Ongoing leg and hip pain 3.5 months post hemilaminectomy and partial discectomy

Tagged: Pain 3 1/2 months after microdisectomy

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

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bbaker1
Participant

March 8, 2017 at 10:52 am

Post count: 3

#24466

Good Morning Dr. Corenman,
I am 3.5 months post surgery and I am still experiencing ongoing hip and inner leg pain. The pain in my hip is almost a pulling/pinching pain and the pain in my inner calf is a burning/tingling pain. I had a hemilaminectomoy and discectomy on 11/21/16. I was good up until about Christmas and then similar symptoms to pre op started to come along. I had a post surgery MRI on 1/24/17, which showed now recurrent herniation. Below is a breakdown of what the MRI found:

L3-L4: There has been interval right partial hemilaminectomy and partial discectomy at this level with resolution of previously seen right lateral recess stenosis. There is mild right neural foraminal stenosis without nerve root encroachment. Edema is seen in the soft tissues posteriorly as well as within the disc. There is postoperative fluid and enhancing soft tissue seen along the surgical tract extending into the laminectomy defect with mild associated epidural enhancement.

I had an ESI 2 weeks ago that helped some, but nothing substantial. My pain management dr wants to do another and see if it will help some more. I was told that it is potentially scar tissue causing this problem, but from what I read off the MRI, scar tissue is not impending the nerve root.

What do you think is the next step and what could be causing this issue?

Donald Corenman, MD, DC
Moderator

March 8, 2017 at 7:25 pm

Post count: 8660

#24469

You note a recurrent herniation but your radiological report does not read for a recurrent herniation. The report notes “There is postoperative fluid and enhancing soft tissue seen along the surgical tract extending into the laminectomy defect with mild associated epidural enhancement”. There is no mention of recurrent disc herniation.

Your symptoms could be from nerve inflammation but infection could also be a part of the differential diagnosis. Make sure there is not a recurrent herniation and if not, an aspiration of the fluid by a meticulous injectionist with cultures could be a next step. I would assume if there is an infection, it would be with a low virulence organism (an organism that can’t cause much damage like P. Acnes).

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.

bbaker1
Participant

March 9, 2017 at 10:06 am

Post count: 3

#24480

Hey Dr. Corenman,
I apologize for the confusion. I meant to say no recurrent herniation.

Infection? interesting, i have yet to have that brought up by a physician. Would there be other symptoms involved with an infection?

I went and saw my spine surgeon today, and he stated he believes scar tissue is irritating the nerve and advised to get another shot. He stated the irritation/inflammation from the scar tissue would go away with time, but it could be a few months for it to do so.

He did say he did not think the pain would get any worse, which is a good sign.

What has been your experience with scar tissue? Does my case sound like that could be the problem?

Thanks!

Donald Corenman, MD, DC
Moderator

March 9, 2017 at 6:21 pm

Post count: 8660

#24489

Scar tissue can affect the nerve root but the chance of that is not high. Inflammation of the root (more common) can “take forever” to subside and is helped along by steroid injections. If you are scheduled for an injection, have the interventionist aspirate and send the fluid for culture. Some of the more common organisms might take as long as 11 days to grow.

Sometimes, it just takes time for the root to calm down. Patience is important.

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.

bbaker1
Participant

May 18, 2017 at 7:48 pm

Post count: 3

#24812

Hello Dr. Corenman,
Hope all is well.
I am continuing to have pain down my right leg, following the l3-l4 nerve path. I had another MRI this past week and the results are below:

Central disc protrusion at L3-L4 indents the ventral thecal sac with mild canal stenosis. Mild bilateral Neural foraminal narrowing is noted at this level. STIR images reveal mild Modic Type I changes along the adjacent endplates at this level.

What does this Modic type I mean and how can it be treated?

My pain is at its worst while sitting and/or standing still.

Thanks in advance.

-Brett Baker

Donald Corenman, MD, DC
Moderator

May 19, 2017 at 2:44 pm

Post count: 8660

#24832

This disc level is going down the cascading degenerative pathway. Modic changes generally mean that the disc no longer acts like a cushion (shock absorber) and the endplates are “getting beaten up”. With greater forces to the spine (falling, jumping, impact), the disc cannot absorb all the shock forces and greater forces are transmitted to the bone endplate. This endplate suffers micro-fractures and “Modic” changes are the result. This generally causes lower back pain and not leg pain unless the nerves are affected by foraminal stenosis (narrowing of the nerve exit holes). Your MRI notes “mild” canal and foraminal stenosis. Of course, beauty and moderator terms (mile, moderate and severe) are in the eye of the beholder.

Your nerve pain (buttocks and leg pain) could be from the prior nerve injury due to the herniation not having healed, possibly from the surgery itself or from your current “mild” foraminal stenosis. If your pain is more constant, it may be from the chronic nerve injury. If the pain occurs more with standing, walking and impact, the foraminal stenosis could be to blame (which is fixable surgically).

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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