Microdiscectomy post OP problems

Tagged: herniated disc, Post operation

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

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Ryan
Participant

October 16, 2019 at 6:18 pm

Post count: 3

#31307

Dear Dr Corenman,

I’m writing in the hopes of receiving a second professional opinion regrading the pain and problems i’m dealing with right now 5 weeks after a surgery.

I am a 35 years old Male and a year ago i was diagnosed with a sever disc herniation at L4-L5 level.
Before the surgery i was not able to walk for more than 10 mins and i was not able to stand up for more than 5-10 mins, i was having this sever sharp sciatica pain and numbness in my left leg because of the disc herniation.

I did a Microdiscectomy at L4-L5 level on August 11th, for the first 2-3 weeks my symptoms was significantly relieved, but all of a sudden the sciatica pain started to kick in and some new kind of pain started showing up in my my lower leg (Shin) and in my left hip, sitting in any form was very painful even for 10 mins.
Although i was able to walk with very minimal pain in my leg. I followed up all the surgeons instructions such as the no lifting, twisting and bending rule and i walked everyday.

I went to see my surgeon on 1st of November and he prescribed Pregabalin 75mg twice a day and Naproxen 500mg twice a day as well and told me to go see him in November again and if my pains is still there he would send me to do another MRI..

As of i’m writing this email i still have problems with sitting down, i can sit on a chair for maybe 10-15 mins before the sciatica pain kicks in but i have almost no pain when walking even for 40-45 mins.. and also standing up is still a big struggle as it was before the surgery..

I’m very worried that i have the disc re-herniated again for some reason and that i would have to do another surgery. I live alone and i have no family to take care of me really so a second surgery can be almost impossible for me to go through..

I’m going to start physical therapy as of next Monday 21st of October. i would really appreciate it if you can give me your professional opinion. is there any chance that all this pains are just part of the nerve getting healed? after 5 weeks why i can’t sit on a chair or sofa or even in my car? is this normal?
and why i still have problem with standing up?

Thank you very much

Donald Corenman, MD, DC
Moderator

October 19, 2019 at 7:23 am

Post count: 8660

#31313

You certainly might have a recurrent disc herniation but the chance of a seroma (a post-operative collection of fluid) is equally possible. One might require a redo microdiscectomy but the other requires an aspiration and steroid injection.

The inability to sit fits with a mass in front of the nerve causing compression when the hip is bent (flexed) which tensions the nerve root. This mass could be HNP but could be fluid too.

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.

Ryan
Participant

October 20, 2019 at 10:48 am

Post count: 3

#31327

Thank you very much for the reply Dr. Corenman. could doing another microdiscectomy weakens my spine and would require a Fusion?

I also could walk for an hour yesterday with no pain, also i noticed the pain that comes with standing up slightly goes away when i keep standing up!! could any of these be a good sign that its not a re-herniation?
and why the disc should re herniate when i followed all the doctor’s instruction?

do you suggest physical therapy? its tomorrow the first session

Thanks in advance

Donald Corenman, MD, DC
Moderator

October 20, 2019 at 12:17 pm

Post count: 8660

#31334

Even if it is a re-herniation, if your symptoms are not impairing, you need therapy and possibly an oral or injectable steroid. If symptoms are impairing, you have a recurrent herniation and you fail conservative treatment, then another microdiscectomy could be in your future. A fusion is only required with three herniations that cause impairing symptoms that require three distinct surgeries.

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.

Ryan
Participant

October 22, 2019 at 12:25 pm

Post count: 3

#31349

Thank you very much Dr. Corenman for taking the time and answering my questions..

So yesterday i did my first session of PT. She did the SLR test and she made to bend and twist slowly.. i had no nerve pain at all, she bent my knee and pressed it towards my stomach i had no nerve pain at all.

she said my muscles are very stiff and the fact that i had no pain while she was evaluating me is a good sign.. she said something about scar tissues and this could become the cause of nerve compression? i didnt understand it completely to be honest..

could any of these be a good sign that my disc is not re-herniated?
also the scar tissue problem. is that a big deal? does it need a surgery to have it fixed?

Thank you in advance
God bless you

Donald Corenman, MD, DC
Moderator

October 22, 2019 at 6:00 pm

Post count: 8660

#31350

The bent knee relaxes the sciatic nerve root so even if the hip is flexed. this bent knee protects the root. Scar tissue forms at every surgery and generally scar is not a big problem. This is however why physical therapy is important to “floss” the nerve while healing to keep the nerve mobilized and prevent adhesions.

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

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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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