[Donald Corenman, MD, DC]

#27078

You have not been ruled out from recurrent herniation if you have not had an MRI after the surgical date. Just because the pain pattern does not radiate far down your leg does not mean this is not radiculopathy. The more the nerve is compressed/irritated, the further the pain will radiate down your leg. If you have a small recurrent herniation, the pain pattern will feel like a sacroiliac joint pain pattern.

I am just publishing a paper that indicates only 6% of patients with SIJ pain have true SIJ pain origin. Most of the SIJ pain is generated by the lumbar spine.

The SI joint has no significant muscle mass that crosses the joint to stabilize it but it is an inherently stable joint.

I believe you need a new MRI and if there is a mass around the nerve (seroma or herniation), you would need a selective nerve root block if the symptoms do not improve. This will diagnose the cause of pain and lead to the correct treatment (if the injection does not give you long term relief).

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]

#27080

Ok, this is much as I expected after further reflection. I perhaps it is somewhat wishful thinking on my part to that it could be a musculoskeletal problem rather than neural. The pain is now more left of center, at the nerve root, slightly behind the knee. Also on the right side buttock, where I had no symptoms prior to surgery.

So far I am managing fairly well with the prednisone, gabapentin (200 mg midday and 200 mg before bed), as well as ibuprofen and turmeric root. I had been off almost all meds prior to this point. Walking has been mostly fine and sleeping also. I awake to little pain, but this morning I noticed it creep down the sciatic nerve as I got moving. What are the chances this will resolve conservatively given these facts?

Also, when should I reasonably expect my surgeon to order an MRI? I am 30 days post surgery and with there is a short window before the holidays. I am expecting company for the holidays and have engagements for the 25 and 26 and I’m terrified that my symptoms could relapse. The onset of symptoms after my first injury was very gradual.

[AMWalker]

#27081

One further question. Could facet joint pain create a similar response? I am feeling a little of a catch when I bend forward and to the right slightly.

[Donald Corenman, MD, DC]

#27083

Possibly facet generated pain but unlikely. You are currently on an oral steroid. Give yourself about 3-5 days after you discontinue steroids to assess your current pain status.

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]

#27084

Thank you Dr. Corenman. I suppose I will have to wait until the new year for more imaging. I’ll be crossing my fingers for a Christmas miracle.

[AMWalker]

#27698

This post is long overdue for an update. My MRI on 12/20/17 revealed no recurrent herniation, according to my surgeon. I am left to assume that my symptoms were due to nerve root inflammation.

Since then I have had a few more similar episodes, the worst of which occurred after over stretching. I was finally prescribed PT about 2.5 months out from surgery at my behest after having some hip bursitis, which has diminished. I was doing a supine rotational stretch when I felt a pull in my back. The next day after sitting in a theater seat for around an hour and some walking, I had strong back pain and some leg symptoms. It responded to a couple days of rest, ice ibuprofen and some Gabapentin. Needless to say at over 10 weeks out, it was discouraging to have a setback.

Other flare ups have occurred in the four weeks since then, induced by certain PT exercises, ice or twice by tweaking it the wrong was, as in adjusting myself in the car seat. It seems such flare ups are shorter in duration and they don’t travel as far down from the root. My strength and stamina and pain are all improving, but progress is exceedingly slow. I am able to dress myself, do some household chores and even lift and briefly hold my ~30lb son. However, I still have not returned to work as a carpenter, as I feel it would be too demanding and strenuous at this point.

I am less freaked out by the nerve flares now— I have learned how to avoid them and manage them when they occur. I feel fairly confident that eventually they’ll be mostly a thing of the past. I do have some other concerns at this point. Absent a flare up I wake up feeling pretty good, but after four or five hours of being vertical I get a deep pain in the center of the spine, at the level of the surgery and below. Interestingly when the nerve is flared up I either don’t have or don’t notice this bony spine pain. I’m curious what the mechanism for this pain could be, and what the chances are that it might resolve in time. As I say, it’s not constant, but seems to be brought on after being vertical or when my back gets fatigued. Sometimes it seems the more active I am the less I feel it, but then it is generally worse the next day.

I am working to strengthen my back and core, but I must be careful not to overdo it. I would be interested to have your insight as to why I notice the Transverse Abdominus activation exercises creating pressure on the nerve root. It seems the increase in abdominal pressure aggravates it an can lead to a flare up. At this point I am torn between how much to pursue my core strengthening and how much to leave the root unperturbed for healing.

Finally, my calf muscles seem to be the most recalcitrant to recovery. When I do a full body stretch upon waking it occasionally induces a cramp in the calf that creates sore tender spots that last for weeks afterwards. The cramps don’t happen at any time other than while stretching. Is this residual from nerve healing, or could this be indicative of some ongoing impingement? As a lay person viewing my latest MRI, I see some residual herniation in the saggital view that is slight indenting the thecal sac, but I don’t see any cause for alarm in the axial images. But my inexpert reading doesn’t mean much.

I am eager to hear any insight you might have on my condition and recovery. Thank you.

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