#10796

A bulge in a normal (not torn or degenerative) disc wall generally will not be a pain generator. However, in a disc that herniated, by definition there was a full through and through tear that allowed the nuclear material to exit. Normally, there are multiple small tears through the disc.

It turns out that the nucleus is also neurotoxic (why God or Mother Nature designed the disc this way is anyone’s guess). The nuclear material can interdigitate into the tears in the wall. The disc wall is embedded with nociceptors (pain nerves). The tear in the wall along with the neurotoxic nuclear material bathing this nerve can cause the back pain.

If you are four months out from surgery and the symptoms are abating, continue down the road you are on. If oral steroids give you significant side effects, please do not take them. An epidural injection or two might break the pain cycle and allow you to progress.

Lordosis of the lumbar spine is generally “set” by the size and angles of the discs. There is not much you can do with this.

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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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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