Disc reherniation confirmed by MRI... surgeon and pain mgt don't sound hopeful.

Tagged: microdiscectomy, reherniation

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LA_Frankie
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January 31, 2021 at 8:58 am

Post count: 21

#33597

You mentioned a few things I thought I would comment on to hopefully set your mind at ease.

I know the absolute frustration of re-herniating. After all, it was the WORST CASE SCENARIO, right? That’s all we talk about the surgery, what is the rate of re-herniation… some say 5%, some say 20%. Well in our case it happened.

I also sought a second and third opinion before committing to revision with my original surgeon. Despite my original surgeon’s reputation, which was very good, I needed to hear at least 3 to 5 other professional opinions. The more I heard the more I was told to give it time.

I was able to walk and function after the re-hern which was MUCH better than prior to surgery when I was bed ridden, in pain 24/ and on pain meds for 12 weeks!

I also suffered severe compression/displacement of the S1. So much so that I experienced neurogenic atrophy in my gluteal and hamstring, some in my calf as well. I am still fighting my way back from that set-back. The muscle may or may not return, time will tell.

And that is the golden rule here: time will tell.

I will tell you what one of my most trusted sports med MDs told me, “If you can function and you are not in tremendous pain, give it at least 6 months before you decide anything.”

I re-herniated 5 months ago. My surgery was 8 months ago. I feel I am 80% back. I did PT a lot, and it was a slow progression. I had some set-backs, but I kept starting back up. I still do my functional strength exercises at home 4-5 times a week. It’s a long haul but it’s better than going under the knife again and increasing your LIFETIME RE-HERNIATION RISK TO 25-30%.

That’s right. Revision surgery will raise your re-herniation risk even higher. That is what made me decide to avoid it at all costs.

I hope you recover fully.

Donald Corenman, MD, DC
Moderator

January 31, 2021 at 10:08 am

Post count: 8660

#33601

Again, indications for microdiscectomy surgery are motor weakness, intolerable pain or functional loss of activity. A recurrent herniation has the same rules.

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.

seb_nied
Participant

January 31, 2021 at 11:33 am

Post count: 24

#33604

Thanks a lot for your comments Frankie.

It helps hearing this from someone that went though the exact or even worse scenario.

Dr. Corenman, thanks also for your comments.
Just one question, when you say “motor weakness and functional loss of activity” what do you exactly mean? Is there a test which can be performed to understand if there’s a concerning motor weakness? Is the 10 raises on toes the right test to do? And how can the residual motor weakness after the surgery be differentiated from the one due to the new herniation?

Thank you both again for your comments.
Sebastian

Donald Corenman, MD, DC
Moderator

January 31, 2021 at 12:12 pm

Post count: 8660

#33605

If you initially had motor weakness, then the improvement prior to the new herniation is your new baseline. For example, if you had an L5 root compression and couldn’t walk on your heels initially but had some strength recovery (could take 4 steps keeping the toes up-heel walking) prior to a recurrent herniation causing total inability to heel walk again, that is progressive weakness due to recurrent herniation. Most cases are however, not as straight forward.

Function means what you can and can’t do in the presence of the herniation. If you can’t surf due to the herniation and surfing is your passion, is that enough impairment to prompt you to choose surgery? If you are three months out and still can’t, that is an indication for 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.

seb_nied
Participant

May 5, 2021 at 4:27 am

Post count: 24

#34037

Hi Frank,
dont’t know if you are still following this post but I thought I will ask you how you are after these several months.
I’ve been doing better with the leg pain since the reherniation but since I have started doing some more PT and exercises my back pain started to ramp up.
I wonder if back pain was also bothering you after reherniation.
Hope you are doing well overall and you are close to 100% now!
Cheers,
Sebastian
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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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Disc reherniation confirmed by MRI… surgeon and pain mgt don’t sound hopeful.