Pain Spike Appx 4.5 Months Post Microdiscectomy

Tagged: recurrent disc herniation

Viewing 4 posts - 1 through 4 (of 4 total)

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stullcj
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February 9, 2016 at 7:26 pm

Post count: 2

#21295

Dr. Corenman,

First, thank you for hosting this forum and for taking the time to answer questions and address concerns that are brought up by your patients and others.

You performed a microdiscectomy on my L4/L5 disc on Sept 25 of last year. After the initial spike in post-operative pain faded and PT began, my pain intensity has been on a downward trend, and was near zero some 3.5-4.0 months out. I was very committed to PT, and my physical therapists have done, an excellent job of seeing me through the recovery. On January 10th or so, I resumed the higher intensity activities I had been working toward, and I did so with a core, back, etc. that was in far better shape than what it was pre-op.

About 1.5 weeks ago, I maneuvered myself into a tubular slide and after a short time (a minute or two), my lower back stiffened significantly, to the point where I had difficulty standing up (and subsequently walking). The stiffness was in my lower back, but I experienced pain running down my left leg into my calf which made it difficult to walk. The character of the pain was very similar to what I had been experiencing pre-op. The stiffness (and accompanying pain) worsened into the evening and the next morning, and subsided by the next evening. Whereas the stiffness is gone, the pain running down my left leg has been left behind, though not to the extreme that it had been. I am not experiencing reduced motor function, which I was experiencing pre-op.

I have had nightmares about re-herniating my disc, but given my activities throughout the period during which the disc was herniated (pre-op), I have a hard time believing that something so minor would result in a re-herniation. I was / am in better shape than I have been in years; my core is dramatically more stable than it has ever been. I was very disciplined about ramping my activity up slowly (over approximately four months). This latest episode has me in an increased level of pain, and has me concerned.

While a remote diagnosis is not possible, I would appreciate it if you could share your thoughts on what I’ve described. Should I expect this to occur on occasion? Can I expect to see the pain subside back to near zero as it had been? Predictions on timing are even less possible, but I would think that some number of weeks (months?) out, whatever aggravation to the nerve I might have caused would subside.

Thank you for any input.

Chris.

Donald Corenman, MD, DC
Moderator

February 10, 2016 at 5:22 am

Post count: 8660

#21303

The symptoms you note certainly could be from a recurrent disc herniation. This also could have been from a nerve root stretch (the nerve can be persnickety after a compressive disc herniation) but these stretch symptoms typically calm down after one week.

You might consider asking your primary care physician to prescribe you a short course of an oral steroid. If the root is somewhat swollen now, this will help to alleviate swelling and calm the root down. If the steroid does not help, it might be time for a new MRI.

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.

stullcj
Participant

February 22, 2016 at 7:40 pm

Post count: 2

#21403

Hello again. Last week, I had appts with my PCP, my chiropractor, and my physical therapist. The PCP prescribed a dose pack of prednisolone and a 30-day supply of gabapentin. I finished the prednisolone this morning and have taken a 400 mg dose of ibuprofen yesterday and today. I have not started the gabapentin due to concerns about the side effects.

The result of the prednisolone was a reduction in pain, but after physical exertion yesterday, the pain is back. The primary symptom all day today was parasthesis in the anterior region of my left calf, which increased throughout the day. This evening after doing my PT exercises, the parasthesis seems to have subsided, but I now have an increase in gluteal pain (near the piriformis, I think). The parasthesis is somewhat new to me, as I’ve really only experienced it post-op. This latest bout seems more intense and less “itchy” (if that means anything) than what I was experiencing shortly after recovery began.

My chiropractor noted nothing of significance and seemed pleased w/ all facets of my strength. My physical therapist prescribed me with some nerve stretching exercises (which do help) and some additional core strength exercises. I have been back at my PT exercises since last week. Again, no loss of motor function; I check every day, multiple times.

My additional question / concern is whether a reduction in pain w/ the steroid is indicative of anything, given the increase in pain today and into the evening. I don’t mean to bother you. If I lived in Vail, I would already have been in your office, but I live some six hours away. I appreciate any input you might have. Thank you.

Chris.

Donald Corenman, MD, DC
Moderator

February 23, 2016 at 9:20 am

Post count: 8660

#21409

You initially had an L4-5 herniation and then a microdiscectomy at that level> If the herniation was in the posterolateral position (the typical position that 95% of patients develop), the L5 nerve would have been affected. This would radiate to the area you notice (“the anterior region of my left calf”).

It is good that you don’t have motor weakness by examination but do read the topic https://neckandback.com/conditions/home-testing-for-leg-weakness/ to make sure you have no motor weakness.

I would assume that you have a recurrent disc herniation. Either that or a nerve stretch inflammation. A new MRI would be helpful and possibly, an epidural injection to calm the nerve down.

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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