Four month post microdiscectomy complications?

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bill335
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July 27, 2012 at 1:42 pm

Post count: 10

#6598

Hi Dr.

I had a micro-d operation on the l5-s1 fours months ago for a very large right herniation that was pitching the S1 nerve. Before surgery, the pain had gotten to the point where I had to pretty much lay on bed all day as it was pinching the S1 nerve causing me to limp when walking on top of pain for two months.

Post surgery I felt great, usual flare up the first couple of days but felt great for the first 6 or 7 weeks. Walked and stand almost pain free, just a small amount of pain here and there. Followed Dr’s instruction to the T regarding lifting and twisting. Started PT the 8th week or so and every since it has been down hill. I started noticing bad right calf pain to the point where I had to take two Advil or Aleeve to get through the day.

The doctor prescribed a week course of Prednisone which helped a lot. Calf pain mostly gone but now have back pain and pain around the right paraformis and thigh. Cannot stand for longer than a hour without pain. Laying down for 15 minutes and pain will be gone but standing up it will come back after say 30 or so minutes. The pain is a lot better than before surgery but it’s enough to effect me from doing much.

Dr. then put me on Neurotin (Gabapentin) 300mg x 3 a day. I have been taking it for a month and haven’t notice anything besides giving me blur vision and being drowsy.

So my question is, does this sound like a reherniation or the nerve “waking up big time” at the 7th week post surgery mark?? Everything I read online seems to indicate people being in lots of pain and nerves waking up earlier, like the first couple of weeks of surgery, and not vice versa like mines. It is now four months and has been very depressing seeing progress go backwards from the first 2 months. Is it time to ask for a second MRI?

Donald Corenman, MD, DC
Moderator

July 28, 2012 at 10:30 pm

Post count: 8660

#6612

If you had good results for eight weeks after a microdiscectomy and then started with recurrent leg pain that has crescendoed, I would put a recurrent hernation near the top of the list for diagnosis.

Chronic radiculopathy (see website) is a possibility but this is a diagnosis of exclusion. This means all other possibilities have to be ruled out before this diagnosis can be entertained.

A new MRI of your lower back with gadolinium would be the next step if you were my patient.

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.

bill335
Member

July 31, 2012 at 8:21 am

Post count: 10

#6629

Thank you for the reply Dr. Corenman. I’ve ask the Dr’s office for a 2nd MRI, hopefully they can get in approve soon and let me know what is going on back there.

bill335
Member

August 6, 2012 at 7:28 am

Post count: 10

#6663

Hello Dr. Corenman,

I did the 2nd MRI last week, can you please help with interpreting the results. Thank You.

_______________________________________________________________________
Findings:

General description: Patient is status post right L5 laminotomy and microdiscectomy. Vertebral bodies are normally aligned. No signal is homogeneous. No evidence of compression deformity. Conus medullaris terminates at T12 and is normal in caliber, contour and signal.

Level by Level description:

L1 – L2: Normal

L2 – L3: Normal

L3 – L4: Normal

L4 – L5: Normal

L5 – S1 There is moderate loss of disc height and disc dessiccation. There is a broad base disc protrusion present measuring 4mm in AP dimension resulting in very mild effacemenet of the anterior thecal sac without substantial central canal stenosis. There is is mild caudal neural foraminal stenosis bilaterally. Patient is status post right-sided microdiscectomy. No evidence of exiting L5 nerve root compression. There is enhancing granulation tissue at the right lateral epidural space encasing the right S1 nerve root at the lateral recess.

Impression: Status post right L5 – S1 laminotomy and microdiscectomy. No evidence of exiting L5 nerve root compression.

Enhancing granulation tissue encases the right S1 nerve root as it traverses the lateral recess.

_____________________________________________________________________

It appears there is a disc buldge (or reherniation) of 4mm at the L5-S1? Will this self absorb with rest and time?

Is granulation tissue the same as SCAR TISSUE? I presume the granulation tissue is touching, pushing, trapping, poking, the right S1 nerve causing my right leg pain? Is there anything I can do to clear up the S1 nerve? More surgery? Injection? Shots? Just wait and rest? Or am I looking at being passed to a Pain Management doctor ……

I’ve stop doing PT stretches or much walking the past few months out of fear of making any problems in the back worst. Should I restart them?

My current symptoms are still the same as above. A assistant from the Dr’s office called and said everything looked ok and gave a new prescription for a single pain med until I see the Dr in a few weeks.

Donald Corenman, MD, DC
Moderator

August 6, 2012 at 9:23 pm

Post count: 8660

#6666

The MRI indicates that you have inflammatory tissue surrounding the nerve root now about two months after the surgery. There is some mild effacement of the root but according to the radiologist, there is no significant compression remaining.

Radiologists can misread the scans but assuming that he or she is correct, the root is now inflamed but not compressed. In my practice, the next step would be an epidural injection of steroid to reduce the inflammatory tissue.

PT is important but has to be performed with great care. Too much aggressive treatment, the root will become more inflamed and your leg pain will worsen. Too little therapy and you will not make progress. This is where the “art” of medicine comes in and a good therapist is worth their weight in gold.

There is always the possibility of foraminal stenosis at the level of surgery that has occurred after the herniation that has not been diagnosed but this would be unusual (see section on lumbar foraminal stenosis).

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.

bill335
Member

November 3, 2012 at 7:01 am

Post count: 10

#7324

Hi Dr. Corenman,

I’m back and needing your expert advice. So I’m a little over 6 months out of the Micro-D. Unfortunately, I still have leg pain, not as bad as before surgery but still enough to bother me daily.

I saw my Dr. who did the procedure shortly after my last post here with you two months ago. The only thing he said was that the nerves takes a long time to heal since my herniation was very large and nothing else. When I asked if Granulation tissue was scar tissue his answer was it was “healing tissue”. Well, it didn’t leave me with much to say considering the radiologist noted it under his impression which really worrys me. I asked for a epidural but he said no. Got a Rx for Ibuprofen 600mg and Lyrica.

My question is, will inflammation of the nerve/nerve root still exist 6 months after surgery? Unfortunately, I’m not sure if I really irritated the nerve since last week because I noticed a little extra increased in leg pain since last week. Time for a steroid pack?

I need to take one 600mg Ibuprofen at lunch to get through the day since returning to work 2 months ago. Is scar tissue really starting to form around the nerve root since I notice a bit of increase in extra pain in the leg since last week?

I am 6 months post microdiscectomy, so what are the options now really?

Have a great weekend Dr. Corenman!
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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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