[Donald Corenman, MD, DC]

#9606

Functional recovery is almost immediate after nerve decompression. The example is of resting your elbow on your ulnar nerve (“the funny bone”) and your lateral hand “goes to sleep”. The immediate recovery of sensation and strength is a result of removal of the compression (lifting your elbow off the table) and the nerve then quickly functioning normally.

If there is nerve damage from compression, the recovery depends upon the type and severity of damage. In the section “Nerve damage and healing” on this website, these different injuries are covered and recovery is explained.

Interesting factoid of note is that I have each book in my examination rooms and most patients prefer to read the Clinician’s Guidebook and not the consumers book.

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.

[radiculopathous]

#9608

Wow… this means that the insult to my nerve was more serious than I had imagined.
This is going to take time then…. this is all going to be regrowth/budding… I really hope my leg function returns.

I keep wondering whether I should have gone to the E/R immediately when the big disc herniation occurred, I wonder if they would have done an MRI and operated on me right there and then to decompress ASAP (my herniation was a “pretty large one” according to the specialists), and that might have lessened my nerve damage. The spine specialists I got on the phone when it happened said that the indication for emergency surgery is for cauda equina (as indicated by progressive weakness increasing and incontinence) and while that wasn’t my case, maybe they didn’t realize how intense the pain was (my thigh was twitching uncontrollably) and to just wait it out but maybe if I’d been there and they’d seen the herniated disc, maybe the emergency person would have offered the option.

There are many tragic stories of permanent damage on the internet, but few stories of recovery – maybe people who recover just don’t bother posting so the sampling is biased. Another useful addition to your most excellent website would be of testimonies of people who have recovered over different periods of time. I guess we can do that on YouTube. I don’t know. Reading like crazy right now…

Thank you so much for your time and resources, Dr.

[Donald Corenman, MD, DC]

#9614

Time to surgical intervention after a disc hernation causing motor weakness is a controversial topic within the spine world. Some surgeons do not think that speeding to surgery will make a difference. These individuals believe that the damage is done right at the time of the herniation and time to decompression does not matter.

I am in the other camp. I have found that timing is important. Yes, there are some patients that have initial damage and decompression timing does not matter as “the damage is done”. However, I get to see many patients who have not had early decompression and have continued motor weakness.

I try to get to these motor deficit patients within one week (hopefully within four days) for surgical decompression and it is my impression that these patients have much better motor recovery than late decompression patients. I am collecting data to discover whether my suspicions are correct or not. A paper should be out in a year.

Anecdotal stories are very helpful to patients to understand what other patients are going through but you have to be careful with these emotional stories. You will find many websites that display these stories but they are self-serving to the surgeon. I started with these stories on my website but stopped when I realized that these stories are not fair. They are selected to display the “great results” of the particular surgeon and not the width and breath of patient experiences.

Published studies will give a much better appreciation of the surgical experience. These studies have to include all results, whether good or bad. I have a 90% success rate for surgery for lower back pain but by definition, 10% will not have found that the surgery was satisfying. Do I put those non-successful stories on the website? If I did put only those unsatisfied patients stories on the site, everyone reading them would think that I was a poor surgeon.

Every surgeon has great success stories. If I had only 50% success from surgery, I could put all the happy patients stories on my site and I would look like a great surgeon. The truth would be different but you as a prospective patient would have no idea.

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.

[radiculopathous]

#9622

My surgeons were in-between I think; it wasn’t clear to them that acting fast initially would result in a better outcome, yet at the same time they acknowledged that if I waited 3 months or more with the symptoms that they would become more likely to become permanent. My surgeon said if I wanted it right away he could accommodate me (“I have some time on Monday” he said – this was the Thursday before, which I think is pretty good). They also acknowledged that there is yet no rule that can help predict whether a patient would recover from nerve damage. These guys are from a well-regarded research hospital in NYC (I know that my surgeon worked on showing occurrence of reherniation in MD patients: 2-5% and not 10% as is seen in other places).

The data that I personally would like to see is not so much personal/emotional accounts from people – and I fully agree you’re doing the right thing by avoiding to place those on your website, it would give it a bit of a scam-ish flavour, which is undesirable – but rather is a scatterplot of “time to 50%/90%/100% recovery” (so 3 plots) as a function of “time to onset of motor control deficit”. It’s probably best to accumulate as many dimensions and metrics as possible and then run that through a simple factor model to see if there’s any power to this.

Given that this is the most common surgical operation in the USA, it surprises me that there isn’t more data available on this. If the process of nerve damage recovery is so nebulous and we have an abundance of patients, why don’t we collect more data? I wonder if neurosurgeons might know better in that area, but when I read about the stuff that they do, it seems more oriented towards cancer issues than bone & mechanics.

Thanks again for your response, your responses are enlightening and I know they will be useful to others,

[Donald Corenman, MD, DC]

#9626

You will find that most of the valuable studies are performed by spine surgeons as it is a little know fact that as a group, we have been involved with complex spine surgery much longer that neurosurgeons. This is even if the term “neurosurgeon” seems like more as a “nerve surgeon” connotation.

The recurrence rate of disc hernations at 2-5% is faulty data in my experience. Don’t forget that many patients who were dissatisfied with their care will not go back to the original surgeon if these patients have a recurrence. They will then not be counted in studies for recurrence by the original surgeon. Also, the activity level of the recurrence patients were never counted into the original studies.

My patient population is very active and I believe probably have a higher recurrence rate due to activity. In addition, I generally do not “lose” patients so I can keep track of patients for the long term. I am currently studying the recurrence rate and that paper should be out in a year. I believe it will be about 10%

Motor recovery is another matter. I have many new patients who come into my office with old hernations and motor deficits. I do not know how many have had hernations with motor deficit who recover and never make it into my office so I can’t draw conclusions. I do have a subset of patients who have motor deficits but don’t get surgery due to other complications (anticoagulation, heart disease, etc).

So I do have a small group who do not get surgery even with weakness but the sample size is not big enough to accurately conclude the recovery rate without surgery. I believe the recovery rate for full motor strength recovery without surgery is about 50%.

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.

[radiculopathous]

#9635

Ha… comments which brings up a few more questions which I believe aren’t covered anywhere.

1. Regarding that recurrence figured… have you seen a correlation between the level of activity during the 6 weeks recovery period and reherniation? That’s probably difficult to assess objectively. I noticed you mention somewhere of a patient that walked 8 miles on the day you sent him home and had to correct for this. I’m one of those guys… I felt so great initially that I visited work on day 3 after my op (involved a 20min subway ride, walked in the building, lied down for 2-3 hours on couches with some short walking in corridors, and a short subway ride home, which was difficult (weak back near the end)… it was way too much and caused brutal inflammation for two days, I paid dearly for it). AFAIK my doc said this was possibly from the noxious materials near the disc that are still being emitted from it that cause inflammation, and not reherniation. I calmed down, and a few days later I went through another 18 hours of inflammaion/pain. So then I just laid down for 4-5 days and didn’t more nor walk other than going to the bathroom, with no pain, and it hasn’t returned since (3 weeks post-op).

2. I guess this begs another question: what are sure-fire signs of early reherniation after op? Because of that pain I experienced after my operation, on my 2-week follow-up visit I expected a follow-up MRI from my surgeon to be sure; I described all these things to him, but my surgeon said “if you had reherniated, you would be in severe pain that does not go away for weeks, so we don’t need to check.” (BTW I’m generally very happy with the surgeon, he’s knowledgeable, patient and involved in research, but my recovery has been disappointing so far, I don’t feel like I’m making linear progress. This is not a negative comment on my surgeon, not his fault.)

3. Another question that doesn’t seem to have a good clarification, and would be a great addition to your book or website, is regarding the specific NATURE of the recovery process. What is it exactly that requires healing and time, what occurs during those 6 weeks in the body? This would be interesting to know. Here are my guesses:
– The cut from the surgery is so small – my surgeon is young, I think he uses latest technique, very small incision, like a half-inch – that I have had barely any pain from it, except for those very rare occasional times where the back has been recruited since the op. So it’s probably not muscle repair.
– There was a laminotomy required to get through, maybe the bones need to somehow heal? Maybe that causes tiredness in the back, as tissue readjusts around the new space?
– Is it that the annulus itself beings some sort of healing process? I reason that it’s not that, because it is not a vascularized membrane, so it does not heal. Or does it somehow scar, or maybe the pulposis hardens? Maybe the bits of annulus need to rub against tissue filling the space?
– Okay, so the nerve begins deinflaming right away, and then begins recovery. But that shouldn’t cause pain and tiredness in the lower back… so…
Do you have any idea what it is that makes the back “feel tired” during this period and limits the length of walks? The mechanical nature of it makes me feel like I should not feel anything beyond some minor muscle pain. I can still just walk 5-10 blocks around my apt before I need to head home. (this is 3 weeks post-op).

4. (This is a bit of a mechanical question.) Doesn’t the posterior longitudinal ligament (PLL) grow back over the annulus once the herniated material has been removed? Would that not protect against a further reherniation a bit? (It seems to me if the annulus is broken, that small bits of disc could just ooze out of there over time, what prevents more from coming out? Intuition tells me that would an awfully unstable situation, not in line with “athletes are back to their thing within 12 weeks”. Wondering how further material is prevented from just bobbing out with movement.)

5. (This is more academic than anything else.) I bought a skeleton model – ok, I know I’m a little nerdy, but I really wanted to understand the geometry of the spine, and they’re 80$ on Amazon – and on the model it looks like a surgeon could have access through the gap between the vertebra (going through the back) without a laminotomy, if going at an angle. I don’t understand why a laminotomy is necessary… it is not possible to reach through between the bones instead of having to cut through? Really just curious.

Feel free to answer these at your convenience or not, I realize this is a lot of blablabla; on the other hand, the answers might be good complements to the rest of the absolutely excellent material on your website. What you’re doing, for such a common operation, is of great service to thousands of people, Dr. Corenman!

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