buttock nerve pain post microdiscectomy

Tagged: Symptoms after a microdiscectomy

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seb_nied
Participant

February 7, 2021 at 6:31 am

Post count: 24

#33631

Thanks both for your comments.

The opinion I received from my doctor was similar to what Dr. Corenman answered. The T2 image shows the herniation has a white interior and my doctor said it might dehydrate spontaneously and we will check it again in 6 weeks with an MRI. He also suggested to avoid any activity in the meantime (don’t do even PT) to not put any unnecessary loading on the spine. If it doesn’t reduce it will calcify and a second microdiscectomy should be considered to remove it as it will keep causing partial nerve compression.

In my case the new herniation is much smaller than the first one, the nerve looks to be partially free but I still have occasional flares and a dull feeling in my leg (strangely mostly in my knee). I’m doing only walking now and I noticed the more walking I do the more my leg feels tired in the evening causing me discomfort. Usually laying reduces my symptoms.
I think the symptoms are probably due to a combination of inflamed nerve from the previous herniation and surgery and a light compression from the new herniation activated only with certain activities that cause certain nerve movements. For example this morning when I moved my foot up I felt tingling in my three last toes which I figured it must have been caused either by a nerve stretch or movement that was causing the nerve to touch the herniation.

From how I understand it now, if the new herniation doesn’t dehydrate and it calcifies, it will not reduce in size and it will still be causing problems even if minor. I’m not sure now how much PT could help after that happens, as I see it more as a solution to reduce the loads on you spine by strengthening the supporting muscles and correcting your posture, but if you have a hard piece of disc protruding, PT will not remove it. Is then another surgery the only solution?

I’m surprised that my doctor didn’t recommend PT to treat the recurrent herniation at this early stage. Maybe this dehydration mechanism is unknown and as Dr. Corenman says no one knows if it will happen and how long it will take. I’m challenging the fact though that if something can be done to reduce loads on the spice in this early healing stage then probably it should be done?!

george
Participant

February 8, 2021 at 3:25 am

Post count: 10

#33633

You didn’t mention how many weeks have past since you had the microdiscectomy.
As you said you might still have symptoms from the first herniation and the surgery.
Maybe is too soon for PT as your surgeon told you.
Iniitially my doctor recommended to start PT two weeks after the surgery, but then telling him that I still have bottock pain and leg pain he told me to wait, then when it was one month after the surgery and I made the MRI he saw the new herniation and he told me that I can start PT if I don’t have intense pain, because I’m not at risk…
Same as you, I have doubts about how PT could help in this kind of situations, I always had then even before the surgery especially because for me it didn’t work before the surgery…
I never had an epidural, have you? As dr Corenman said, it might help.

seb_nied
Participant

February 8, 2021 at 5:04 am

Post count: 24

#33634

Hi George,
I had the surgery on the 30th of December so I’m hitting now the 6th week. The second MRI was done 4 weeks after the surgery and the doctor told me to wait for another 6 weeks from the recurrent herniation, meaning in total 10 weeks after surgery. I’m now 2 weeks after the recurrent herniation and I’m not in extreme pain, on the contrary, some days when I keep it easy I am almost pain free.
I’m kind of scared to start anything that might compromise my recovery but as I’m a very active person I also don’t want to lay down and just wait.
A lot of friends are telling me that PT helped them a lot that’s why I’m staring to seriously consider this option as I’m hitting now my 6 weeks after the OP.
I haven’t tried yet injections, the doctor at the hospital said this could be an option if the pain persists for weeks after the re-herniation.
Tomorrow I have a consultation with another doctor to review my two MRIs and my current situation. Will keep you posted!
Sebastian

seb_nied
Participant

February 10, 2021 at 4:01 am

Post count: 24

#33637

Hi,
A brief update from the visit with the new neurosurgeon yesterday.
He was very clear that there are 2 options, the conservative one and the surgery if the conservative one doesn’t work.
He proposed to go ahead with 3 cortisone injections (one every month) together with medications and physio. Medications consist in 3 days of cortisone pills (Fortecortin) and a cycle of nerve pain medication (Neurotin). If it comes to a situation that in one or two months I do not see any improvement and if the 3rd MRI that I have scheduled in 4 weeks doesn’t show any reduction of the new herniation I will probably discuss a revision microdiscectomy.
In the meantime he strongly suggested PT and try to move as much as possible. Double check with the therapist what kind of movements and exercises are recommend and start training my leg which is currently badly in atrophy.
I will continue with this plan and let know how it progresses.
Cheers,
Sebastian

george
Participant

February 10, 2021 at 10:23 am

Post count: 10

#33638

Hello Sebastian,

Thanks for the update.
How bad is your pain on a scale 1-10? Mine is a 4.Do you have pain when walking or when sitting or after sitting? When you say your leg is badly in atrophy , what exactely does that mean, do you feel it tight when walking?
I’m asking you because a lot of days during my recovery/after reherniation, especially when walking I felt this way, my leg was feeling like it was shorter, and something was keeping it tight in my bottock(I don’t know how to explain this better).Now it’s better but I still feel it that way sometimes.
I’m also considering cortison injections, please let me know if you feel better after the first one.
After you check with the therapist could you please share with me what kind of exercises he ore she recommended you?
I wish you well and let’s hope your situation will improve.

seb_nied
Participant

February 10, 2021 at 11:35 am

Post count: 24

#33639

Hi George!
Thanks for your message and for sharing your conditions. I’d say that my symptoms are pretty much what you described. I have a 3-4 out of 10 pain, really tight muscles in my calf and thigh, sometimes a cramp feeling mostly in the calf, high discomfort if my press with my knuckles on my buttock muscles and a loss of sensibility against temperature on my calf, my last three toes and bottom of my foot.
By atrophy I mean the size of my leg. I lost quite a substantial amount of mass from my calf, hamstring and buttock. That’s probably where the leg weakness is coming from. I think it’s slowly getting better as I’m able to do more calf raises without feeling cramps in the muscle.

I generally feel good during walking and laying, I’m feeling higher discomfort after sitting and standing for a longer time and also during the evenings if i do too much walking and standing. I’m thinking that my back muscles give up after a certain point and my leg pain gets worse. I found my sweet spot by doing 3 to 4 20/30-minute walks per days. If i do this sometimes I’m pain free.

I think this sounds like we are pretty much on the same boat! I will let you know my developments of course ;)

Cheers,
Sebastian
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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.

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