[LC_IN_NYC]

#30903

Dear Dr Corenman,

Thank you for this reassuring response. I want to let you know that I was able to schedule the microdiscectomy with my provider for this week. I also visited with my physiatrist and another surgeon, who concurred with your advice. I am very appreciative of the expertise and empathy that you’ve shared here; it helped me to be more confident in being proactive about this situation.

Perhaps you can offer a final bit of guidance regarding conflicting advice I have been given re: rehab post-op? My surgeon advised that I will not begin physical therapy for 2-3 months, although I have some light stretches to begin at around 6 weeks. The surgeon that gave a second opinion advised he would begin light leg strengthening at 2 weeks, and core at 6 weeks. I will discuss this with my surgeon, but wondered what you advise in your practice (in the case of a revision and high risk for reherniation, and with leg/foot weakness?). These are such vastly different timelines, and I want to ensure that I give myself the best possible chance at recovery.

Best,
LC

[Donald Corenman, MD, DC]

#30905

My timetable is to start PT at day 10 and go for 6 weeks. See this: https://neckandback.com/pre-and-post-op/microdiscectomy-and-lumbar-decompression-recovery/.

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.

[LC_IN_NYC]

#31159

Dear Dr Corenman,

I am writing with an update and question since my earlier post re: my L4-L5 reherniation. As I wrote before, I reinjured my disc on July 25, 10 days after surgery while doing recommended gentle post-op stretches in bed. My original injury had taken place 3 weeks prior, causing severe left leg weakness and foot drop. A microdiscectomy on July 16 removed a large 5cm disc fragment, and totally relieved my left leg pain until the reherniation brought on new pain in both legs.

The reherniation and revision microdiscectomy process, unlike my first surgery, has been painfully complicated. It was originally scheduled for August 22nd after two courses of steroids did not alleviate tailbone pain and sciatica. Unfortunately, my procedure had to be further delayed until September 9th because a UTI came up in my labs and required multiple antibiotic courses to clear. So, I spent 1.5 months with the reherniation, after 3 weeks with the first herniation and a brief pain-free period in between. Happily, I regained nearly all of my leg strength during the waiting period despite the reherniation. The sciatica also began to diminish when walking — I comfortably walked 5 miles the day prior to my procedure. However, the pain continued to be severe while standing or sitting, and a new MRI showed no improvement in the disc, so we moved forward with the revision which removed another very large fragment.

Now I write you with hopes of gaining more perspective re: my expectations for this recovery. Unlike the first surgery, I have had continued sciatic pain since waking in the OR two+ weeks ago. The pain diminished somewhat with the help of a Medrol pack, but I continue to feel flares in my legs when standing for more than a few minutes and it is worse at night. I am limiting my activity to only 8-10 five minute walks a day per my surgeon, so this pain comes on fairly easily.

My surgeon believes this is not a cause for concern yet and that it is simply nerve irritation from the two injuries and surgeries. Still, I am unable to shake the concern that I could have somehow reherniated again despite my lack of activity. My injuries happened first with a cough and then with a stretch, and I was able to walk without pain despite a large herniation, making it difficult to know when to be concerned or how to mitigate risk.

So my questions: Is my nerve root really simply battered, and should I just expect several weeks or months of pain before it settles? If that’s the case, is so severely limiting my activity to my benefit? I work at a demanding nonprofit administration job in Manhattan, and wonder what my expectations should be of myself for a return to work, as well.

I am admittedly frustrated — I am now three months out from my original injury, but only two weeks out from my revision surgery. While I am willing to do whatever it takes to recover, I have watched the seasons pass and miss my daily life.

Thank you for your time.

Best,
LC

[Donald Corenman, MD, DC]

#31167

It is hard to determine how the root will heal with 2 back-to-back herniations in so short a time. Yes, this could be “battered root syndrome” but because you so easily reherniate, a recurrent disc herniation cannot be ruled out. As long as you have no motor weakness, you can afford to wait another two weeks to give the root some more time to calm down. If your symptoms do not improve in this period of time, a new MRI with gadolinium is appropriate to order to look for reherniation or even a seroma compressing the root.

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.

[LC_IN_NYC]

#31169

Dear Dr Corenman,

Thank you for your response. I had been holding out hope that it wasn’t a reherniation because I had sciatic leg pain in the recovery room, and did not think it could have injured that quickly. I was also told that the new herniation was fairly large and that he also had to remove scar tissue and bathed the root in steroids. I understand that my nerves have been through a great deal of trauma, and hope they just need time.

If it is inflammation, do you agree with limiting activity to 8-10 five minute walks (45 min) a day after the two week mark? There is not weakness, but I do feel myself wasting away the strength that I regained.

And in the event it was a reinjury, is there any chance it could heal conservatively? The idea of another surgery is quite disturbing.

I have a follow up with my surgeon next week, and will discuss with him.

Best,
LC

[Donald Corenman, MD, DC]

#31171

Pain should be your guide. Too much activity will trigger the root. Yes, this can heal conservatively (without the presence of motor weakness). If you again have a reherniation (third time herniation), you would need to consider a fusion to ablate the disc and prevent further injury to the nerve root.

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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