Oral steroids and recovery after microdiscectomy

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KB32
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January 14, 2022 at 8:42 am

Post count: 16

#34739

I am a 32 year old, active female and I had a microdiscectomy surgery about a month ago. This is my second microdiscectomy/laminectomy on my L4/L5 within 9 months due to reherniation. Supposedly now there is not much disc left due to the two massive herniations.

I am well aware that there is residual nerve pain that lingers during the recovery for a few months. I remember all too well the bumpy recovery from my last microdiscectomy. Some weeks are good, other weeks different pains arise. As you move and start to slowly stretch, the nerve root can become irritated. Its quite the balancing act between stretching/strengthening enough and stretching /strengthening too much. Eventually time, physical therapy, acupuncture and massage therapy allowed me to recover to about 90-95% within 3 1/2 months. I was overall very happy with my recovery up until I reherniated again.

It’s been 4 weeks now since my second surgery and I am doing pretty well. So far I am happy with where I am. A few minor setbacks here and there depending on activity level, but I feel like the nerve pain I feel is reasonable. Still having residual calf nerve pain and occasional buttock pain. The pain is minimal compared to before surgery. I can do nerve glides and static abdominals without upsetting the nerve. But if I try to stretch the hamstring, I will piss off the nerve and rally irritate it for a few days.

I am curious to hear your experience with past patients and their recoveries in regards to prescribing them an oral steroid early on after their surgeries. Does a dose of oral steroids help reduce inflammation enough to allow them to make progress with stretching and strengthening earlier on in their recoveries?

To me it seems like the greatest limitation in the recovery process is upsetting that nerve root. The minute you upset the nerve, it seems to set you back a few days. It doesn’t appear to me with my recoveries that you can stretch through the pain and it will get better. It seems like you have to stop, wait for it to calm down, before proceeding slowly.

Donald Corenman, MD, DC
Moderator

January 17, 2022 at 3:36 pm

Post count: 8660

#34743

This is the problem with nerve root inflammation. If the root is swollen, any type of stretch can “piss it off” with the annoying pain and paresthesias. With a persnickety nerve root, I am a fan of oral steroids to reduce the root irritation. This does not mean you can stretch it too much as when the steroid wears off, you might pay the price. However, if you know prior to the steroid how much the root can stretch, you can then add 10% to the stretch after the steroid is active to gain some advantage.

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.

Donald Corenman, MD, DC
Moderator

January 17, 2022 at 3:36 pm

Post count: 8660

#34744

This is the problem with nerve root inflammation. If the root is swollen, any type of stretch can “piss it off” with the annoying pain and paresthesias. With a persnickety nerve root, I am a fan of oral steroids to reduce the root irritation. This does not mean you can stretch it too much as when the steroid wears off, you might pay the price. However, if you know prior to the steroid how much the root can stretch, you can then add 10% to the stretch after the steroid is active to gain some advantage.

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.

KB32
Participant

January 21, 2022 at 11:27 am

Post count: 16

#34763

Thanks for your prompt response!

I have one more question for you that has recently come up. At the start of week 4 I recently started experiencing dizziness. I have never had any issues with dizziness or vertigo before. It’s been persistent for 7 days so far. I feel like I am “swaying back and forth” for the majority of the day and feel like my equilibrium is off. The feeling is similar to getting off of a boat after you’ve been on one all day. Spatial awareness is slightly off and I’ve been having difficulty concentrating. My neck has been sore, but could be related to sore muscles from lying down a lot lately. Overall, I feel better when i am lying Down.

Is there any chance this would be related to the surgery?

Donald Corenman, MD, DC
Moderator

January 21, 2022 at 2:00 pm

Post count: 8660

#34766

One of the problems that can occur with anesthesia is a breaking off of an otolith in the semicircular canals of the ear. This small stone can cause the hairlike sensors in the canal to trigger with different positions. There are specialized maneuvers to trap this stone and can be found through an ENT specialist.

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.

KB32
Participant

February 10, 2022 at 10:23 am

Post count: 16

#34824

Dr. Corenman,

Thank you for your quick reply. Your website has been a wonderful source of information for me this past year!

I have one more question for you. I am now 8 weeks post-op from my revision l4/l5 microdiscectomy. Overall I am still a lot better than I was before surgery. I still have nerve pain in my left calf and buttock as well as some lower back pain, but it’s minimal compared to before surgery. How long does the nerve root take to heal with a revision surgery that occurred within 9 months from the prior surgery? Should I expect this residual nerve pain to stick around longer since its a revision? I started feeling really good about 12 weeks after my first surgery.
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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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