More surgery to remove debris after microdiscectomy

Tagged: continuing symptoms after surgery, microdiscectomy, recurrent disc herniation

Viewing 6 posts - 1 through 6 (of 16 total)

1 2 3 Next

Author

Posts
SarahUK
Participant

July 18, 2015 at 4:39 am

Post count: 12

#20033

Hi there,
For the past year I have had the most excruciating pain in my foot – having excluded a cause in the foot itself it was found I had a small herniation st L5 S1. I responded very well to nerve root blocks and it was then suggested that I had a microdiscectomy – which I did 6 weeks ago. From the moment I woke up I still had foot pain which became more and more excruciating. A repeat MRI at 2.5 weeks post op found evidence office sort of residual ‘ debris’ or a tissue mass touching the S1 nerve which was inflamed and enlarged. I had two more nerve root blocks but these have done nothing to shift the pain which is now also in my lower back and coccyx (is it possible for the S1 nerve to give coccyx pain?) . It is now suggested I have another surgery to clear out this debris. But I am terrified as the first surgery made everything so much worse. However the pain is unbearable. The surgeon says I have ‘ very sensitive nerves’ but if that’s the case, surgery is likely to inflame them more right ? Please kindly give me your thoughts. This is very worrying .
I’d appreciate your opinion.
Thanks

Donald Corenman, MD, DC
Moderator

July 18, 2015 at 10:44 am

Post count: 8660

#20034

I can understand your reluctance to have yet another surgery to decompress the nerve. The nerve is swollen which means it will take some time to heal or calm down. I assume the “debris” is confirmed to be disc material and not inflammatory tissue which will not respond to surgery. This confirmation generally is done via a new MRI with gadolinium.

Your pain seems to be quite significant. This would prompt me to consider a redo decompression sooner than later (assuming this is residual or recurrent disc material and not inflammatory scar).

I will assume that you trust your surgeon and he or she is capable of doing a good job of freeing the nerve root. I do worry about your coccyx pain as this is not typical for an S1 nerve root referral pattern. Nonetheless, it seems if the assumptions are correct, a redo microdiscectomy is required. It is possible that these symptoms might not respond quickly to surgery.

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.

SarahUK
Participant

July 18, 2015 at 12:06 pm

Post count: 12

#20037

Thank you so much for your reply !
Just FYI I had a nerve root block on L5S1 a few days ago and for a brief period (2-3 hours) ALL my foot and back/coccyx pain went away – but then came back with a vengeance . However, because it did disappear for this short time, the doctor concluded that these nerve roots ( I guess especially S1 as it is swollen) are the cause of my problems.

On another note, the ‘debris’ showed up on an MRI just 2.5 weeks after surgery so that is too early to be scar/inflammatory tissue right ? Will the contrast enable them to specifically identify what kind of material it is ?
Thank you for all your help – I really appreciate it !

Donald Corenman, MD, DC
Moderator

July 18, 2015 at 12:11 pm

Post count: 8660

#20039

The results of the nerve block help to indicate that all your symptoms stem from the nerve root. You could have a hematoma (pooling of blood products) that can cause compression but this can be ruled out based upon a new MRI with gadolinium.

The “debris” is unlikely to be scar only 2.3 weeks post surgery. This debris is most likely a recurrent herniated disc or some fragments that could have been “hidden” when the microdiscectomy was initially performed.

Please let the forum know how you progress.

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.

SarahUK
Participant

July 18, 2015 at 12:20 pm

Post count: 12

#20040

Thank you SO much – I can’t tell you how much I appreciate your replies !
If it is a hematoma, would they operate ? Sorry for all the questions !
S

Donald Corenman, MD, DC
Moderator

July 18, 2015 at 12:23 pm

Post count: 8660

#20042

If it is a hematoma, generally this will absorb away in 6-8 weeks. If the pain is too incapacitating, an interventionist can aspirate this blood with an injection and place some steroid to calm the root down.

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.
Author

Posts

Viewing 6 posts - 1 through 6 (of 16 total)

1 2 3 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