Numbness after microdiscectomy

Tagged: Infection after lumbar herniated disc

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Donald Corenman, MD, DC
Moderator

November 20, 2020 at 12:34 pm

Post count: 8660

#33393

I’m happy to hear you have had the debridement and fusion with identification of the bacteria. How you have the correct antibiotic and your lab numbers are surprisingly descending quickly.

I wonder if you had a dural tear prior to this surgery as most patients will have significant positional headaches in the presence of a chronic dural tear.

Your nerve was adhered due to fibrosis so it is good that it was freed but doing that con come at a price of further nerve irritation due to root manipulation.

Progressive symptoms can be from inflammation, root damage from manipulation or the possible onset of CRPS due to the burning quality of the pain(see https://neckandback.com/conditions/complex-regional-pain-syndrome-crps-reflex-sympathetic-dystrophy-rsd-causalgia/). Don’t worry too much about the latter but keep it in mind. You might as them about using gabapentin for nerve 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.

Sailormoon
Participant

November 20, 2020 at 5:51 pm

Post count: 29

#33395

Hi Dr Corenman,

Thank you for your explanation.

In term of pain, right now i dont have severe pain. I do have pain in certain position, but all of them is tolerable but very uncomfortable. The soles of my foot is tingling all the time. When walking it feels like i have much small stone at the soles. Not to mention mild burning at my calf, tightness of calf. Very2 uncomfortable.

I able to walk but my legs become weaker. Is there possibility i will end up paralyzed?

The doctor give me pregabalin, i took them one day and then it makes me like a zombie, no balance when walking. It only help me to fall asleep.

Is there anything i can do to stop the symptoms progressing? From inflammation, root damage or CRPS.
Maybe i still at early stage and might be can stop the symptom progressing?

Donald Corenman, MD, DC
Moderator

November 21, 2020 at 8:26 am

Post count: 8660

#33396

It sounds like you are being treated (finally) appropriately. I think if you carefully watch your symptoms, you will find that you are probably not progressing symptom wise. Keep a watch on your symptoms but don’t use anxiety to misinterpret your symptoms as progressing. Nonetheless, if you are truly worse (progressive weakness), contact your surgeon immediately.

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 22, 2020 at 6:42 am

Post count: 29

#33397

Hi Dr Corenman,

I really hope that it is something that i dont need to worry about.

Thank you so much for your detail information and response. It really help me a lot.

Sailormoon
Participant

November 28, 2020 at 7:58 pm

Post count: 29

#33424

Hi Dr Corenman,

My nerve deterioration still going on. Burning sensation, reduce skin sensory, and pin and needle at the bottom of my feet become wider. Lately i also have deterioration on bowel movement. And its hard for me to stand on tiptoe now. I’m 100% sure that its not only in my head.

MRI non contrast had already performed and showing black shadow similar with herniation on central of the canal. The black shadow wider compared to previous MRI. I saw some of the black dot inside the canal start to covered by the black shadow. I compared the MRI image with the one on your youtube channel with title how to read MRI.

I dont know whether the black shadow is pus, scar tissue or else. The disc already empty so i think its not herniation. I ask the surgeon about this, but he said nothing wrong with the MRI. He said that we have to ensure the infection fully healed.

While i think the infection is already healed. Because the ESR reduced again to 40 and CRP is 1.4 and the most important thing i no longer have back pain and i able to sit now. My doctor said because my ESR still high then i still have infection, while all i know it should be combination CRP + WBC just like you said. ESR high have many factors, right?

I running out of idea to whom i should asked about this. I came to neurolog to read the MRI but she said only the surgeon who performed the surgery who know what it is. She offered me to have EMG.

If the black shadow inside the canal is pus, can it absorped by body? Can scar tissue grows so fast and made symptom like i have? Do you have any advise for me?

Donald Corenman, MD, DC
Moderator

December 1, 2020 at 6:27 am

Post count: 8660

#33425

Normally, when you obtain a post-infection MRI, the images include a gadolinium set of images. Gadolinium (Gad) in injected into your vein before the images are obtained. The Gad “lights up” on certain sequences to determine if the “black shadow” is inflammatory tissue or some type of mass. Your symptoms seem to be progressing so that is not a good sign but your lab numbers are improving which is better.

If the black shadow is pus, it will be hard to cure the infection as this “pus pocket” can be walled off and unreachable by the antibiotic. However, if it is phlegmon, a mass of healing inflammatory tissue, the results could be much better. The Gad would help determine the difference.

I’m not sure what to do here as my experience is different than what you have been going through. Here in the USA, I would consult as many experts as I could get my hands on to gain more wisdom but it seems that where you live, that is a difficult task.

Please stay in touch.

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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