Buttocks pain after L5 / S1 microdiscectomy

Tagged: leg symptoms after a lumbar microdiscectomy

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Donald Corenman, MD, DC
Moderator

June 26, 2019 at 11:49 am

Post count: 8660

#30629

Increased pain 4 days after surgery is concerning. A new MRI was appropriate. Two MRIs within 6 weeks maybe means the second MRI was not of good quality. I will assume that infection was ruled out through imaging and lab tests as that is a possibility for your symptoms.

If no infection, a steroid injection would be the next suggestion. Make sure you don’t have lateral recess stenosis which would require a redo decompression or foraminal stenosis which would require a fusion.

See https://neckandback.com/conditions/lumbar-foraminal-stenosis-collapse/ or
https://neckandback.com/conditions/lateral-recess-stenosis/ to see if either of those fit your 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.

nbassano82
Participant

June 26, 2019 at 4:25 pm

Post count: 4

#30630

Thanks for the quick reply. I don’t believe foraminal stenosis as that was never shown before or after the surgery on the MRI w contrast. My surgeon believes it’s nerve irritation. It’s been 6 weeks and I haven’t noticed any improvement. I did have the epidural steroid injection about 2 weeks ago but that didn’t help either. What is a reasonable time frame for nerve pain to last? It feels like anything more than walking causes a lot of irritation and makes it worse. I’m

My surgeon offered do a revision and try to create a little more space off the nerve.

nbassano82
Participant

June 28, 2019 at 4:41 pm

Post count: 4

#30646

Hi dr. Corenman

Here is my follow up mri about one month post surgery. For some reason. They didn’t release it to me until I asked.

Impression
Similar residual/recurrent left paracentral/foraminal disc protrusion compressing and posteriorly displacing the left S1 transiting nerve root. Improving enhancement of left S1 transiting nerve root and left lateral epidural space. Decreasing postoperative fluid collection.

Narrative
MRI LUMBAR SPINE WITHOUT AND WITH CONTRAST

** HISTORY **:
36 year old man, status post microdiscectomy L5-S1 left, which was done on 5/13/19.

** TECHNIQUE **:

MR images of the lumbar spine were acquired without and with 8 mL Gadavist intravenous contrast.

COMPARISON: Postoperative MRI 05/24/2019

** FINDINGS **:
NUMBERING: Last fully formed disc space is designated L5-S1.

SPINAL CORD: Normal conus. Conus terminates at the L1-L2 level. No abnormal intrathecal enhancement.

DISCS: Similar disc desiccation and mild disc height loss at L5-S1. Redemonstrated is the residual/recurrent left paracentral/foraminal disc protrusion compressing and posteriorly displacing the left S1 transiting nerve root (series 6, image 14). Improving enhancement of the left S1 transiting nerve root, left lateral epidural space. There is small fluid collection following the left L5-S1 hemi-laminectomy. The fluid collection in the region of the left epidural space measures approximately 0.9 x 0.9 cm (series 9, image 15). Superficially within the subcutaneous tissues of the fluid collection measures 1.5 x 0.9 cm (series 9, image 14), which is smaller in size previously.

BONES: Vertebral body heights and alignment are normal. Marrow signal is normal.

SOFT TISSUES: As described above.

T12-L1: No spinal canal or foraminal stenosis on the sagittal plane.

L1-L2: No spinal canal or foraminal stenosis on sagittal plane.

L2-L3: No spinal canal or foraminal stenosis.

L3-L4: No spinal canal or foraminal stenosis.

L4-L5: No spinal canal or foraminal stenosis.

L5-S1: Redemonstrated is the residual/recurrent left paracentral/foraminal disc protrusion compressing and posteriorly displacing the left S1 transiting nerve root (series 6, image 14). Improving enhancement of the left S1 transiting nerve root and left lateral epidural space. There is small fluid collection following the left L5-S1 hemi-laminectomy. The fluid collection in the region of the left epidural space measures approximately 0.9 x 0.9 cm (series 9, image 15). Superficially within the subcutaneous tissues of the fluid collection measures 1.5 x 0.9 cm (series 9, image 14).

OTHER: None

I’m having more pain now than before my surgery. Given the results. Would it be appropriate for a revision surgery or as my surgeon suggested wait thinking it will get better on its own. What would be a reasonable time frame. I don’t feel like waiting as the pain is bad.

Donald Corenman, MD, DC
Moderator

June 29, 2019 at 9:58 am

Post count: 8660

#30651

You have what I assume is a recurrent disc herniation at the same level (“Redemonstrated is the residual/recurrent left paracentral/foraminal disc protrusion compressing and posteriorly displacing the left S1 transiting nerve root”). The radiologist implies that this appears to cause the same amount of compression as the first disc herniation. It sounds like you might need a redo microdiscectomy. I don’t think waiting will improve the situation if your pain is worse than prior to the initial surgery.

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.

nbassano82
Participant

July 10, 2019 at 6:00 pm

Post count: 4

#30728

My Surgeon says that there is only a small residual annular bulge that is touching the nerve which he doesn’t consider compression. He indicates that a follow up surgery would be to explore the nerve root and make sure there isn’t something else that isn’t showing up on the mri.

It’s just really disheartening how sensitive the nerve is. I had been feeling well for a few day and then one day back at work and the sitting made me feel worse than I’ve felt in a long time. Is this all part of the healing process. Do you have any experience where a patient needs an exploratory surgery? FWIW I’m now about 8 weeks post surgery. Pain level sitting is about an 8.

Donald Corenman, MD, DC
Moderator

July 14, 2019 at 9:30 am

Post count: 8660

#30731

I am not clear if your surgeon is inaccurate in his assessment or the radiologist is exaggerating the imaging findings. By your lack of nerve root pain improvement after surgery and possible worsening pain, it could be that the radiologist is “more” correct. Whatever the surgeon wants to call it (“exploration of the nerve root”), a redo surgery and removal of that fragment seems to be the better pathway to take.

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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