[Ana1982]

#20612

Dear Dr. Corenman,

I am extremely grateful for the opportunity to have an answer to my question from you.
I had a microdiscectomy“>microdiscectomy close to 7 weeks ago. The first 3 weeks were rough in terms of inability to walk longer than 20 minutes without tiring, night hip pain and constant incision stiffness. Weeks 4 and 5 I started noticing improvement. I had been on physical therapy“>physical therapy from day 10 and in weeks 4 and 5 I started feeling more like myself. Was able to walk longer, and had almost no pain, except for the incision site stiffness.

Close to the 5 weeks mark, I went out for a long walk, close to 3 miles, at a pace that was brisker than before. My back was inflamed afterwards, and I had some hip pain the following day, but I didn’t think much of it, because those episodes happened during my previous recovery and would resolve with rest“>rest in 2 days max.

However, two days after the long walk, I developed buttock nerve pain in my right side, the very side that was compromised before surgery. Just to mention, even before surgery, I never had much leg pain. Only the low back, buttock and groin pain, with occasional shootings to my both legs. Oh and also, before surgery, I did have right side thigh pain, but not for long, as I decided surgery was my best option pretty soon, so I guess it did’n’t have time to develop. .

Anyways, this newly developed, post-surgical buttock pain hasn’t resolved even after 2 weeks. It’s not extreme. When I walk I barely notice it. IT’s sitting that brings it on. There is close to 10 cm line in my right buttock that is tender to the touch. I have been careful with avoiding sitting. I haven’t sat for longer than half an hour at a stretch after surgery and I wonder whether this pain will aggravate once I go back to work in two weeks, as I have a sitting/office type job.

Could this be a reherniation? Could it be that the nerve is just waking up and healing? Though I had no pain in this right buttock area post surgery, I did have numbness and tingling. Could this new pain be a sign of a still existing compression, or is the nerve just saying “hello, I am alive”?

I have also started swimming two days ago. I swam close to an hour and a half (with pauses in between, obviously) and afterwards I felt amazing, the nerve pain was reduced by a half. Should I continue this vigorous swimming program, or should I be more careful and dial it back a notch?

Thank you immensely for your answer.

Ana

[Donald Corenman, MD, DC]

#20613

Return nerve pain after a microdiscectomy can originate from three issues; nerve inflammation, re-herniation or seroma formation.

The most common is inflammation. The nerve root when decompressed, can swell. Any activity (like walking) can stretch the root. When the root swells, some return of symptoms can be expected. It is a matter of time before the swelling recedes and the root “feels better”.

Re-herniation can occur and can happen to 10% of individuals who have a herniation (no matter if surgery occurred or not). Symptoms are generally more severe than inflammation above but don’t necessarily have to be. Typically, there will be an activity or motion that causes an immediate pain that does not improve with time.

Finally, seroma formation can occur. A seroma is a fluid-filled pocket at the surgical site that develops after surgery. This is actually a very common occurrence but typically does not cause symptoms. On occasion, after activity, this fluid pocket can expand and cause pressure symptoms.

Recognizing any of these conditions requires a repeat MRI with gadolinium. Before a new MRI is ordered, I will give the patient an oral steroid to reduce inflammation. If that treatment is not effective, depending upon symptom severity, I will order an MRI.

Thankfully, escalation of symptoms is rather uncommon and does not need to be addressed with most patients.

I endorse any activity that reduces symptoms and does not cause rebound increase of symptoms later that evening. I think swimming is just fine.

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.

[Ana1982]

#20615

Dear Dr. Corenman,

thank you, I truly appreciate your answer. Obviously, I need to do a fresh MRI with gadolinum to discover what’s truly happening. In the meantime, I hope you don’t mind me asking another question.

I do daily stretches, one of them being lifting legs straight while lying down. Before surgery, I couldn’t do this without there being a sharp, stabbing pain in my back, when lifting either leg, especially on the right side. Now I can do it pain-free. All I feel is the tightness in my hamstrings, no stabbing pain like before. Is this “straight leg test”of any relevance for determining whether it’s a reherniation or not? I am aware it might not be a positive test, but I was just wondering whether it meant anything.

Thank you for your answers and your advice,

Ana

[Donald Corenman, MD, DC]

#20620

Any activity that causes the leg to bend at the hip (hip flexion) with the leg straight (no bent knee), will stretch the sciatic nerve and the hamstring muscle at the same time. The loss of this pain after surgery is a good indicator that the nerve is relative free of compression.

If the nerve is still irritated or swollen, there can still be pain present, greater on the side of the prior herniation. It takes time for this swelling to reduce as noted before.

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.

[Ana1982]

#20625

Dear Dr. Corenman,

I sincerely thank you for your helpful advice. If I lived in the US, I would certainly choose you to be my doctor.

I am happy to tell you that the buttock pain reported before has significantly subsided. I had a few physical therapy sessions (electrotherapy including tens, magnet therapy and laser therapy) that made things worse almost immediately, but for the last two days I have been doing much better. I am still doing my exercises daily, plus swimming every other day and overall I am feeling pretty good.

However, in the last two days, I have noticed some nerve tingling down my right leg, at the back of the knee, heel, and the big toe. It’s not painful. It’s just a sort of sensitivity I haven’t had since the surgery. Could it be that I haven’t walked enough? Other than swimming, exercise and two hour-long walks a day, I have been spending most of my time in bed for the rest of the day.

Should I increase my walking? I am going back to work in roughly 10 days. I have a sitting job, 3 hours total commuting per day. That’s going to be almost 12 hours on my feet a day. How to best prepare for it, if there is a way? I know it would be best to still be on sick leave, but this is not possible. Is there a way to increase my physical fitness before work, so that the chance of having pain during the workday stays minimal?

I thank you from the bottom of my heart for your answers.

Ana

[Donald Corenman, MD, DC]

#20657

“Nerve tingling” or paresthesias are common post nerve decompression. These symptoms might be annoying but don’t pay too much attention to them as these paresthesias tend to go away over time.

“Work hardening” is a specialty in physical therapy so you might contact a specialist to see if they can help you. If this service is not available, try to do activities at home that mimic your daily work schedule to develop muscular conditioning and a “reserve” for the initial days at work. You will be fatigued the first couple of days until you develop stamina.

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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