buttock nerve pain post microdiscectomy

Tagged: Symptoms after a microdiscectomy

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george
Participant

January 16, 2021 at 2:20 am

Post count: 10

#33548

After viewing the MRI, my surgeon word were:
“you have a recurrence, but it does not seem a severe compression, in addition the fragment seems to have a tendency to dehydration, so it may shrink over time
if the pain is not so bad, I’d say we should wait.”

What do you think about this approach?
Why the recurrence happened so soon, are there any reasons for this or it just happens?
I’m feeling hopeless right now, it’s like turning back in time with 10 months but now with a larger herniation, which scares me because I’m a very active person, I was skiing, cycling and doing all kind of physical work and activities , that’s the reason why I went for the surgery , to get rid of the pain and to be able to do all this activities again.
What should I understand , that if the pain is not so bad I could live with it? Isn’t there a risk to get worse considering that the herniation is larger than the first time, will I be able to have an active life or,any kind of sudden move or strenouos activity might agravate the situation?

Thank you very much for your time.

Donald Corenman, MD, DC
Moderator

January 21, 2021 at 9:27 am

Post count: 8660

#33561

Unfortunately, recurrent herniations occur for no reason at all at about a 15% rate. I’m not as worried about the size of the recurrent HNP as your symptoms. If the pain is tolerable and you have no motor weakness, then conservative treatment can continue. If however, you have pain that you cannot tolerate or motor weakness, I would recommend a redo microdiscectomy.

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.

george
Participant

January 26, 2021 at 2:55 am

Post count: 10

#33570

Hello Dr.Corenman,

The pain is tolerable and it doesn’t prevent me from walking, however 4 days ago I’ve started to exercise(kinetotherapy) and the pain intensified a little bit , especially when I’m sitting.Is this normal?
If I may, I want to ask you another thing , is it possible for the herniated fragment to dehydrate, so it may shrink over time, as my surgen told me?
Have you encountered this in your career?

Thank you for all your answers.

seb_nied
Participant

February 6, 2021 at 12:34 am

Post count: 24

#33621

Hi George!
I see you are in a very similar situation as I am. Had a recurrent herniation after my microdiscectomy which is giving me some troubles. My doctor told me the exact same thing you wrote, that the new herniation is white in the middle meaning it has a chance to dehydrate, but if it doesn’t then it would eventually calcify and will need to be removed. I was wondering how you are in the meantime.
Cheers,
Sebastian

george
Participant

February 6, 2021 at 10:29 am

Post count: 10

#33627

Hello Sebastian,

Sorry to hear that you are in a similar situation.
I was waiting for doctor Corenman to reply, if he had any similar cases, if it’s really possible for the fragment do dehydrate and what exactely that means, besides the fact that it might shrink, because in my logic, if it will dehydrate that equals to calcification, but is just my assumption.
Let’s say it will dehydrate , I was wandering if it’s safe to live with it there , what that means for the future?Maybe your surgeon answered to this kind of questions?
I don’t know how big is your reherniation, mine is bigger than the first one,but like Dr Corenman said in previous replies , it’s important where is the herniation located in the canal, the symptoms are related to the location.
Since I’ve wrote the last reply, my symptoms improved a little bit, I don’t know if it’s because I started to exercise or because it’s dehydrating…
I’m planning to make another MRI in a few months to see exactely what’s going on there, I’m really affraid of another operation considering what happened.
I hope your condition will improve ,I know it’s hard but we need to be patient for now I guess .

Donald Corenman, MD, DC
Moderator

February 6, 2021 at 10:49 am

Post count: 8660

#33628

Any new or recurrent fragment can dehydrate and lose some volume, reducing the compression on the root and allowing less symptomatology. The “white” within the fragment in a T2 image certainly could be water and have a better chance to lose volume (compression) but no one knows if that will happen or how long it will take. In the face of motor weakness or impairing pain, a redo microdiscectomy should be considered. If the pain is tolerable and no weakness is present, I would recommend an epidural injection which can dehydrate the disc fragment more rapidly and stabilize the pain generated by the nerve faster.

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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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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