L5S1 MD - persistent sciatica

Viewing 6 posts - 1 through 6 (of 27 total)

1 2 3 4 5 Next

Author

Posts
Bikingenjo
Participant

September 16, 2022 at 11:43 am

Post count: 21

#35281

First of all, thank you very much for maintaining this forum. You’ve done a tremendous thing for people around the world who have used your advice and counsel.

26/M

I originally herniated my L5S1 5 years ago but managed it conservatively with PT and Epidurals. I reherniated twice over that time and the most recent time (5 months ago) it was bad enough that I couldn’t walk and decided to look into a microdiscectomy.

Had the operation done about a month ago, and was feeling quite good just 2-3 weeks out. I still had some persistent glute tightness on the side of the herniation but was able to walk and move around without pain or much sensation.

I went back to work and was sitting 12 hours a day. Additionally I am a big biker and I tried biking at around the 3 week mark – just an hour ride nothing crazy – and since then my sciatica has come back. It’s mostly located in the uppermost part of my glute, and my back. I don’t think I reherniated as I never experienced that sharp shooting pain, but I’m not sure.

The sensation is somewhere in between tingling and painful, but it’s more distracting than anything else. I’ve taken time off work as I literally cannot focus on anything with this buzzing going on in my glute— however I’m still able to walk 10ish miles a day without problem. I’ve never had numbness or weakness and even prior to surgery my sciatica never went past my knee.

You recommended to others on the forum to take an oral steroid – I requested this and was prescribed MethylPREDNISolone. Hard to tell if it’s doing anything, I still have that buzzing in my glute but was relatively pain/sensation free for a decent amount of time last night.

Just curious what you think might be going on, or if this is normal. I guess I’m worried I’ll have the sensation for a long time, or even the rest of my life!

TLDR: 5 years of compressed nerve, got surgery a month ago. Was feeling better initially but pre-op symptoms returned on 3rd week, potentially caused by a short biking trip. What might be causing this? Did I complicate my recovery by going back to sitting at work and trying to bike? When might I expect to feel better by?

Bonus: my surgery was on my left side. When I bend laterally to the right, I hear some crackling on my left side around where the disc is. It sounds like pouring milk over rice crispy treats. Additionally, when I squeeze my glutes really hard I can hear something pop near my sacrum. Any idea what these are? Are they potentially related to my pain?

Thank you doctor

Donald Corenman, MD, DC
Moderator

September 16, 2022 at 3:06 pm

Post count: 8660

#35282

For a root that has been under compression for the last 5 years, it could take 6 months for improvement. If the symptoms are at least 50% better than before surgery and have not substantially become worse, you can afford some time to allow improvement. If after another 4 weeks, there is no improvement, it might be worth it to get another MRI with gadolinium. Seromas (fluid collections) can cause mild compressive symptoms and if necessary, can be evacuated with an injection.

You note: “When I bend laterally to the right, I hear some crackling on my left side around where the disc is. It sounds like pouring milk over rice crispy treats. Additionally, when I squeeze my glutes really hard I can hear something pop near my sacrum. Any idea what these are?” These are probably joint (facet/SI) releases, similar to what a Chiropractor’s adjustment sounds like. If they are not painful. you can ignore them.

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.

Bikingenjo
Participant

October 18, 2022 at 6:29 pm

Post count: 21

#35333

Thank you for the response. I am 2 months post op now and there was a period where I felt no symptoms (a few glorious days!). However, I’ve started to feel mild sciatic symptoms on the opposite (right) side which has been perfectly fine while my left side suffered from sciatica for 5 years!

Looking online, sciatica switching sides seems quite common though I’ve yet to come across an explanation as to why that is.

Summary: I had a microdiscectomy at l5s1 on my left side after suffering from sciatica for 5 years. My right side has been perfectly fine my whole life until 10 days ago when the sciatic symptoms seem to have migrated. Any idea why this is?

(I am getting a new MRI tomorrow and am considering sending to you for your review via your service)

Thanks again

Bikingenjo
Participant

October 18, 2022 at 6:46 pm

Post count: 21

#35334

I should note that while my symptoms may seem mild they are bad enough to prevent me from running or biking.

Donald Corenman, MD, DC
Moderator

October 19, 2022 at 8:44 am

Post count: 8660

#35335

With new contralateral symptoms and some return of your original symptoms, a new MRI is warranted. When you get the radiologist’s report, cut and paste it here. We will discuss it.

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.

Bikingenjo
Participant

October 21, 2022 at 8:26 am

Post count: 21

#35342

Thank you Dr. Corenman

I’m still waiting to see their analysis/findings, but here’s a photo from my MRI. Is it me or does it look like the disc is still pressuring the L5S1 nerve?
Author

Posts

Viewing 6 posts - 1 through 6 (of 27 total)

1 2 3 4 5 Next

You must be logged in to reply to this topic.

Donald Corenman, MD, DC

Average rating:

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel

L5S1 MD – persistent sciatica