Glute pain 7.5 months post op

Tagged: Continued gluteus pain after a lumbar decompression

Viewing 6 posts - 1 through 6 (of 6 total)

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Thecarter
Participant

September 20, 2018 at 10:51 am

Post count: 7

#29395

Hi Dr,

I’m 7.5 months post microdiscectomy at the L5-S1 level on the left side. I had pain from my left lower back to the left side of my foot. I couldn’t walk it was so severe. My left leg started to get smaller.

It took several months for the pain to regress to tolerable levels and start physiotherapy. I was and still am doing physiotherapy several times a week and daily stretches / exercises, focusing on core, back and legs.

Recently, my recovery felt great and my physiotherapist recommended some exercises at the gym and to finish off in the pool.

I tried the elliptical (20 minutes) followed by several low weight resistance exercises. My lower back was supported with each one. I then went into the pool and swam for 15 minutes. That day, I felt fine. The next day I woke up and the left side of my lower back hurt. It did so for two days. Then I noticed a sharp pain in my glute periodically throughout the day.

I notified my physiotherapist who did the SLR test. The SLR test does NOT cause the glute pain.

It’s now been like this for 8 days. Random points through out the day, I feel the sharp glute pain.

Did I just cause a nerve flare up because this is the most active I’ve been now? Even though it’s been 7.5 months. I’ve been very confident in my recovery as of late, after a Rocky start. I’d hate to think it’s reherniated. I’m confident I didn’t do any activity to cause a reherniation, your thoughts?

I respect and value your opinion.

Thank you.

Donald Corenman, MD, DC
Moderator

September 21, 2018 at 7:06 am

Post count: 8660

#29398

You might have residual disc herniation that was quiescent until you increased activity or you could have a small recurrent herniation. At now 8 months after your original herniation with these symptoms, I would order a new MRI.

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.

Thecarter
Participant

September 21, 2018 at 8:27 am

Post count: 7

#29401

Hi Dr,

Thanks for the quick response. I respect and understand you can’t diagnose me without seeing me.

How long would you give these symptoms before prescribing an MRI?

The glute pain is only periodic through the day and SLR is negative.

Should I be giving this a timeframe? If the symptoms disappear in another week or two do you think it was a flare up or further investigation would be necessary?

I would be paying for the MRI privately so I’m trying to decide if I should get in it now or wait a bit.

Thanks.

Donald Corenman, MD, DC
Moderator

September 23, 2018 at 9:00 am

Post count: 8660

#29409

There is no rush now so you can wait. If the symptoms don’t resolve with increased activity, a new MRI should be considered.

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.

Thecarter
Participant

September 26, 2018 at 6:21 pm

Post count: 7

#29425

Hi Dr. Corenman,

This issue has been on my mind the last couple of weeks and I’m leaning towards the MRI, even if it’s for peace of mind. I did just want to run something by you please.

I’ve discovered what motion produces the glute pain. The glute pain on the affected (left) side is felt when I’m standing and I raise my left leg inwards in, knee bent, to put the left leg into underwear/shorts/pants. It’s faint but I feel it and it’s for less than a second.

I told my family doctor about these symptoms because I was also feeling pain to the touch on that trochanteric bump on my left leg. She doesn’t believe it’s a reherniation, she thinks it’s trochanteric pain syndrome. She recommended I work on strengthening the abductor muscle.

The sports physiotherapist I’ve been seeing for 4 months believes that it’s a strained ligament in the glute. His reasoning for this is the pain was not produced by the straight leg raise. Sitting, standing and walking does not provoke the pain.

To confuse me even more, I’ve noticed the left side of my left foot feels numb periodically through the day. I don’t know if it’s my mind playing tricks on me because my thoughts are about this 24-7.

What do you think is happening? It really throws me for a loop to think this is a herniation. I’ve taken the last 7.5 months so conservatively that I’m not even picking up my toddler children yet, no running, twisting, bending. Am I being naive to think that this isn’t a herniation? Just doesn’t make sense to me when you see people doing load bearing squats or deadlifts a month after surgery and they’re fine.

Once again, thanks for your time and expertise. This forum is amazing.

Donald Corenman, MD, DC
Moderator

September 27, 2018 at 6:29 am

Post count: 8660

#29426

Gluteus pain that occurs with flexion and internal rotation can occur from radiculopathy, internal hip disorders like labrum tears and more uncommonly from trochanteric bursitis. If an examination points to your hip (positive grind and log roll tests), then a simple ultrasound guided diagnostic injection would be in order. If you have severe point tenderness over your greater trochanter that radiates into your gluteus region, a diagnostic/therapeutic injection into the greater trochanteric bursa would be helpful. I think it is still reasonable for a new lumbar MRI with continued gluteus pain.

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.
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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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