Is No Pre-Surgery Numbness An Indication of Severity of Nerve Damage?

Tagged: Gastric weakness after microdiscectomy

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JillA
Participant

April 19, 2018 at 5:46 pm

Post count: 2

#28092

Hi Dr. Corenman – Thank you for your wonderful site, I’ve been reading it since my surgery was scheduled and have gained much insight.
I’m now 8 days post-microdiscectomy due to a 5mm herniation of L5 S1 with “contact and possible compression of” (per MRI) the S1 nerve root. It was like that for 3 months. I am now nerve pain free, which is wonderful.
Prior to surgery, I had intense sciatic pain but no numbness, tingling, or notable loss of muscle strength. I also had an NCS and EMG done and my neurologist was encouraged by what he saw and heard (or didn’t hear ? in those, with an indication toward no “permanent“ nerve damage. Post-surgery, I have numbness in the thigh and also the foot, and my gastroc and soleus muscles are very weak (I cannot stand on the ball of my foot at this point). I do not have foot drop, just the calf weakness. I understand after talking with my surgeon that these are all “normal” in terms of post-surgical issues, and that the nerve, now that it’s decompressed, will take time to heal.
I am a 43 year old female marathoner who is quite healthy otherwise, and I will start intensive PT in 3 weeks (and will treat it with the same discipline as I do everything else in life :).
With respect to time being the only true indicator (you and my surgeon agree on this), is my lack of numbness/weakness pre-surgery any indication that perhaps it is only the myelin sheath that was damaged as opposed to the nerve itself and with as much PT as is needed, my calf muscles may make a recovery?
I’m prepared for whatever you have to say, and I appreciate your time very much.

Donald Corenman, MD, DC
Moderator

April 21, 2018 at 10:22 am

Post count: 8660

#28100

I am concerned if you did not have calf strength deficits prior to your surgery. In any case, you would not have foot drop with an S1 nerve issue as the “foot drop” muscles (anterior tibialis and peroneals) are L4 or L5 muscles. The S1 nerve does go to the gastrocnemius and soleus muscles which cause the foot to plantar flex (ball of foot goes downward for push-off). See https://neckandback.com/conditions/walking-disorders-nerve-joint-injuries-change-gait/

If you had no muscle strength deficit prior to surgery, it is logical to assume that there was a traction injury to the S1 nerve during surgery. The nerve has to be retracted to obtain access to the herniation. This is an unusual situation but I have seen this before.

No numbness prior to surgery might be a misunderstanding as pain generally accompanies numbness but you can’t generally tell that numbness is present because the pain overshadows this numbness. A very careful physical examination with the use of Wartenberg pinwheel, sensory testing can pick this numbness up but generally most spine physicians do not take the time to do this test.

Hopefully, the weakness will resolve as being a marathon runner, you need to have a functioning gastric-soleus group to be more efficient in running. Loss of this motor group will decrease your efficiency by at least 20%.

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.

JillA
Participant

April 21, 2018 at 12:09 pm

Post count: 2

#28104

Thank you for responding, Dr. Corenman –

Just two more quick things:

1. Is it possible that I had the weakness prior to surgery and was simply in too much pain (it was pretty awful) to notice? I was happy just to be walking most days, let alone making a concerted effort to push off in any way.

2. If indeed my nerve suffered a traction injury during surgery, is this something big that can heal over time and can re-strengthen with PT?

Donald Corenman, MD, DC
Moderator

April 22, 2018 at 8:18 am

Post count: 8660

#28108

Yes, you might not have known that you had weakness as if your leg had significant pain and you were limping, you might not have known about your leg weakness. That is what a thorough physical examination is designed to uncover.

Traction injuries heal many times but healing is unpredictable. See https://neckandback.com/conditions/peripheral-nerve-anatomy/

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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