buttock nerve pain post microdiscectomy

Tagged: Symptoms after a microdiscectomy

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Donald Corenman, MD, DC
Moderator

March 22, 2021 at 1:15 pm

Post count: 8660

#33787

“Three weeks after surgery I had a small accident sliding on ice after which I felt my symptoms slightly aggravated but not dramatically”. Should be OK.

“January 28th 2020 – MRI” Was this with gadolinium?

“1-2 days of aggravated pain which force me to lay down for most of the day to recover”. This can be a recurrent HNP or chronic radiculopathy.

“My first surgeon is proposing again a revision surgery based on these results….another surgeon to get a second opinion as the image is not really clear to me. My osteopath/physio is recommending to wait it and if in 3 to 6 months my symptoms are not getting better then consider a revision surgery”.

Get another opinion to make sure the information you have is correct. It is not wrong to wait further while getting a second opinion. Please report back after getting a second opinion.

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.

seb_nied
Participant

March 22, 2021 at 1:36 pm

Post count: 24

#33789

Thanks a lot Dr. Corenman for your answer.
None of my MRIs were done with gadolinium, should I request one with in the eventually of another surgery? Perhaps would this help to understand if I am facing a potential chronic radiculopathy or if there is something touching and irritating the nerve?
Will report the opinion of the second surgeon, I am meeting with him the day after tomorrow.
Regards,
Sebastian

Donald Corenman, MD, DC
Moderator

March 22, 2021 at 1:44 pm

Post count: 8660

#33790

Make sure your next MRI has gadolinium.

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.

seb_nied
Participant

March 24, 2021 at 4:42 am

Post count: 24

#33798

Hello Dr. Corenman,
just got a second opinion from another neurosurgeon.
He states there is clearly a recurrent herniation or a small fragment from the first surgery which is still compressing the S1 nerve root. Additionally this is aggravated by the nerve swelling which he could clearly see on the MRI. He is also of the opinion that a revision surgery is necessary as after 3 months I still do not have any noticeable improvement of my symptoms. Answering my question if time will help he said “you can wait but I really doubt that without a revision you will get better”.
Apparently the first surgery was done well, no material was removed from the facet joints and the residual scar tissue is not causing any problems from what he can see.
He suggested that a revision surgery should be minimally invasive and should aim only to remove the residual disc material and remove any material from facets and lamina. Apparently the hole in the disc from the original herniation was really big and it most likely caused the reherniation. He also mentioned for the revision surgery it would be good to use some sort of scaring agent on the disc to improve the healing of the hole.
I am feeling in a limbo now. I am hearing a lot of opinions that for the long term (>6 months) a surgery and conservative treatment will have the same effect, also in this forum. On the other hand I have opinions from 2 neurosurgeouns that a revision is necessary.

Donald Corenman, MD, DC
Moderator

March 24, 2021 at 8:04 am

Post count: 8660

#33801

“He also mentioned for the revision surgery it would be good to use some sort of scaring agent on the disc to improve the healing of the hole”. This worries me somewhat as the root lies right on the annular tear. What is to prevent the scaring agent from scaring to the nerve root?

I think your case is somewhat different from the typical “6 month rule” that you will have the same results for surgery vs waiting a further period. You do have a recurrent disc herniation and with symptoms that are impairing and not improving, a redo microdiscectomy might be the better approach.

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.

seb_nied
Participant

March 24, 2021 at 8:54 am

Post count: 24

#33805

Thank you very much Doctor for the feedback, really appreciated.

I don’t know what he meant when he was talking about this scaring agent, I understood it was something that would help the annular tear to heal, but it was unclear to me how. I didn’t ask about details as it didn’t seem too relevant at the moment as he will not be the one eventually performing the surgery.
Your statement “What is to prevent the scaring agent from scaring to the nerve root?” makes total sense to me and I will report this to the surgeon during our next discussions.

I will talk with my first surgeon to set up a date for teh operation.

Also, would you agree with the approach of preserving as much as the facet joints and lamina instead of removing material to further free up the nerve root?

Regards,
Sebastian N
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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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