pain after surgery

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Tiku311
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December 8, 2011 at 5:23 am

Post count: 4

#5191

I’m a 35 year old cardiologist and unfortunatley have a h/o back surgeries. The first was an L5/S1 lami/discectomy on the right in ’97 with immediate relief of symptoms. I did well for over 10 years until ’08 at which time I developed left sided back and leg pain. I underwent an MRI revealing a left sided L5/S1 herniation. The pain distribution was different on the left then the right but I assumed that was due to some degree of asymmetry in my dermatomal distribution. I dealt with the pain conservatively for 3 years (including a couple of epidurals with minimal relief). Finally the pain progressed and I finally had surgery in 6/11 with a left sided L5/S1 microdiscectomy. Since surgery I’ve had ongoing radicular left leg pain though my back pain is significantly improved. I had an epidural in 10/11 with some improvement but now the pain is back. Interestingly the pain distribution now includes the prior area before the surgery but also new areas in my left leg as well. The pain is not as severe as it was before surgery but it is now almost constant and especially when I sleep on either side. Unfortunately due to the constant symptoms and difficulty sleeping, I’m considering a repeat procedure (even “laser spine” surgery for FBSS). Please advise.
Any assistance would be greatly appreciated.

Donald Corenman, MD, DC
Moderator

December 8, 2011 at 6:23 am

Post count: 8660

#5192

To reiterate your history, a microdiscectomy L5-S1 right in 1997 with good relief. 2008 noted development of left lower back pain and leg pain and an MRI noting a left herniation at L5-S1. Conservative care insued for three years with a microdiscectomy on the left on 6-2011.

After surgery, the back pain improved but the left leg pain has not. An epidural two months ago helped somewhat. The pain is not as severe as prior to surgery but is now constant where before it was intermittant. Pain now occupies both the old pain pattern and a larger distribution area but only in the left leg. Is that correct?

Is the pain constant but varies with position? Is the pain worse with standing and walking but improves with sitting or the reverse? Does the pain have the same previous quality or is it changed? Is it more of a burning quality now? Do you have any weakness?

Pain that doesn’t improve after a microdiscectomy could be from many factors. A hidden fragment that was not removed during surgery, a space occupying hematoma that formed after surgery, a recurrent disc herniation (these can occur just getting up the day after surgery), a foraminal collapse or chronic radiculopathy (see website) are just some of the possibilities.

Have you had an MRI post-operatively with gadolinium? This would be one of the most useful initial tests. Make sure the MRI is performed on at least a 1.5 tesla machine or better yet, a 3.0 tesla machine.

“Laser spine” surgery in my opinion is a gimmick that would not help. The laser is simply an ablation device that destroys tissue using heat and should have miminal use in the spine. You need a good work-up to determine what the pathology is and no surgery unless there is reason to operate.

Hope this helps.

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.

Tiku311
Member

December 8, 2011 at 6:54 am

Post count: 4

#5193

Thanks for quick reply!
Your summary of my problem is spot on.
I did have an MRI with gadolinium 2.5 months post op and it revealed postoperative changes around the nerve root. There was also mention of some osteophytic changes but no mention of residual or new disc herniation. No mention of foraminal collapse. I know that a foraminotomy was not performed at the time of surgery (and perhaps it should’ve been since it’s the second surgery on the same level).
The pain I have now is worse primarily when I sleep on either side but left greater than right. It is also bothersome when I sit. It improves with standing and feels the best when I walk. It is a burning and cramping type pain and similar to the prior pain but, as mentioned before, more constant, less severe, and involving a larger distribution. I also tried both neurontin and lyrica with some relief but the drowsiness made work difficult so I stopped both.
Of note, I also have some mild paresthesias in my right foot which are new.
I attempted to exercise last week and after 30 minutes on an elliptical machine I developed numbness of both great toes which is a new finding. My preop numbness was primarily in my 4th and 5th right digits. Fortunately there is no significant weakness I notice in daily activity but a physical therapist noted reduced strength in my left glut.
I’m approaching the 6 month anniversary of the surgery and don’t feel like celebrating.
I don’t want another procedure but need to find an explanation as to why I feel the way I do.
Thanks again.

Donald Corenman, MD, DC
Moderator

December 8, 2011 at 9:59 pm

Post count: 8660

#5194

Pain that improves with standing and walking is most likely not from foraminal stenosis or lateral recess stenosis. Burning/cramping pain is associated with chronic radiculopathy, more so if night pain is part of the symptom complex.

A selective nerve root block (lidocaine with steroid) can be helpful for symptom relief and diagnosis. If there are no compressive elements and the root is swollen or surrounded by inflammation, there may not be any surgery that can help. It may be worthwhile to get another pair of neuroradiologist eyes on the MRI.

If this turns out to be chronic radiculopathy, you may be a candidate for a spinal cord stimulator. You can have a trial (it is an outpatient experience) and if you like it, have the device implanted. There are occasions that if this is chronic radiculopathy, time with be helpful to reduce pain but that is not a guarantee.

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.

Tiku311
Member

December 13, 2011 at 11:13 am

Post count: 4

#5220

Thanks for the help.
I’ve also recently been diagnosed with a central C4-C5 herniation without nerve root involvement but some degree of central cord compression. I’m having bilateral radicular arm pain which is improving slowly. However I’m also having some mild paresthesias in the right leg which is new as my only pain before was the left leg. Have you seen cases of cervical cord compression causing radicular symptoms in the lower extremities?

Donald Corenman, MD, DC
Moderator

December 13, 2011 at 1:59 pm

Post count: 8660

#5222

Cervical cord compression can cause myelopathy which in turn can cause paresthesias in the upper and lower extremities. There should be more symptoms than these paresthesias however. Imbalance, some loss of fine motor control, possible electric shocks down the spine and other symptoms could occur. If the paresthesias increase with neck extension, this could be myelopathy as the spinal canal narrows with extension and cord compression increases.

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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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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