6 weeks post surgery, pain remains!

Tagged: Buttock Pain

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Shellyc
Participant

July 10, 2018 at 11:55 am

Post count: 6

#28742

Hi Dr. Corenman,

A few months ago I posted my spine MRI results here which you graciously responded to and I had a referral in to come and see you but was able to get in with a surgeon here in Grand Junction much quicker so I consulted with him and he sent me to a hip specialist. I am now 6 weeks post hip surgery for a completely detached labrum and after 4 weeks on crutches I began walking again only to experience the pain that I had prior to surgery once I began to put pressure on my leg. My hip surgeon is concerned that I have a back issue due to the pain which begins in my right buttock and extends down through my hamstring but also lingers down into the lower extremity with prickly sensations. I’ve met with 2 spine surgeons already and have had an epidural with no success. I’m just wondering what your thoughts might be on this and am again considering engaging in my referral to come see you. Thanks for your continuing help! (My MRI findings are below.)

FINDINGS:
MRI examination of the lumbar spine is performed without intravenous gadolinium enhancement.

L1-2: Broad-based disc bulge with a central disc disc protrusion with annular fiber tear. This
flattens the anterior thecal sac but there is no significant spinal stenosis or neural foraminal
narrowing. No frank disc herniation. This could be a site of pain however.

L2-3: Broad-based disc bulge with a small annular fiber tear. No disc herniation. No spinal
stenosis.

L3-4: Mild spinal stenosis due to accommodation of broad-based disc bulge and facet joint
hypertrophic change. Neural foramen are patent.

L4-5: Mild to moderate spinal stenosis due to broad-based disc bulge and facet joint ligamentous
hypertrophy. This causes significant narrowing of the lateral recesses and conceivably L5 nerve
root impingement within the lateral recesses bilaterally. The neural foramen are patent.

L5-S1: Mild facet joint degeneration. No spinal stenosis. No neural foraminal narrowing.

IMPRESSION:

1. Moderate multilevel degenerative disc and facet changes, with moderate spinal stenosis at
L4-5. Significant narrowing of the lateral recesses at this level due to facet joint osteophyte/
hypertrophic change.

Donald Corenman, MD, DC
Moderator

July 10, 2018 at 12:13 pm

Post count: 8660

#28743

Your MRI does not live in a vacuum. The symptoms have to be related to the MRI. What are your symptoms? Please be specific in your symptom descriptions. See https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-lower-back-and-leg-pain/.

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.

Shellyc
Participant

July 10, 2018 at 2:05 pm

Post count: 6

#28744

Thank you Dr. Corenman, I hope this helps!

My pain started when I tipped over on my road bike in July 2016. My toe clip got stuck and I fell on to my left side. The next morning both my hips and lower back hurt. I eventually sought treatment with a physical therapist who discovered my SI joint had seized up and helped me with pain relief but without a diagnosis she couldn’t help too much. I eventually met with an orthopedic surgeon who first told me surgery wouldn’t help me and so we proceeded with an epidural in February 2018. When the epidural was ineffective, he then gave me my 2 spine surgery options. This felt inconsistent to me so I continued to seek information/answers. I sought help from a trusted chiropractor earlier this year who encouraged me to get hip xrays. In the meantime, I also met with a different spine surgeon who believed the issue lied in my hip so I got xrays and MRI of my right hip and met with a hip surgeon who diagnosed me as having a completely detached labrum and cyst in my right hip socket. I am now 6 weeks post hip surgery and have been off crutches for less than 2 weeks. Since I began walking off crutches, the pain I describe below is what I am experiencing. It is important to note that this pain existed prior to my surgery after the bike fall but seems to be worse now. This has been a very frustrating 2 year process for me and even after surgery I’m struggling significantly so I am hoping you can give me some direction on where to go next.
Presently, my right buttock has a constant sharp pain in the center which radiates downward to the lower end of the buttock. The hamstring is tight (2-4) and I get pins and needles in my calf, mostly on the lower outside. My highest level of pain in my buttock has been 10 to where I couldn’t stand or walk at all and had to get to a chair immediately. That has been within the last week. Prior to my hip surgery, the pain levels ranged more 6-8. Presently on a moment by moment basis I would probably rate it is a consistent 8/9 but only when standing or walking, and walking incline or upstairs is increasingly aggravating. When sitting or laying, there is no pain. I cannot walk any distance and have to sit for 10-15 minutes after any activity (walking, cooking, cleaning, shopping). Percentage wise I would say the buttock carries about 80% of the pain then the other 20% goes down the back of my leg. I have about a 20-30% weakness in this leg as a result of the pain. My back is not experiencing any pain but the 1st ortho I met with suggested the bulging discs were pressing on a root nerve (forgive me if my terminology is incorrect) and that was causing the butt and leg pain.

I should also tell you I frequently experience blotchy purple, white, and red feet and my lower legs and feet are cold most of the time.

I am a fitness nut and enjoy all types of activities such as running, bicycling, weightlifting, dancy cardio classes, and I used to engage routinely in extreme power moves. I completely ceased exercising about 3 months ago and all I’m doing now in my surgery recovery is light spin bike and 5-8 lb upper body weight training. No core/abs or legs. One of the most painful things for me to do is bend over and pick something up off the floor.

As for my work, I am a real estate agent and spend about 50% of my time at a desk and the other 50% of my time in the car showing houses etc. I am only able to work a few hours a day right now due to surgery recovery and continuing pain.

I am very grateful for your time!
Shelly

Donald Corenman, MD, DC
Moderator

July 11, 2018 at 4:18 pm

Post count: 8660

#28757

“Presently, my right buttock has a constant sharp pain in the center which radiates downward to the lower end of the buttock. The hamstring is tight (2-4) and I get pins and needles in my calf, mostly on the lower outside, When sitting or laying, there is no pain”. Standing and walking pain cn occasionally radiate from the hip but commonly is caused by foraminal and lateral recess stenosis of the spine. See https://neckandback.com/conditions/lumbar-foraminal-stenosis-collapse/ and https://neckandback.com/conditions/lateral-recess-stenosis/.

Your quote “I should also tell you I frequently experience blotchy purple, white, and red feet and my lower legs and feet are cold most of the time” would not fit with a hip or nerve disorder in the spine.

Copy and paste your spine MRI results here and we can discuss possible nerve involvement.

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.

Shellyc
Participant

July 11, 2018 at 5:37 pm

Post count: 6

#28758

Thank yo so much! I just don’t know where to go from here. Below are my MRI findings:

FINDINGS:
MRI examination of the lumbar spine is performed without intravenous gadolinium enhancement.
L1-2: Broad-based disc bulge with a central disc disc protrusion with annular fiber tear. This flattens the anterior thecal sac but there is no significant spinal stenosis or neural foraminal narrowing. No frank disc herniation. This could be a site of pain however.
L2-3: Broad-based disc bulge with a small annular fiber tear. No disc herniation. No spinal
stenosis.
L3-4: Mild spinal stenosis due to accommodation of broad-based disc bulge and facet joint hypertrophic change. Neural foramen are patent.
L4-5: Mild to moderate spinal stenosis due to broad-based disc bulge and facet joint ligamentous hypertrophy. This causes significant narrowing of the lateral recesses and conceivably L5 nerve root impingement within the lateral recesses bilaterally. The neural foramen are patent.
L5-S1: Mild facet joint degeneration. No spinal stenosis. No neural foraminal narrowing.
IMPRESSION:

1. Moderate multilevel degenerative disc and facet changes, with moderate spinal stenosis at
L4-5. Significant narrowing of the lateral recesses at this level due to facet joint osteophyte/
hypertrophic change.

Shelly Cross

Donald Corenman, MD, DC
Moderator

July 11, 2018 at 6:35 pm

Post count: 8660

#28759

L4-5 “significant narrowing of the lateral recesses and conceivably L5 nerve root impingement within the lateral recesses bilaterally”. Lateral recess stenosis fits with your current symptoms. You should consider a selective nerve root block to diagnose and possibly treat this pain. See https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic/ and https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections/.

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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