Four month post microdiscectomy complications?

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Donald Corenman, MD, DC
Moderator

February 24, 2013 at 12:07 am

Post count: 8660

#8070

After a disc herniation, the disc will be narrower and have less shock absorption ability. This narrowing however rarely causes symptoms. Only about 10% of patients will develop lower back pain after the herniation.

There really is no way to reduce the chances of the disc becoming painful other than changing occupations (no more ditch digging) or advocations (stopping running, tennis and other impact sports). However, since the chances are only 10% that lower back pain will occur, I really see no need to modify your lifestyle.

Why some individuals have lower back pain with the exact same disc changes as others who have no pain is a Nobel prize winning question. The answer probably has to do with nerve innervation and sensitization.

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

April 28, 2013 at 5:07 am

Post count: 10

#8520

Hi Dr. Corenman,

Just a one year update. For the most part I feel good, not 100% but a lot better then one year ago. I’m here for some suggestions again from you.

I have this strange symptom now:

This new problem started about 3 or 4 weeks ago. I noticed that my incision site has started to hurt when I touch it, it’s ok when I leave it alone. I use to massage/touch it with my fingers with zero pain. It now feels tender and the color of incision site, to me at least, looks a little more red that then what I think it should be for one year out (looking at the incision site when dry). I do use a small ice pack and electric heat pad daily after work. On top of this, I noticed a small Skittle size (lump?) at the incision site, comes and goes. I cannot always feel it especially after Ice or Heat on the back.

I have gotten a couple of bouts of pain down the right leg after noticing this new problem but it lasted for only a couple of seconds and completely gone afterward. No where as bad as before. Not sure if this had anything to do with the incision site problem or inflammation. Sitting is about the same as before.

Other then this new problem, it’s been ok. Progress is slow but steady. I look forward to your reply and again Thank You.

Donald Corenman, MD, DC
Moderator

April 28, 2013 at 10:20 pm

Post count: 8660

#8521

This, more likely than not is a small filament of sensory nerve that is “caught” in the incision and has become inflamed. If the incision is only tender (no pain but for touch) and not painful without direct stimulation, it might be annoying but not problematic.

You can try capsicum cream on the incision (over the counter) to reduce the irritation. This should slowly go away over time.

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

May 1, 2013 at 4:05 am

Post count: 10

#8551

Hi Dr. Corenman,

I had a chance to visit the doctor because the area looked a little worst compare to the weekened and the diagonisis was granuloma if I heard correctly. Before seeing the doctor, I had applied some Neurospirin and stuck a band aid on it and over night I guess a small area of the incision “burst”? Defintely more painful after the area burst. I called and explained the situation to the Doctor’s Office and luckily they managed to get me in asap.

Anyway, of course it had to turn out to be a non-normal siutation. Was told to wash the area with soap (I use Dial) and continue with Nerospirin and bandaid and come back in a month. If it doesn’t close by then the Dr. said he would have to stich it up again. Of course the only thing that came to mind was “WHAT THE”.

My concern now is granuloma bascially means the incsion has reopened? How does it reopen after a year? Do these things really closed by itself? Is there anything I should look out for, not do or do in the mean time to prevent the situation from getting worst?

Thanks Doc.

Donald Corenman, MD, DC
Moderator

May 1, 2013 at 6:11 pm

Post count: 8660

#8557

A granuloma is essentially a collection of white blood cells that are trying to surround and eject a foreign body or infection. Sutures under the skin that have not yet dissolved can cause a granuloma. If the sutures were of the non-dissolving type, this is not uncommon. Dissolving sutures should have been resorbed after three months.

A late small focus superficial infection is unusual but not unheard of. The plan to use dial soap to clean the incision and allow the incision to “granulate in” is a standard treatment. Antibiotic ointment can keep the opening clean and moist while the incision is healing.

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

June 11, 2013 at 11:06 am

Post count: 10

#8865

Hi Dr. Corenman,

Just wanted to update, visited the Dr. last week and got the good news, the wound has closed. Wasn’t one of those typical paper cut wound that closed in a few days, this took the entire month to close with daily soap, antibiotic ointment and bandage.

Starting to feel a lot better, still not 100% but a lot better. Thank you for taking the time out to answer my questions the past 10 months. Nothing short of amazing getting such a precise, assuring, quick answer from you.
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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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