Viewing 4 posts - 1 through 4 (of 4 total)
  • Author
    Posts
  • stullcj
    Participant
    Post count: 2

    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
    Post count: 8656

    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
    Post count: 2

    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
    Post count: 8656

    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.
Viewing 4 posts - 1 through 4 (of 4 total)
  • You must be logged in to reply to this topic.