Leg Pain After Microdiscetomy Explanation Please

Tagged: Leg pain after lumbar microdiscectomy.

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utahguy058
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July 15, 2017 at 1:00 pm

Post count: 3

#25552

I had a microdiscectomy on my L4/L5 to take care of a herniation. I am not certain when the herniation began, but I know that about a year and a half ago was when intense across back into my buttocks and a numb foot started. I went through conservative measures for a year and a half hoping for recovery. I made great progress, with just back pain after standing awhile that radiated into my hip and an intermittent numb foot. A surgeon had been telling me that I had nerve damage and that I would need surgery if I didn’t want it to progress to where I was dragging my foot. I am a teacher and did not like the idea of it progressing to a point of dragging my foot. It seems like it was compressed for 18 months then.

On June 8th I had a microdiscectomy and woke up from surgery with leg pain. I had not experienced leg pain prior and was concerned from the onset. I always hear about those with leg pain waking up to it gone. The surgeon said it went well. When I saw him at 10 days post op he said my nerve was compressed a long time and will take time to heal and not to worry. Most days I have leg pain, I have had a couple days where it isn’t as bad, but then it comes back just as bad. The doctor gave me a Medrol pack which didn’t help, and just four days ago I had a nerve block on my L-5. I had a day where I felt some relief, but the next day it was back. The two things that make it the worse are sitting, which is just torture for anything longer than 5 minutes, and if I lay on my left side. Prior to surgery I could work with my pain full time, now I fill that isn’t an option and devastated.

Here are my important questions I can’t seem to find an answer to.

1. If it is a nerve healing or inflammation, then why would certain things like sitting and laying on my left side make the pain worse? It seems that it would be constant instead of situational based on position. This question has me baffled and I don’t meet with the surgeon for awhile yet.

2. What is a fair amount of time after surgery for a nerve to heal with leg pain, assuming leg pain is normal for a nerve healing? I am 5 weeks and 2 days post surgery.

I truly appreciate any insight that you may offer me. I am really struggling with the pain, and the fear that I will not be able to work again.

Thanks,

KC

Donald Corenman, MD, DC
Moderator

July 16, 2017 at 8:18 am

Post count: 8660

#25557

If you had this herniation for 18 months without any motor weakness, the comment from your surgeon was wrong. The only way you could have developed progressive motor weakness after 18 months is with a recurrent disc herniation (another fragment coming out of the same hole in the disc). The chance of that recurrence was only 10%.

Nonetheless, if you had symptoms that were not tolerable, surgery generally should be performed earlier than 6 months of symptom onset to have the best results. It does sound however that symptoms were tolerable before surgery.

Leg pain after surgery has multiple reasons. The nerve has to be manipulated (gently moved) during surgery and this manipulation can irritate the nerve. This could take as little as 2 weeks to calm down or as much as 4 months. Since you note that sitting is the biggest symptom producer, you could have has a recurrent disc herniation immediately after being moved off the surgical table or possibly, a hidden fragment was inadvertently un-removed and you have continued nerve compression. You could have a seroma (a fluid collection) that could be compressive but this disorder normally fades away after some time.

I am surprised that you had an epidural steroid injection without a new MRI. Normally, a new MRI is warranted if you have had increased pain after surgery and if the pain doesn’t resolve with oral steroids. A new MRI should be considered.

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.

utahguy058
Participant

July 16, 2017 at 11:51 am

Post count: 3

#25561

Dr. Corenman- I appreciate your well thought out response. It was very helpful and informative. I will call my doctor to see if they are willing to do an M.R.I. They have been opposed so far, even though I got leg pain which I never had since waking up from surgery. I have two quick follow up questions

1. What is a reasonable amount of time to try conservative treatment for a reherniation of a disc? I suppose it has been 5.5 weeks already. If I did have a second surgery what are the odds that it would be a success?

2. I also am worried about work as I have worked full time prior, but fear that this pain will keep me from work, if there was a second surgery, or conservative treatment are outcomes favorable to someone being able to go back to work full time?

Thanks so much again,

KC

Donald Corenman, MD, DC
Moderator

July 16, 2017 at 7:25 pm

Post count: 8660

#25567

There will be a reason for the leg pain- most likely a recurrent disc or a missed fragment. Without motor deficit changes, 6 weeks is a reasonable time to wait before a new MRI. Ask for one now.

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.

Ghostgirl
Participant

July 17, 2017 at 1:06 pm

Post count: 4

#25575

I went conservative too, for as long as I could. I had a quote “massive” rupture at L4/5 and bone chips around my spinal cord. Had a hemidiscectomy in September of 2004 wherein they also removed bone ‘schrapnel’. It was a long operation. 10 days later, I had another one. A week after that, my doc finally fused it. By then, I had permanent nerve damage in my right hip, leg, and foot. I asked my surgeon if this would go away. He said, ‘sometimes it does, sometimes it doesn’t.’ 13 years later, I still have the pain. IMHO, it should have been fused in the first surgery. After the fusion and subsequent hardware removal (the titanium was literally poking through my skin), they had to go in and remove excess bone that had grown between and around my vertebra. And because fusing vertebrae causes problems with the discs above and below the disc in question, I ended up having microdiscectomies at L3/4 and L5/S1. I understand the desire to be ‘conservative,’ but sometimes appropriate action needs to be taken in appropriate situations. I am a leg-dragger.

Donald Corenman, MD, DC
Moderator

July 17, 2017 at 4:14 pm

Post count: 8660

#25578

Ghostgirl-I know you had an unacceptable result but fusion for a disc herniation is only necessary in 10% total of the cases. An initial herniation normally has a 90-95% rate of satisfaction for surgery. Even a recurrent herniation surgery has a high acceptable satisfaction rate. Most individuals with foot drop (a “leg-dragger”) if they get surgery quickly enough will have resolution of their weakness. It sounds like things did not go well for you and you now have chronic radiculopathy (see https://neckandback.com/conditions/chronic-radiculopathy/).

I agree that surgery needs to be performed on a timely basis and if the surgical wait is prolonged, the results can be less than ideal.

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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