microdiscectomy recovery

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riley
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September 3, 2011 at 9:41 pm

Post count: 3

#4843

hello..I had a “significant’ ruptured disk and after MRI on 5/25/11 had epidural. Siatic pain was gone but numbness in right leg & weakness in toes. Spine doc in Denver recommended microdiscectomy 7/11 but used MRI from 5/25/11 which was taken before epidural. After surgery doc said will probably have perm. nerve damage as he went in and disk was almost all gone. Is it the norm that a MRI 2 months old would be used and there isn’t one used that very same day of surgery? Could not a MRI before surgery have showed no disk material and therefore, no surgery needed? His post op did mention going in and cleaning up the area but it seems weird that xrays/new MRI was not used. I was in the back brace 6 weeks as if I’d had a fusion as he said there was little to work with in the L4/L5 area and I guess it’s pretty weak /degenerated in that area he said.
Question…start PT 9/13 and hope to get back to work Nov 1 but am a flight attendant..Lots of twisting, lifting, pushing. Works galleys a lot which is lots of bending/twisting so is 6 weeks /twice week reasonable about of time for PT for near 100% recovery? Also, this scar tissue build up is a huge lump in the back, will that soften because it’s very tender and painful sitting. Lastly, How likely now is re-rupture of L4/L5. Thank you for your time..

Donald Corenman, MD, DC
Moderator

September 3, 2011 at 11:16 pm

Post count: 8660

#4844

A new MRI is only warranted if you have had a significant change of symptomatology and not just relief of symptoms. If you had more intense pain or different pain, a new MRI is necessary.

Some spine surgeons have different algorithms for treatment but most will perform surgery sooner than later if weakness is present.

An epidural in the presence of weakness I feel is not the best idea because it will reduce the symptoms of pain and paresthesias (tingling) but will do nothing to reduce the pressure on the nerve root. The patient (and ordering physician) will feel there is substantial improvement because the annoying symptoms have been reduced and will be lulled into thinking there is less compression on the nerve root which is not accurate.

There are times that an extruded disc herniation (a herniation that is fully ejected from the disc space and is an unattached free fragment in the canal) will migrate out of the canal in a short period of time. The operating surgeon will find the tear in the disc and some small fragments but the main offending herniation is not to be found.

I have seen on some occasions that the fragment is missed in surgery as it might be “tucked away” in a hidden corner and doesn’t reveal itself easily. These patients will have continued pain and weakness after surgery and have to be differentiated from chronic radiculopathy patients (see website for that condition).

The post-operative treatment varies from surgeon to surgeon. Your surgeon uses a back brace. I use a soft corset like those seen on Home Depot employees for six weeks. A recurrent disc herniation can occur in the immediate post-operative period and the position of BLT needs to be avoided (bending and lifting while twisting). The corset reminds the patient not to BLT.

I take care of many flight attendants and six weeks is not unreasonable to return to work if you have a strong core and good body mechanics. There is considerable overhead work with your job which magnifies bad body mechanics. The key here will be the physical therapist as this individual will be working closely with you for this period. I would depend upon the therapist to tell me if there are any remaining mechanical faults or weakness that would put your return to work in jeopardy. Of course, you need an experienced spine therapist to make that judgement.

The lump in your back is most likely from a seroma that developed or inflamed muscle and fascia and should soon recede. If it is painful to lie back with sitting, you can use a small wash cloth, fold it over and cut out a center hole slightly bigger than the protrusion. Tape this over the area. This will reduce the pressure while sitting. You could also tape this to your corset and wear the corset while you work for another 4 weeks.

Re-rupture of L4-5 is called a recurrent disc herniation and the chances are 10% in an active population.

Hope this helps.

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.

riley
Member

September 4, 2011 at 10:23 pm

Post count: 3

#4851

This is so amazing. I can’t tell you how much I appreciate the time you’ve taken to answer my concerns. One last thing (I promise)…what do you think of this “back2life” machine you see on the informercials? Before my epididural my therapist had me try it and for 12 minutes you feel as if could do nothing at all. The following day I was in so much pain I was physically ill and it took 3 days to get me back to just being in horrible pain instead of this killer pain! I’m hesitant to ever use that again but now that I’ve had the microdis. could this actually be helpful for people?
Again, so impressed with your in depth response, I can’t begin to tell you how I appreciate it.

Donald Corenman, MD, DC
Moderator

September 5, 2011 at 5:47 am

Post count: 8660

#4854

Most machines are not worth the money paid for them. There are some good one (Med-X and Cybex strengthening machines both come to mind) but most are not worth much for treatment. These machines are generally traction type machines like the DMX 9000, are very expensive and generally not very helpful. The “back2life” machine is an inexpensive traction unit that “rounds” the lower back (reduces lordosis). It would give temporary relief to some patients but with vertebral instability, this maneuver would increase mobility which would increase pain.

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.

riley
Member

September 5, 2011 at 9:35 am

Post count: 3

#4856

thank you very much Dr. Corenman. I appreciate your time a great deal
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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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