Constant sciatic pain 13 days after Microdisectomy

Tagged: recurrent herniation in the lumbar spine in the post-op period

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Nyc22
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October 28, 2018 at 6:48 am

Post count: 7

#29733

Hi Dr. Corenman,

I had a bilateral L5/S1 Microdisectomy and foraminatomy to remove a large left-sided posterolateral disc herniatiation that had migrated centrally. It had been causing constant sciatic pain in both legs and feet for 3 months. My surgeon said that extruded disc fragment was 3 cm in length. Prior to the surgery, I had 4 epidural steroid injections over the course of the 3 months. Since the surgery, the sciatic pain has been significantly worse than it was before surgery. This may be explained by the epidural steroids masking some of the pain. It is constant and I can only find some relief from lying down with my feet raised. I also have been taking naproxen 500mg twice a day with 1000mg of Tylenol every six hours. I am also experiencing some pain and muscle stiffness in my back where the disc fragment was located. I have done a bit of twisting, which I’m afraid has caused me to perhaps reherniate the disc. I know that I am supposed to be walking a great deal, but walking quite frankly makes me feel worse off than lying down. Should I just continue to walk if it increases the pain? I should also note that I live in NYC and it is difficult to do anything without walking. I’m afraid I’ve Been walking a bit too much—-I started walking around 2 miles a day the day after the surgery, but have walked upwards of 3 or 4 miles some days. I now am back to walking around 2 miles a day; would you advise walking less to relieve the pain? Is there anyway that this nerve pain can be relieved through another means? My surgeon won’t order another MRI to rule out a reherniation and won’t put me on a steroid pack to ramp down the inflammation because I used a lot of steroids previously. I’m supposed to return to work tomorrow, but I’m not sure how I can return in my current state. My apologies for all of these questions—I truly appreciate your help.

Donald Corenman, MD, DC
Moderator

October 28, 2018 at 5:45 pm

Post count: 8660

#29736

Your statement “Since the surgery, the sciatic pain has been significantly worse than it was before surgery” is generally unusual as with most post-surgery removed large herniated fragments, pain relief should be substantial. What normally is the residual is numbness-not pain. The first thing I would do is to obtain a new MRI. You could have a recurrent fragment, a missed fragment or a seroma (collection of fluids) that is compressing the root.

Is the pain only in one leg or is it both?

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.

Nyc22
Participant

October 31, 2018 at 2:51 am

Post count: 7

#29754

Thank you, Dr. Corenman. The Pain has been in both legs. My surgeon has still refused to give me an MRI, but agreed to put me on a steroid pack, which significantly reduced the pain (although there is definitely still pain.) I had thought all was moving in the right direction until I got out of a taxi yesterday and bended slightly while getting out (I was still wearing by back brace.) I felt a shooting pain in my right lower back near the right of the disc. I then felt shooting pain down my right leg. It has calmed down a bit, but my right leg now has around the same level of pain as before the steroid pack. Is it possible this is a reherniation or just a flare up of the nerve root? Not feeling horrible pain in the left leg and the disc was on the left side. In general, how do you know if you have a reherniated fragment versus a flare up? Thank you.

Nyc22
Participant

November 1, 2018 at 5:17 pm

Post count: 7

#29757

Dr. Corenman, I finally convinced my surgeon to get me another MRI. The MRI found that there is mild enhancing fibrosis in the operative site on the right side of the L5-S1 hmmilaminectomy and a small approximately 1.2 cm x 0.5 cm. seroma in the postoperative site (no definite communication with the theral sac is seen) There is also a small bilateral 2 cm x 1 cm posterior paramedic left and smaller, right posterior paramedian postoperative seromas seen in the subcutaneous soft tissues at the L5-S1 level.The MRI found enhancing postoperative fibrosis in the left hmmilaminectomy site and enhancing fibrosis surrounding the descending left S1 nerve root sheath.

Finally, there was some really not good news. At L5-S1, there is a small approximately 2.2 mm AP x 6 mm transverse dimension, non enhancing left foraminal disc herniation with mild left-sided foraminal narrowing. There is no spinal stenosis or right-sided foraminal narrowing. I only found all of this out from the MRI report. My surgeon actually told me on the phone that there was just some normal granular tissue near the disc since the surgery, but now I’m very concerned about this new, small disc herniation. Should I be concerned? What should I do about this herniation? Do you think this is the cause of my continued pain in both legs? Very nervous right now.

Donald Corenman, MD, DC
Moderator

November 4, 2018 at 7:50 am

Post count: 8660

#29762

I am surprised that your surgeon did not give your the full information regarding your current situation. The seromas by themselves can be compressive and cause radiculopathy. Even without the news of a separate disc herniation, these seromas can be treated with needle aspiration and application of a steroid injection (transforaminal epidural steroid aspiration and injection).

You do have some residual disc herniation or small recurrent herniation (“2.2 mm AP x 6 mm transverse dimension, non enhancing left foraminal disc herniation with mild left-sided foraminal narrowing”) which seems not to give you any symptoms (“Not feeling horrible pain in the left leg”). This can most likely be ignored if reasonably painless.

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.

Nyc22
Participant

November 4, 2018 at 8:21 am

Post count: 7

#29767

Thank you, Dr. Corenman. I am now having pretty intense left leg pain while the right leg pain has diminished. I’m also continuing to have pain in my lower left back. My surgeon claims that the herniation shown on the MRI is not really a recurrent disc herniation and seeing that is normal postoperatively. He will likely not elect for me to have an ESI as I had 4 in the 3 months prior to the surgery. I believe I’m maxed out on steroids at this point. Thank you for your continued help.
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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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