Continued Back Pain After Surgery

Tagged: back pain after a lumbar microdiscectomy

Viewing 4 posts - 1 through 4 (of 4 total)

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koobi336
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July 2, 2019 at 10:42 am

Post count: 10

#30675

Hello Dr. Corenman,
I have written before, but still have an issue and wanted some current advice on a specific question.

My history is I had a micro-discectomy L4/L5 back in 12/3/2018. There was dural tear that was not discovered until later and developed into a large psuedomengicel, so I had a second surgery 2/7/2019 to repair and suture the dural tear.

I had an MRI since the 2nd surgery and it showed the psuedomengicel fully enclosed and getting smaller, so it seems the spinal fluid leak is stopped. There is some degenerative disk issues, but not showing a re-herniation. They said they did not see any nerves that seemed to be compressed or entrapped by scar tissue (can you see this well from an MRI?). X-rays showed no spinal alignment issues that would account for this continued pain.

I never had back pain before the surgery, just sciatica in my leg, but I have had continued back pain and leg/foot numbness since and it has been almost 5 months since the second surgery. The pain is lower back and even into the tailbone. I can’t sit long at all. It is getting some better with time, but the slightest exertion will set me back to more pain.

I have read many pieces of advice that suggest yoga and/or pilates to help with back pain. However, what seems to set me back the worst is whenever I do any yoga stretches or poses that pull the knee to the chest or stretch the lower back it sets me back a week or more with pain.

My specific question is, do you think this stretch hurts because I am too tight and I need to push through the pain and just continue doing it? Or, am I best off not doing anything like this that I know makes it worse and just give it more time? If this is caused by some sort of nerve adhesions and it is just going to continue unless I can break them free then maybe I need to push through the pain. But, if it is caused by nerves still healing and needing to not be irritated further until they heal then I don’t want to do anything that further irritates. Just not sure what option I should take here. Thanks for your advice.

Donald Corenman, MD, DC
Moderator

July 8, 2019 at 7:53 am

Post count: 8660

#30708

MRIs are generally accurate for nerve compression and scaring but since the MRI can resolve down to about 2mm, there are some things that can be missed. “They said they did not see any nerves that seemed to be compressed or entrapped by scar tissue (can you see this well from an MRI?)”.

Back pain after a microdiscectomy can be generated by a degenerative disc as the disc can be incompetent (by definition or you wouldn’t have had the HNP in the first place). If the back pain is only on one side (the side of the herniation) and always accompanies the buttock/leg pain, this pain can be nerve root related. However if the pain is central and can come on independent of the buttock/leg pain, it probably is discogenic in origin.

If stretching the hamstring triggers the pain, this is the same maneuver as stretching the sciatic nerve. This can cause immediate pain or delayed onset pain (6-12 hours later) and is an indication of either a continued fragment compressing the root, adhesions or chronic radiculopathy (see https://neckandback.com/conditions/chronic-radiculopathy/). Maybe consider a selective nerve root block to calm down the nerve (https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic/).

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.

koobi336
Participant

July 8, 2019 at 8:37 am

Post count: 10

#30711

Thanks for your reply. Would it be an acceptable strategy to just try to not do anything that I know aggravates the nerve for awhile and see if it will calm down on its own? I assume the only reason to continue doing the hamstring stretch would be if this chronic radiculopathy is caused by adhesions then it may help to break those up, otherwise it would be best to just not do it since it causes the nerve to be more irritated right?

If the nerve root block is very advantageous for healing and actually contributes to the healing then I would consider it, but if it is just to relieve the immediate pain while the natural healing takes place then I can deal with the pain. Is that the case or would the nerve root block aid in the healing? Thanks.

Donald Corenman, MD, DC
Moderator

July 9, 2019 at 8:35 am

Post count: 8660

#30720

This is the art of medicine as there is no absolute rule to follow when stretching the root. Too much and you will “pay for it later”. Too little and the scar can contract, shortening the root even more. There is no penalty for waiting. Time is on your side. The nerve block can accelerate healing and break the pain cycle but there is no guarantee.

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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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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