Back pain postpardum

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Swathwood
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October 17, 2014 at 6:37 am

Post count: 1

#11547

Hi dr-I’m hoping you can guide me in the right direction. I just had my second baby six months ago. The anesthesiologist botched my epidural.-I left the hospital with seven puncture wounds and a bottle of Vicodin. A second anesthesiologist had to come in and try and the epi was administered but I only received five min of relief-then my whole left leg was numb for a full day. I couldn’t feel it or bear weight on it. Needless to say it was a bad experience (I had an epi with my first child and it worked just fine).

Two months postpardum I started experiencing low back pain right in the epi spot. I went to my pcp and she prescribed muscle relaxers and meloxicam which I was hesitate to take since i was nursing. I received an MRI and it came back normal. Started pt and in September I started feeling better and went off the meloxicam. Four weeks ago I started experiencing pain so I started taking the meloxicam again. Well a few days of this and I woke up one morning in horrible pain and was up all night. A new physical therapist took a look at me, said my pelvis was misaligned and it’s si joint dysfunction. So it’s been 3 weeks of treatment for this new diagnosis, mind you none of my pain is where the epi went anymore, it’s all to the left of my spine right near the joint but not on it. It hurts all the time, a dull ache. I can’t sleep on my back because it hurts so much. I saw a spine specialist last week who took one look at my MRI, said my spine and joints look great, did some tests and said it’s not sijd. Told me To go swimming at the gym, said I just had a baby, basically sent me on my way. My pain level is 4/10, it’s not horrible rather nagging and as I mentioned its in a different spot now, pretty much over the sacrum. The meloxicam doesn’t seem to be working as much either-I’m not getting any relief while using it.

My question is-does this seem like sijd? I’ve also read about arachnoiditis and that scares me. I have no pain radiating down my leg. But I feel this pain all the time and it’s very bothersome. Would a non contrast MRI show arachnoiditis? I don’t know where else to turn. I scheduled an appointment with a neurologist next week because I want to cover all of my bases. It aches and even touching the skin hurts. I’m stretching, walking every day and doing my si joint exercises. I wasn’t sure if pain patterns can change with arachnoiditis because mine clearly has. Other than a dull constant ache, I’m having no other symptoms like urinary issues-just pain in a localized area (it’s almost like a vertical line down my sacrum). Using a tennis ball on the area temporarily relieves pain but then it all comes back. I’m not sure if this even sounds like nerve pain. I’m able to function normally I’m just in pain and haven’t turned a corner yet unfortunately. Can arachnoiditis occur in the sacral/glute area?

Any assistance you could provide would be greatly appreciated. I want to add the pain is all on he same side (left) where my leg went numb-left leg.

Donald Corenman, MD, DC
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October 17, 2014 at 10:57 pm

Post count: 8660

#11550

I’m not clear on your symptoms. You initially stated that the painful area was where the epidural injection occurred and then you noted that “none of my pain is where the epi went anymore, it’s all to the left of my spine right near the joint but not on it”.

What joint are you talking about? Is it the facet joint at the lower lumbar spine or the sacroiliac joint on the left? When did the pain shift from the epidural site to this new site?

Although the sacroiliac joint (SIJ) is the most common region for pain in the lower back, the SIJ is almost never a pain generator. See the section on “sacroiliac joint pain syndrome” to understand how this joint in involved with pain.

By inference, it seems like your MRI has no findings (“took one look at my MRI, said my spine and joints look great”). This is not helpful as sometimes findings can be overlooked. I do not like to look at imaging through someone else’s eyes (radiological reports).

If you have constant pain and hypersensitive skin (“It aches and even touching the skin hurts”-allodynia), a nerve injury cannot be ruled out. This could be a chronic radiculopathy or arachnoiditis (see website for those descriptions). Arachnoiditis is visible on a standard MRI without contrast.

If you do have one of these disorders noted above, membrane stabilizers like Lyrica or Gabapentin can be helpful for 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.
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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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