Back pain after microdiscectomy

Tagged: microdiscectomy and lower back pain after, possible SI joint syndrome

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Michaelrch
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October 15, 2016 at 11:28 am

Post count: 19

#23210

Dear Dr Coreman

In June 2016 I had a microdiscectomy for a big herniation of the L5 S1 disc that initially caused intermittent leg pain then, after a fall of my bike, weakness in my left calf. I had surgery within 10 days of the onset of weakness.

The surgery was successfully. The leg pain was noticeably reduced and the leg weakness was reducing over time.

I had no back pain before or immediately after the operation.

At six weeks (31/7/16) I was feeling good. I was able to walk for an hour, stand for about 4 hours a day to work at my desk etc. All good.

Then I overdid the exercise, joining my family on a 90 minute hike, mostly uphill. I was still feeling ok so I also rode a bike for 25 minutes. The next day I was hit with really bad leg pain and also new back pain. The leg pain mostly subsided after about 10 days but the back pain did not.

I had another MRI 2 weeks later and this showed no reherniation but there was additional scar tissue. My surgeon said to just keep doing the PT and wait. My family doctor said rest and take more painkillers. I took about 2 weeks in bed then very slowly got moving again. I spent a month on Prendnisone (20mg daily) until mid September. I have been doing PT again for 5 weeks.

The leg pain is mostly gone so long as I don’t stretch the leg much. The back pain is a problem though. I am doing my PT (back and core strength) and the pain is tolerable while I am really careful (1-3 ache with sharp twinges), but I can’t sit for more than 20 minutes, can’t stretch the leg, can’t stand for more than 10 minutes etc. If I do too much I either suffer the same day or the next few days depending on the scale of my error. So I am signed off sick from work etc.

My new doctor (a rehab specialist) has said it is nerve pain due to inflamnation of or damage to the nerve root which sounds right I guess. He said no to steroids either oral or by injection. I asked straight and he said no, I guess because the previous course did not fully fix the issue? He has told me to stick with the PT but I guess that is about supporting the spine rather than healing the nerve right?

I am wondering whether I should really push for the steroid injection as I see you have recommended it to other patients, otherwise what I can do to help with recovery, and last how to judge my prognosis. My current symptoms are really limited my life. I was previously very active and fit.

Many thanks for your help. It is great what you are doing here.

Donald Corenman, MD, DC
Moderator

October 15, 2016 at 12:03 pm

Post count: 8660

#23211

If you have no recurrent herniation based upon MRI (make sure this reading is confirmed by the radiologist) and your pain is mostly lower back pain (not localizing to the side of the previous herniation which means something else), then you are one of the 10% who have developed degenerative disc disease/lower back pain after the disc herniation.

I do think that epidural steroid injections are generally good to treat this disorder along with core strengthening and understanding the biomechanics of this disorder (see https://neckandback.com/treatments/conservative-treatment-mechanical-lower-back-disorders/). These injections may not be helpful but if they are effective, the pain relief will allow you to progress in your conditioning and strengthening.

I like the 20%/week rule to increase activity and prevent flair-ups. I am just writing this section so look for it in the next week or two to understand how to increase activity without aggravation of symptoms.

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.

Michaelrch
Participant

October 15, 2016 at 12:28 pm

Post count: 19

#23212

Dear Dr Corenman

Many thanks for the very quick response.

Sorry I missed if some key information i think!

Yes the pain is on the side and level of the previous herniation. It is mainly localised about 2cm left of my scar, but it can spread if it gets bad, at the same level.

I had an MRI at 4 weeks when I was going well, then another at 10 weeks at which point the back pain had started. My surgeon said several times that she could see no difference in the disc height or shape between the 2 scans. My new doctor could not see any changes either. The S1 nerve root was looking swollen on both. There is apparently enough space in the foramen for the nerve all the same.

I bought the nerve pain diagnosis as it was consistent with the very fast onset of the pain after my over-exercise day. As part of the diagnosis process the doctor did some stretching/pulling of my leg and caused pain in the leg first, then the back started burning.

On the upside, my leg weakness is still much better than pre-op. I can tip toe for a bit and so on.

I will continue to build up my physio exercises. I am sneaking up by maybe 10-15% each week which I seem to be getting away with.

Donald Corenman, MD, DC
Moderator

October 15, 2016 at 12:41 pm

Post count: 8660

#23213

Local pain that is unilateral on the side of the prior nerve root decompression can be nerve generated and not disc generated pain. I would assume if you “did too much” that you would have pain that extends into the SI joint and buttocks as well as more intense pain at the current location. If so, this is nerve root generated pain.

Continue with your current program as this is the best way to rehabilitate your back. I do think an epidural could be beneficial but is not imperative.

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.

Michaelrch
Participant

October 15, 2016 at 12:53 pm

Post count: 19

#23214

Many thanks again Dr Corenman

Yes, that matches what is happening. I do get mild aches in the glute and upper back of the thigh. I kinda ignore it most of the time as it is easily tolerable compared to the back pain. I could not say for sure re the SI joint but I have had pain on the bit of the hip/sacrum that protrudes slightly.

So on with the PT. I see the doctor again in 3 weeks. I will see about the injection again. Worst case, my surgeon left this option open when I saw her last 6 weeks ago. She was not keen at the but I got the sense she would not object after another couple of months.

Anyway, thanks so much again. I will do my best to update the thread as things change in case it helps others later.

Donald Corenman, MD, DC
Moderator

October 16, 2016 at 5:23 am

Post count: 8660

#23218

You probably have residual nerve root inflammation and would benefit from an ESI. Please keep us informed.

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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