[Qrkr0730]

#30557

Let me ask you three questions:

1) Why am I sweating like a pig around the area where my surgery took place

2) Do you think I went back to work too soon and need more time off?

3) Why you think my post MRI didn’t show any improvement?

[aa3105]

#30624

Hi Dr. Corenman,

I am a 28 y/o F who recently had a L5-S1 microdiscectomy for decompression of left S1 nerve root 3 weeks ago. To backtrack, I had some left glute/ upper thigh pain in December… got a referral to PT and by the time I got scheduled for a PT eval (2 weeks later), my pain resolved. So, I just went to the eval and worked on some stretching since then. I also continued to train for a run. I woke up with severe left leg pain some time in March and presented with typical S1 radiculopathy symptoms– numbness, sharp/ aching pain, and some tingling that at first started to come about with back extension and flexion and then progressed to constant leg pain. Started PT again. Got an MRI which showed 19mm far right to far left L5-S1 disc extrusion that displaced the left S1 nerve root backwards. After 8 weeks of doing PT, I decided to get the surgery.

Overall, I am doing well since surgery. I have numbness to the back of my left upper leg and left knee. I am noticing new sacral pain but is minor. I started PT this week for post-op stretching and strengthening and now have return of some pain symptoms but on a milder level. I may be hyper focusing on it… but I tend to think that I may have re-herniated my disc which I am assuming is not the case but may just be due to inflamed nerve root still and tight muscles? I guess I am just looking for reassurance and any additional information you can share…

1) Is it true that only time will tell if the numbness goes away? I was told within 2 years.

2) Is return of left leg pain (some aching/ dull/ discomfort along the S1 dermatome) normal when starting PT? How do I know if I re-herniated my disc?

3) I was told I can return to high impact cardio, but to be mindful of movements… Is it not too soon? Or is it okay to use an elliptical (without arm motions)? Any other advice on when to return to running. Does it matter if it’s on concrete or treadmill?

4) I was told I have early disc degeneration at L5-S1 which may have contributed to the mild disc height loss/ disc dessication… any advice on preventing that from progressing. My worst fear is re-herniation. I also have a disc bulge at L4-5 that was minor and also has mild disc height loss.

Thanks,
Amy

[Donald Corenman, MD, DC]

#30625

This is for the last question in this thread which is different than the initial inquiry. What are the expectations after a micro disc surgery?

Numbness typically fades away in 6 months. The patch of numbness will get smaller over time (the numbness the size of a dollar bill will recede to a 50 cent piece) but you still might have a small area of permanent numbness that you won’t notice unless you scratch your leg.

It is not unusual that some ache in the leg returns with increased function. The nerve was significantly inflamed with herniated compression and that could take as much as a year before the ache fades (or you adapt to the ache and ignore it). If the ache draws your attention while doing activities (but doesn’t stop your thought processes-a VAS pain of 4 or less on a scale of 1-10), then a short course of an oral steroid can be helpful. If the pain is greater than 5-6, a new MRI could be helpful to see if you have a seroma (a small collection of post-surgical fluid that compresses the nerve) or even a recurrent disc herniation. The seroma can be aspirated through an injection and the recurrent herniation can be treated with an epidural steroid injection or even recurrent surgery.

High impact cardio activities require BLT (bend-load-twist) activities, I like to eliminate at least one of the three letters (no twisting if bending and loading or other combinations) as the BLT position is the toughest on the disc and has a higher chance of disc injury or recurrent herniation. Running is tough on a disc. If you get high impact-absorptive running shoes, you will be better off. They are less efficient but more protective.

For my athletes, I don’t let them participate in competitive activities for 8-12 weeks depending upon how they progress in PT. Ellipticals are great machines without using the arms (twisting of the BLT variety) as they allow cardio without the high impact. Treadmill running is generally better than running on concrete as the machine absorbs some impact, lessening the strain on the disc.

By definition, you have degenerative disc disease of L5-S1. You can’t herniate a disc without treating through all 30 rings of the annulus. Annular tears define degenerative discs.

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.

[Donald Corenman, MD, DC]

#30627

This is to the first thread question.

1) Why am I sweating like a pig around the area where my surgery took place.

I can’t answer this. Local sweating is governed by the sympathetic nervous system which originates from the thoracic spine, not near where you had surgery.

2) Do you think I went back to work too soon and need more time off?

Time off depends upon your job duties. More time off is necessary if your job is of higher demand (heavy lifting). A microdiscectomy post-operative course with heavy lifting requires at least 6 weeks and I would want 8-12 weeks of light duty. For an intellectual job (desk work), you should be able to go back to part time work in one week.

3) Why you think my post MRI didn’t show any improvement?

Your MRI demonstrated no large herniations so I would assume that your surgery was successful.

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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