Numbness and motor weakness post-op

Tagged: Motor weakness after lumbar microdiscectomy

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jbsangus
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January 31, 2012 at 12:45 am

Post count: 6

#5477

Hi doc, I am 48 have had long history of leg pain finally had surgery 8 weeks ago. surgeon said worst stenosis ever in 25 years doing this surgery. Laminectomy 4levels from L2 to S1 both sides, right side was really bad, said nerve root at L5 down to size of pencil. Now after surgery i can stand straight and tip head back with no pain, but now back side of right leg and whole foot is numb right after surgery, also dural tear repair layed flat for 2 days. Motor weakness right buttocks,back of leg and ankle, can’t push down on toes. Been doing physical therapy and walking on treadmill everyday. I am walking with help of cane and severe limp. Doc says should come back in time. I was a very active person, how long should i wait before i get another opinion? What are your thoughts on this? Also, I still have bladder and bowel weakness and numbness. Thank You

Donald Corenman, MD, DC
Moderator

January 31, 2012 at 3:55 am

Post count: 8660

#5480

It sounds like the surgery for stenosis (I assume) was successful as now you can stand up straight without pain. The additional symptoms need to be addressed.

The first question I have for you is what was your deficit prior to surgery? Did you have the weakness, numbness or pain in the leg before surgery? The inability to walk on your toes is the S1 nerve. Was that inability present prior to surgery?

Did you have bladder and bowel dysfunction prior to surgery or is this new?

Ask your surgeon if the dural tear was just a small pinhole leak with a repair or a large tear with herniation of the nerve roots through the tear. Were any nerve roots injured during the tear or repair? Is there anything else that he can tell you?

An EMG may be helpful about 6 weeks after the injury to determine to what extent the problem is if the symptoms are new.

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.

jbsangus
Member

January 31, 2012 at 6:19 am

Post count: 6

#5481

Thank you for quick response. My symptoms started in my 30’s have known i have spinal stenonsis for about 15 years doctors say it is genetic. was walking bent forward, could not walk or stand for very long because of leg pain. After surgery i have all these new symptoms with right leg numdness and weakness, right buttocks muscle won’t work, down back of leg to foot, limited movement of toes, foot completly numb. I do have strength in front of my leg so i can pull toes up with ankle. Bladder and bowel issues are new since surgery. My left leg came out of surgery perfect. I am a farmer and need to know if this is going to be permanent. I could walk on my toes prior to surgery. He did not say he injured a nerve but did say nerve will be swelled for a while and that nerves take a long time to heal, he said what don’t come back in 12 months won’t come back. Thank You Doctor.

Donald Corenman, MD, DC
Moderator

January 31, 2012 at 7:27 am

Post count: 8660

#5482

Based upon your new onset of leg weakness and bowel/bladder dysfunction, there was some injury to the nerves. This would include the S1 and possibly the L5 nerve as well as the bowel and bladder nerves (nervi erigantes). The nerves can recover but may not fully recover. I agree with the surgeon that you won’t have a full idea for six to twelve months. A new MRI might be helpful to ascertain if there is any continuing compression.

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.

jbsangus
Member

January 31, 2012 at 8:44 am

Post count: 6

#5483

Is there anything i can do to speed the healing of the nerves ? Will walking on treadmill and physical therapy daily help or hurt it? I will be trying to get back to a somewhat normal life a little at a time.

Donald Corenman, MD, DC
Moderator

January 31, 2012 at 8:59 am

Post count: 8660

#5484

Unfortunately, nerves heal in their own due time. Nerve healing is very slow. There is not much that can be done to speed up nerve healing. There are some studies that might indicate using an electrical muscle stimulator is detrimental so if offered, stay away from that machine. You might need a custom orthosis for the weakness. That is a plastic device that fits over your ankle to stabilize your foot when walking and standing. I assume that your therapist has offered that to you.

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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