Numbness after microdiscectomy

Tagged: Infection after lumbar herniated disc

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Donald Corenman, MD, DC
Moderator

November 3, 2020 at 12:42 pm

Post count: 8660

#33342

Unfortunately, with an abscess present, you will need surgery. This would also explain why you have progressive nerve root symptoms. You need this surgery. Do not wait. A fusion should be conducted with this anterior approach, as fusion is required to “cure” the infection. Make sure they get good culture results so they know the infecting organism and make sure you get “culture and sensitivities” to know the correct antibiotics to use after surgery.

If you wait, you could develop sepsis (overwhelming infection) and that has a high mortality rate.

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.

Sailormoon
Participant

November 3, 2020 at 4:16 pm

Post count: 29

#33344

Hi Dr Corenman,

Thank you for your prompt reply.
I just want to know why the fusion need to be performed from anterior?

A week ago, doctor told me that if the infection isnot heal, he will perform surgery from anterior to clean up the infection. But at that time he didnt mentioned about fusion at all.

Im not having discussion yet with my doctor regarding this surgery, because when MRI done, he already go home. I got the news of plan for surgery from his nurse that come to visit me to inject the antibiotics. She will arrange me to talk to my doctor by phone today to get the detail about surgery.

I will ensure what you advise regarding bacteria culture etc to be done to me. Thank you so much.

From MRI, i saw the abscess located at the disc at side near the stomach, not near the nerve, but the pus spread from the abscess location up to the incision site. Including the nerve.

If he perform draining from anterior, can he clean pus at my nerve root too?

From MRI i saw almost half of my nerve root had black color and the black area wider compared to previous MRI. Today i feel my right leg become weak.

The doctor’s schedule for surgery is this Friday. I hope itsnot too late. I hope my cauda equina nerve didnt damage as i already have saddle anaesthesia on my right. Im so freak out

Sailormoon
Participant

November 4, 2020 at 2:57 am

Post count: 29

#33345

Hi Dr Corenman,

I talk to my doctor, he said he will clean the infection from back, took the sample for culture and then he will check stability of my spine to have it fused, if its not stabil, he will open the anterior too.

He said it will be open surgery. And then percutaneous something.. (i didnt understand) and he said he will took the bone from my stomach to insert at my L5

He said he wont touch the nerve. If he didnt touch it, then what about pus at my nerve? So i will still have nerve deterioration right? I confuse

Sailormoon
Participant

November 4, 2020 at 6:20 am

Post count: 29

#33346

Ok, seems the surgery is:

debridement+stabilisasi posterior, and if my back not stabil, he will do ALIF. So he will open my back and my stomach

Donald Corenman, MD, DC
Moderator

November 4, 2020 at 6:57 am

Post count: 8660

#33347

Normally, the surgeon goes where the abscess is located. He might be able to drain the abscess from the back of the spine. A fusion is typically used if surgery is performed in the face of infection but it is not wrong to only drain the abscess by itself.

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.

Sailormoon
Participant

November 19, 2020 at 8:22 pm

Post count: 29

#33392

Hi Dr Corenman,

I already had debridement + stabilization posterior 2 weeks ago, continue with antibiotics IV and pus culture already match with antibiotics given. 8 days after surgery CRP increase to 15 and ESR increased to 80. Antibiotics IV + oral continue 3 days later and then blood check showing CRP 4 and ESR 60. Now im on antibiotics oral.

On surgery, the surgeon found that my dura is already ripped and so thin. He stitches the leak. And he found that my nerve is so sticky and he make it free float.

After surgery until now i still have nerve deterioration in term of numbness and leg weakness. It still progressing. I have progressing burning sensation. It quite fast. Im sure something still happening. Doctor said, nerves take time to heal. But what im thinking it should be not progressing right?

Any advise?
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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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