[Donald Corenman, MD, DC]

#27019

I am always here on the Forum.

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.

[AMWalker]

#27039

Hello Dr. Corenman,

I had begun a little light stretching which had somewhat excited my nerve, but after an undisturbed nights rest it was feeling better. About midday on the following day I attempted to remove a sock while standing, by hooking my big toe into the ankle of the sick on the other foot and pushing it off. The foot I was balancing on was my symptomatic leg pre surgery. I felt a sort of snap/pinch in the outside buttock area that gave me a jolt and since I have had an increase in pain along an all too familiar pattern along my leg, with slight tingling in the buttock and a reduce tolerance for walking without inducing pain into the calf. There is also an intermittent sensation of coldness on the outside top of the foot.

I am trying to not be overly alarmed at this point and am chalking it up to an incidental muscular entrapment of the nerve, but needless to say the recurrence of old symptoms is disconcerting. I’m not certain if such a mechanism for nerve excitement or inflammation is sufficient to explain my symptoms. Can symptoms of reherniation come on gradually, or is there almost always a precipitating incident that is obvious? I have almost no back pain or pain at the incision site.

Thank you for your time.

[AMWalker]

#27040

After a little investigation and feeling around on my back/buttock, I suspect the nerve may have been temporarily entrapped in the foramen, but I can only speculate. Is this is indeed what happened, is it likely to be a persistent problem given the collapsed disc space? Will it be ameliorated by enhancing the muscle tone on supporting structures that have lost time as a result of the injury?

[AMWalker]

#27043

Further investigation has led net to consider a movement of the iliolumbar ligament as the cause of this latest problem, given the “snap” sensation and that occurred during an awkward movement. Could that ligament or other similar ones nearby, have pinged of the nerve root, irritating it? I do have pain to the left of the midline and at the top of the iliac crest in that area, sensitive to pressure. Though the nerve excitement down the leg has thankfully abated, there is still pain at the root, exacerbated by a straight leg raise around 30 degrees and ambulating has become more strained and painful. Any insight you might have is greatly appreciated.

[Donald Corenman, MD, DC]

#27069

Your symptoms could be from a recurrent disc hernation. As you say, the disc collapsed after the hernation so foraminal stenosis is a possibility but less likely. The iliolumbar ligament is nowhere near the nerve root so cannot cause compression or injury to the root.

Give it time. If the symptoms become more problematic, you can ask your surgeon for an oral steroid which can be helpful to reduce inflammation.

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.

[AMWalker]

#27075

Thank you Doctor. I have all but ruled out recurrent herniation, as the sciatica like symptoms gradually faded since the incident. Nevertheless a pain persists deep in the buttock about an inch from the midline and three to four inches down from the incision L5-S1. There is also pain in the hip joint and the outside of the hip, and some along the rear rim of the ilium. I am on my second day of a six day prednisone pack, which is helping.

I am considering sacroiliac strain, sprain or misalignment to be the cause. I have been suspicious of this problem throughout the course of my injury in addition to the sciatica, at various times feeling it to be “out” or “jammed”. A chiropractor has helped in the past and once or twice I’ve had it accidentally readjust on its own, with a “pop” and some relief. It hadn’t been an issue in the weeks leading up to surgery, nor after, and until this latest incident I had all but forgotten about it. With the nerve compression now relieved, it is easier to sort out these overlapping and mimicking conditions. What I thought was sciatica since this latest incident was referred pian in a slightly different area.

I am still at a lack for understanding the mechanism for SIJD as it relates to disc herniation, though I realize there does seem to be a medically recognized correlation. Could the muscle weakness resulting from nerve compression lead to destabilization of thejoint? Mechanical changes in the spine thahave causeD ligament laxity? More important, how shall I proceed with a diagnosis at this point, and when and what modes might I seek for safe adjustment since my surgery?

I appreciate your insight and tireless service to your field. I can’t thank you enough for providing a valuable resource for sorting out these often complicated issues.

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