Back pain after microdiscectomy

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

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Michaelrch
Participant

November 9, 2016 at 11:53 am

Post count: 19

#23394

Hi Dr Corenman

I had the ESI on Monday at 3pm do just over 48 hours ago. It all seemed to go fine. I left feeling very numb as expected. I started noticing some back twinges coming back after only about an hour while most of my butt and leg were still numb which was a bit concerning.
Yesterday things had settled down but I did not was still getting twinges, mostly when lying down after short walks (10 mins). I slept really badly and today I am basically where I was before the injection. If there was any impact it was very short-lived.
Today I am doing 20 minute walks as instructed by my doctor but I get sharp shooting pains after them and general ache in my lower left back again.
So pretty disappointed. My doctor had expected the pain to be gone at least for a few weeks but no such luck.
I am thinking I must have some picked up kind of chronic nerve damage back in July for the pain to be this tenacious. Is that plausible? It is generally a slight burning ache most of the time with highlights of shooting pains after moving around.
Aside from just doing more physio I have no idea how to attack this now. I am on my back most of the time again trying to let the nerve to calm down with the steroids. I will be slowly restarting my exercises tomorrow and building back over a week. I guess if the ESI has not worked then oral steroids are a waste of time? The MRI shows no herniation…
I would really appreciate your thoughts on this. Many thanks
Michael

Donald Corenman, MD, DC
Moderator

November 12, 2016 at 1:17 pm

Post count: 8660

#23410

Based upon your description of a large herniation and the subsequent motor weakness, you probably had some chronic damage to the nerve. I am happy that you had the surgery within 10 days of the pain and weakness. It is probable that you did have damage to the root and unfortunately will take some time to improve.

The nervous system doe not have a lymphatic system to drain extra fluid. Think of the lymphatic system as the “overflow drain” on a bathtub. If water fills the tub faster than the drain can remove it, the tub would overflow. The “overflow drain” removes this excess water.

The Lymphatic system is the overflow on the tub and this lymphatic system is missing in the nerves. This means that root swelling takes significantly longer to resolve-months to occasionally a year.

I still like epidural steroids even though this injection was not effective in your case. Oral steroid can still be effective as well as membrane stabilizers (Neurontin, Lyrica, Topomax-see medication section).

Please keep in touch to let us know your progress.

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

November 13, 2016 at 2:15 am

Post count: 19

#23423

Many thanks again Dr Corenman
What is tough for me is that I had no back pain for the first 6 weeks after the surgery. I was having a really straightforward recovery. I could stand for up to a hour without trouble though I did not sit much. I was working and walking almost at will.
The real trouble started after my very ill-advised uphill hike AND then a few days later, several hours standing for work.
My original calf weakness is now under control, and while I cannot lift up on that toe from flat, I can tip toe across the room if I am asked to.
So I figure that maybe the hike caused more inflammation, then the standing (which was fine before) caused my back to actually press down on the more swollen nerve causing more damage. Is that plausible?
The other thing that people keep saying when they see my scans is ‘scar tissue’. I have read extensively about how this can cause problems starting in weeks 6-12. It’s the only visible change between the MRI I had at week 4 (when all was good) and week 10 (not ok). The thing that does not fit there for me is that the onset of my pain was overnight after the hike (then worse and more focuses after the standing), not gradually over a few weeks. That said, maybe all the activity roughed up the healing tissue and caused more scar tissue to form causing longer term pain…
Sorry, to go on. I really struggle to cope when my doctors are vague about what is going on. I had to effectively self perscribe my ESI as my doctor is 95% focuses on weakness in my muscles rather than any pathology around the nerve. I am building a sux pack on all the abs work but I don’t see what actual good it is doing!
On a more positive note, I think that the general level of pain (frequency and intensity) is more likely down than up since before the injection, but it’s honestly hard to know for sure.
Many thanks again

Donald Corenman, MD, DC
Moderator

November 13, 2016 at 6:25 am

Post count: 8660

#23424

I would agree that the hike inflamed the nerve root and caused the flair up. You are probably getting some relief from the steroid injection. This medication once injected can take up to a week to work effectively. Patience now is the best treatment advice.

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

December 1, 2016 at 1:50 am

Post count: 19

#23503

Dear Dr Conenman
So yesterday, on the recommendation of my old GP who is a family Friend, I saw a new surgeon, a professor of neurosurgery. He looked at my scans and spotted a lump of material showing up black on the scan that is lying right next to my S1 nerve at the L5 S1 level that has slightly shifted between the week-4 MRI (no back pain) and the week-10 MRI (back pain). In the week-10 scan the nerve is more swollen and the black ‘shard’ of material is pushing more against the nerve as the nerve is more distorted in shape. So his recommendation is first to try another ESI, in case we can shrink the nerve away from this material and take the pressure off, else he wants to do a revision to clear this material away from the nerve. He says a small fragment like this will cause a small sharp point pressure on the nerve and that would cause a disproportionate amount of pain. I asked about scar tissue causing more trouble. He says he will leave in some gel to inhibit adhesion of any additional scar tissue to the nerve, and in most cases, the dangers of scar tissue, while not zero, are less common than is sometimes thought. He has been at this for 20 years so I am prepared to trust him!
Anyway, it goes to show the usefulness of multiple opinions. I think my original surgeon was just stumped and got fed up with me complaining. This new guy is engaged and far more positive about getting me back to full function.
Ironically, I have just read up on Tiger Woods. His last surgery was exactly like this revision proposed, to clear out a small nasty fragment that was causing ongoing back, hip and leg pain. Today he is back to playing pro matches (albeit a year later).

Donald Corenman, MD, DC
Moderator

December 4, 2016 at 12:11 pm

Post count: 8660

#23511

So you do have a recurrent herniation or a missed fragment. This surgeon is correct in that a smaller fragment can cause significant pain due to the nerve being more immobile (due to scar). I also agree with the epidural use as your weakness is not worse and actually has improved.

It is highly unlikely that you have an infection post-operatively but just make sure this possibility has been noted and rejected. If and or when the redo surgery occurs, just make sure to ask if the surgeon thinks he needs to culture the incision.

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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