Back pain after microdiscectomy

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

Viewing 6 posts - 13 through 18 (of 33 total)

Previous 1 2 3 4 5 6 Next

Author

Posts
Michaelrch
Participant

December 5, 2016 at 1:04 pm

Post count: 19

#23513

Thanks Dr Corenman
There is another twist. The radiologist that did my ESI today disagrees that there is any disk fragment or other debris near the nerve. He sees everything near the disk as enhancing contrast so it has blood flow do it’s not debris.
I am next to see the surgeon next week but I have emailed him this news in the meantime.
Who knows – maybe the ESI will work a miracle this time. He went in from the side to try to maximise uptake in the relevant area. But TBH in general I don’t understand how steroids reducing inflammation will help with tethering of the nerve by scar tissue so am dubious and rather disappointed but will not give up just yet!
I will keep doing my exercises to free the nerve from the scar tissue with gusto while I wait for my next appointment.

Michaelrch
Participant

December 11, 2016 at 1:20 pm

Post count: 19

#23521

Hi Dr Corenman
I have been mulling things over and have read another thread here that explained a few things about scarring (your thread with Bird, really informative).
Only one of 4 doctors that have looked at my August MRI see any reherniation. The radiologist last week was pretty adamant that there was none. So I was thinking.

I am pretty flexible in my leg now. I can touch my toes with no pain (which is encouraging). However sitting and standing still are still bad. Plus I found that if I lie flat on a bed or in a reclining chair then the ache sets in (back and leg) very quickly but if I can tilt my pelvis up on the bad side then I can get away with it.

Looking at the MRI there is a clear swathe of scar tissue on the outside and just above the S1 nerve root. So I am thinking that maybe, while I have managed to keep the nerve untethered from the scar, the presence of the scar tissue is still compressing the nerve at the top and outside.

My reasoning as to why my why scar tissue became an issue overnight (as opposed to over a few weeks) after overactivity (when all this started) is that the movement and strain caused the nerve to swell up a lot and the motion of the joint disrupted existing scar tissue so it thickened up and maybe shifted into a worse position.
Then as to why things are better than they were (although far from fixed) is because the nerve has become less inflamed over time and maybe the scar tissue has consolidated a bit.
So… does that sound consistent to you? I read in the other thread that scar tissue does shrink over time as a natural process. Did I understand that right? I sure hope I did as if my understanding is right then I guess that is my best shot for recovery given surgery to remove scar tissue is a big no-no.
I have a tricky chat coming up with my surgeon on Wednesday I reckon…
As ever thanks so much for your help.

Michaelrch
Participant

December 21, 2016 at 4:34 am

Post count: 19

#23531

Hi again Dr Coreman

I went for my next meeting with the surgeon last Wednesday. He said words to the effect of “look you have symptoms that suggest something is pressing on the nerve. The last MRI may not show anything clearly but they don’t always capture everything that’s actually in there”. I was sceptical as the last thing I want to is plough ahead with unnecessary surgery and make things worse. After some umming and arring we agreed I would have another MRI and schedule one last ESI in my IS joint in case that was inflamed.

I had the MRI on Monday. I got the CD and took it home to look at it. I could immediately see that a structure that the surgeon had pointed to as a potential problem (a black line sitting right next to the nerve) was even more clear and was also clear in the contrast image so could not be scar tissue. I thought ‘that’s it! That’s the junk that has been irritating the nerve all along’. I got myself mentally ready for surgery and was really glad that there was something to explain my symptoms that could be removed.

The next day the radiologist called again about the new MRI. He said 100% the object I saw is NOT disc material. He said it was most likely a blood vessel and that there is no disc material impinging on the nerve.

So I am back to where I was. I would really love to believe the new surgeon. He is a professor of neurosurgery with years of experience. His narrative says that a minor surgery will fix me. But the images and all other doctors (4 so far) that have seen them say no reherniation or problem material in there except scar tissue. No one else has suggested revision surgery.

My next appointment with the surgeon is 20th January… My last ESI is 28th December.

Apologies, I know thee is no question here. I just wanted to keep the thread up to date.
Merry Christmas :)

Ps if you are interested in seeing the images I would be happy to share them. Just let me know how I can do so. I dont have the radiologist’s report but even if I did it would all be German as I am in Switzerland, so not sure that would be useful, even with help from Google Translate!

Donald Corenman, MD, DC
Moderator

January 6, 2017 at 3:52 pm

Post count: 8660

#24063

The neurosurgeon is correct in that on rare occasion, the MRI does not show “everything”. I remember a case last year of a US Ski team member that had significant leg pain and the MRI only noted scar tissue. He understood that surgery would be a neurolysis only (removal of scar tissue) with about a 50% chance of success. He still wanted surgery so we went ahead. Low and behold, there was a fragment of herniated disc under the root that was “hidden” by the scar. Surgery relieved his leg pain. I am not saying that this might be the “magic cure” but that these things do occasionally happen. If there is no recurrent herniation, the chances you will be happy are about 50% with neurolysis surgery.

I am sorry to disclose that I only review images as part of a “long distance consult” in which I personally review your handwritten history from my forms, review all consultations and images and call you. I do charge a fee for this service.

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

January 7, 2017 at 5:17 am

Post count: 19

#24077

Hi Dr Corenman
Many thanks for getting back to me. Since my last email my surgeon has reported back on the recent MRI with a call before Christmas He is now minded to agree with the radiologist and says that if there was something on the August MRI here does not think it’s there now. It may have been reabsorbed. So just scar tissue remaining.

Also, I had another ESI, this time more diagnostic into the SI joint (28/12/16) Actually it did seem to work a bit. I think i have had some reduction in pain overall and pain at the top of the SI joint specifically seems to be a noticeably less. Tricky to say when pain seems to come and go in various forms and places but I think that is the case.

My nerve symptoms have been a little better the last few days as well. Less ache and shooting pain in my leg which is very welcome. Definitely not gone, but certainly better than say, a month ago. I am still having to be careful and sitting for more than 20-30 minutes causes the pain to start up again and I have take care doing stretches etc as getting that wrong can cause pain that lasts a day or so.

If anything, I am finding as I am trying to be more ‘normal’ with less pain in the leg and along the nerve then I am getting more axial pain, actually in the spine itself. When it comes, its a sharper more steady pain rather than the slightly less focussed and zappy nerve pain. It comes on especially after I try swimming or lots of standing around so I am thinking it’s actually pain from the disc after sheering or compression. Not much I can do about that I guess, except building the core muscles for support. Everyone seems to recommend swimming. I do it with minimal twisting if I can, but it does seem to irritate something actually in the spine. Again this is less than when I tried swimming a couple of months ago, but still in two minds. Do I carry on in moderation in an effort to rehab the back overall or is the residual pain telling me ‘no, not yet’?

Re the nerve pain, you mentioned neurolysis. It sounds like you were talking about a surgical procedure in the case of your pro skier. On that topic, is there anything in RACZ neurolysis? It looks like a glorified ESI with added enzymes to break down scarring so I guess should not risk re-scarring that surgery might cause. Have you seen evidence that the RACZ prodedure is safe and effective?

Thanks again.
Michael
PS I am certainly not averse to a paid consult btw. I will keep that in mind.

Donald Corenman, MD, DC
Moderator

January 8, 2017 at 9:17 am

Post count: 8660

#24091

RACZ neurolysis is an old fashioned treatment (caudal epidural) now as “new and improved”. It is really just a caudal injection now with a catheter. I find it to be unnecessary and not as effective as a TFESI or ESI. I think you are on the right track. The back pain is most likely from the disc and needs some time to “settle”.

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.
Author

Posts

Viewing 6 posts - 13 through 18 (of 33 total)

Previous 1 2 3 4 5 6 Next

You must be logged in to reply to this topic.

Donald Corenman, MD, DC

Average rating:

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel