L5/S1 discectomy overseas, nerve damage and post-op unclear

Tagged: Followup after discectomy, weakness recovery

Viewing 5 posts - 1 through 5 (of 5 total)

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whitecat74
Participant

November 6, 2019 at 7:19 am

Post count: 3

#31398

Dear Dr Corenman

I am thrilled to have found your website, I will send you my files for a second opinion once I have them all. In the meantime I have a few questions:

In March 2019 I developed what I thought was a metatarsal stress fracture on top of my left foot from running around in high heels and being overweight in recent years. MRIs showed a strain but not a fracture. The pain continued then evolved to piriformis pain in the right buttock, then sciatic pain.

I saw a variety of physios, acupuncturists, ostheopaths in the U.K., France and even Taiwan. I was travelling a lot for work, in economy seats not helping things, at a desk job in pain the rest of the time. I had a strange symptom, for weeks I experienced a strong painful spasm every time the very last second of emptying my bladder (but no one seemed to think it was related).

On a trip to France I woke up one morning in excruciating pain and my right foot had gone partially numb. One ambulance later a spine surgeon told me he could not let me leave the hospital without an operation, that I had an enormous L5-S1 hernia that was compressing the nerve root. My file also said caudida équina.

Today I am 4 weeks post op (not micro, regular discectomy). I was given no follow-up instructions and have since left France I am back in London. I was able to walk quickly post-op but feel that my progress stalled after about a week. My foot remains numb on the bottom, far side and up the ankle. I have a short stride and a noticeable limp and my hips feel out of sync.

My questions are as follows:

1) After how long should I get another scan – x-ray or MRI?
2) I do think (obviously) I have nerve damage. Are there any activities that I should or should not be doing during this recovery phase while I wait for the extent of the nerve damage or recovery to be known? I will then happily forward these to you for a second opinion.
3) Do you think I need physio or is time the best ally at this stage?

They noted some other problems like mild scoliosis and hip misalignment due to one leg being shorter than the other so I do know I will need to see a specialist about that.

Thank you so much, sorry for the long post but I’m a bit left in the dark given that I haven’t had any follow up.

Best regards

Elsa

whitecat74
Participant

November 6, 2019 at 7:28 am

Post count: 3

#31399

I have two other things that I forgot to mention:

– the metatarsal pain in my opposite foot is back, but I assume that’s all part of it
– I have had vertigo since the operation, it seems to be triggered by anytime the scar is pressed or when I look up suddenly to the right or move my head quickly. This part is a little stranger, I can’t figure out why I have this, could it be additional nerve damage?

Donald Corenman, MD, DC
Moderator

November 8, 2019 at 8:56 pm

Post count: 8660

#31411

It seems you have some nerve damage. Since it is so close to your operation, it is hard to tell what your potential outcome will be. It can take up to 18 months to know where you will be.

For follow-up instructions, you can refer to these two, one for post-operative rehabilitation and the other for continuing maintenance. https://neckandback.com/pre-and-post-op/microdiscectomy-and-lumbar-decompression-recovery/ and https://neckandback.com/treatments/conservative-treatment-mechanical-lower-back-disorders/.

A physiotherapist would be a very good choice for your rehabilitation. I start my disc patients after 7-10 days on PT and go for 6 weeks.Some patient can get vertigo due to anesthesia. It generally passes in time.

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.

whitecat74
Participant

November 22, 2019 at 3:06 am

Post count: 3

#31516

Dear Dr Corenman

Thank you, I followed your advice and saw a physio. I have S1 nerve damage causing some motor problems – I cannot lift my affected leg on tiptoe unless I use the other one as well and cannot really walk further than a few steps on both tiptoes. Additionally I have weakness in the calf/ankle/etc as well as numbness in the foot and Achilles heel.

Reading your pages on motor problems, I understand the following:

– I will either recover in the first 12 weeks

Or

– I will likely not recover if it hasn’t happened by 12 weeks, given that even in 18 months, the nerve growing back would not have time to reach all the way to the foot before the muscle dies.

Is there anything that accelerates nerve growth? Does vigorous exercise or yoga or nutrients/supplements help or not at all?

Thank you!

Donald Corenman, MD, DC
Moderator

November 23, 2019 at 9:29 am

Post count: 8660

#31519

The notation that if it doesn’t[t get better in 12 weeks, it generally won’t recover is incorrect. It can take as much as a year for recovery of a nerve root. See https://neckandback.com/conditions/peripheral-nerve-anatomy/ and
https://neckandback.com/conditions/how-muscles-recover-from-nerve-injuries/

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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