[LC_IN_NYC]

#31292

Dear Dr. Corenman,

As promised I am writing with a follow up since my last post regarding my L4-L5 revision microdiscectomy two weeks ago. As I await my six week visit during the week of October 21, I’d appreciate additional insight you may have.

I discussed my continued nerve pain with my surgeon at my three week visit, but he wanted to wait on an MRI. He believed that my pain was inflammation based on the size of the fragment removed during the revision surgery (4cm, my first was 5cm) and wanted to give my nerves more time to calm. I should note I also have a bulging disc at L5-S1 and a visibly puffy seroma.

Since that visit, my nerve pain has waxed and waned with the back pain decreasing and becoming mostly stiffness. Things actually seemed to be improving at four weeks —- I even had a pain free day —- and so I held back on pushing a new MRI. However, as week five comes to a close, my pain has recently taken a turn that has me questioning my recovery. Specifically, I’ve noticed: an occasional uncomfortable tightness along my mid-spine when taking a deep breath while lying down; tenderness on either side of my low back (where my primary back pain was with the herniation); and some deep pain in the incision area. My sciatic pain, which is typically better while walking, has become a bit more frequent at a level 2-3. It is worst in the parts of my left calf/foot that have residual numbness (all weakness but my big toe is 90-95% resolved), though my right leg experienced nerve pain too
(and has since the second herniation). I’m not having unbearable standing or shooting pain like pre-surgery, more of a mild ache in different parts of my legs. I took a 45 minute walk today that was totally okay, though I have some leg pain at rest as I write.

Mostly, I’m curious about this mid-back sensation and new tenderness? Could this be related to reherniation or scar tissue? Is there any chance I’m just feeling extra sensitive given the degree of my injuries? I felt I was progressing positively albeit slowly but am starting to worry my back is too compromised. I am being super careful, but did accidentally sneeze over the past few days due to allergies. I expect to have a new MRI in a week but don’t think I can push things forward sooner.

Best,
LC

[Donald Corenman, MD, DC]

#31297

Your complaints of “occasional uncomfortable tightness along my mid-spine when taking a deep breath while lying down; tenderness on either side of my low back (where my primary back pain was with the herniation); and some deep pain in the incision area” is to be expected as you have a disc injury. This disc will “settle” and stiffen while it scars and local back aching and stiffness is to be expected for about 3 months.

Your nerve root pain has improved “My sciatic pain, which is typically better while walking, has become a bit more frequent at a level 2-3” and this root will continue to be sensitive for 6 months.

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]

#31622

Dear Dr Corenman,

Thank you for your feedback above and please pardon my delayed reply. I write with an update and request for further guidance, as I’ve so appreciated your insight throughout my recovery. It has been quite helpful when informing dialogue with my surgeon and care team.

First, the sciatica caused by the disc re/herniation at L4-L5 seems to be on the path to being mostly gone. Since my October post the nerve pain has become much less frequent, though the it is still aggravated mildly from overactivity or in certain positions.

That said, at nearly 3 months since my second microdiscectomy (the first was July 2019; second was September 2019), I am experiencing a concerning onset of low back pain. My low back pain had largely diminished until now, and was never as much of an issue as the sciatica, but it is now increasing daily when standing or sitting making even remote work with a sit-to-stand desk difficult. The increase in pain followed a new herniation at the C6-C7 level three weeks ago, which caused mild pain in my left arm but seems to be improving conservatively with rest and a soft collar. The neck injury means I can no longer work well lying down, making me pretty useless.

The new onset of pain also coincided with an increase in time spent sitting, which at first was going great. Finally, I have a bulging disc at L5-S1 with degeneration at L3-L4, so I am unsure if there is one obvious cause of my new symptoms or if this is a confluence or things? I’m also nervous about epidural fibrosis given the timing. The pain feels like pure inflammation throughout my low back, with occasional sharp pain and tenderness near or above the surgery site. For reference, I had almost no low back pain before the second microdiscectomy and walked 6 miles the day prior, but the radiculopathy when standing still and herniation was so severe that I had to move forward with the surgery. It’s quite disappointing to now come out of this with a great deal of back pain but little sciatica.

My surgeon is monitoring these details and believes that there is a chance I will improve over the next few months with conservative therapy. I walk about 2.5 miles per day but have not been cleared for any other PT out of caution. When I am, I will be working with a highly respected specialist in spinal rehabilitation.

While I understand my back is going through traumas, and I clearly have DDD, I am confused as to the origin of this new low back pain and what I can do to improve my quality of life. I am 31, have a career that I am passionate about returning to, and am feeling a bit lost despite the many resources at my disposal. Is time really all that is needed here, or can I be doing more? I absolutely do not want further surgery but wonder if my PT timeline is off, or if I should be requesting injections, more tests, etc.

I appreciate your guidance. Thank you!

Happy holidays,
LC

[Donald Corenman, MD, DC]

#31631

Disc hernations are caused by through and through tears of the annulus which of course means significant degenerative changes to the disc. Think of the disc as a car tire full of jello instead of air turned sideways and resting between two vertebral bodies. Not only have you torn through the full sidewall of the tire, but you have lost half the air (jello) in the tire. The side walls are now bulging not unlike when a tire has lost its air pressure. There is more stress on the sidewalls (annulus) of the disc which causes more lower back pain.

Hopefully, the disc walls will fibrose (scar) and stiffen which will reduce your lower back pain. This takes time but no one knows how long this can take. Work on core strengthening (I like Pilates) and ergonomics (correct posture for each loading event).

Sometimes, epidural steroid injections can be helpful.

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]

#31641

Thank you for this helpful explanation; it is appreciated. I am hopeful that strength building and time will help once I am cleared for therapy. It has been 5 months since my original herniation, and 5 months since I have been to my office or had a normal life, so I am beginning to feel concerned that things are not more improved by now.

With respect to the sudden onset of more low back symptoms nearly 3 months, is this common? Prior to three weeks ago, I was not experiencing severe low back pain. I was improving, and able to stand for fairly long periods. Sitting was also improving, and I never woke up with back pain apart from the immediate post-herniation and post-op periods — it always set in end of day following activity. This increase seems to have followed the neck herniation, which is why I was concerned that it might warrant further imaging to rule out further injury or instability?

[Donald Corenman, MD, DC]

#31642

If you had an immediate onset of symptoms at the time of increased lower back pain, you could have a new annular tear along with the previous herniation. The disc herniation in the neck should not increase lower back pain but if you position your torso differently to accommodate your new neck and arm pain, an argument can be made for increased lower back pain due to different positioning.

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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