Parathesis

Tagged: Hip and thigh pain after lumbar fusion

Viewing 5 posts - 1 through 5 (of 5 total)

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JimMiller
Participant

April 24, 2017 at 9:41 pm

Post count: 40

#24695

Hi Dr. Corenman,

I am almost 8 weeks post op from TLIF at L5,S1 for grade one spondylolisthesis.

The surgeon only removed facet and pars fracture on right side (the TLIF side).

I am walking one mile per day and feel good while walking, however since the surgery I have had numbness, tingling, and sharp pain on my right thigh and buttocks; it does not go past my knee. The symptoms seems to get worse with ambulation and seem to get better when laying down. However symptoms can also be intermittent with sitting and laying down. I have already taken a medrol dose pack, which did not give relief. I am now taking Lyrica, which seems to take the edge off a bit but makes me tired. I have not started PT yet.

1.) Do you think this will eventually go away on its own?

2.) What would you recommend ?

Kind regards,

Jim

Donald Corenman, MD, DC
Moderator

April 24, 2017 at 10:57 pm

Post count: 8660

#24697

The TLIF side is also the side of nerve manipulation to get in the cage. This could sensitize the nerve. The differential includes that along with seroma (small collection of blood or fluid), screw stenosis (the screw is irritating the nerve) and cage malposition. Ambulation symptom increase does not rule anything out at this time. Did you not get temporary relief with the oral steroid?

Do give this symptom some time to abate (unless the symptoms are incapacitating). If symptoms are problematic, you can ask 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.

JimMiller
Participant

April 24, 2017 at 11:07 pm

Post count: 40

#24698

Yes, I did get temporary relief with the oral steroid. As a matter of fact, the symptoms were not as severe right after surgery. They gradually became worse and I thought the oral steroid would take care it.

Please note, I have a transitional vertebrae so I believe this is technically being called L4-L5….does this makes a difference ?

Also, what nerve root would you say is causing my symptoms of right sided front and hip parathesis (does not travel down to knee)?

Thank you for the fast response. The symptoms do make it difficult to walk more than half mile and I would like to rehab further !

JimMiller
Participant

June 2, 2017 at 9:34 pm

Post count: 40

#25130

Hi Dr. Corenman:

I wanted to follow up with you once again with regard to the above. After taking lyrica for some time much of my thigh numbness, tingling, burning nerve symptoms have decreased, although still present. However I am still left with significant hip pain on right side and in right groin area (at least I think it is from the hip).

I asked my surgeon about it and he said these symptoms were not from nerve root retraction at L5,S1 but from the lateral femoral cutaneous nerve being compressed while on operating table (meralgia paresthetica).

Questions:

1.) Do you believe pain is from DJD in hip or meralgia paresthtetica ?

2.) If gait has changed after surgery would the hip become irritated like this ? Perhaps shifting more weight to hip while walking ?

Obviously, I need to walk as much as possible to rehab so I need to keep mobile!

Please let me know your thoughts.

Thank you,

Jim

Donald Corenman, MD, DC
Moderator

June 3, 2017 at 10:25 pm

Post count: 8660

#25134

The differential of hip pain from radiculopathy, hip disorders and “meralgia parenthetic” is not too hard. See these section on the website:
https://neckandback.com/conditions/femoral-acetabular-impingement-syndrome-fai-hip-impingement-syndrome/
https://neckandback.com/conditions/meralgia-paresthetica-lateral-femoral-cutaneous-nerve-entrapment/
https://neckandback.com/conditions/symptoms-of-lumbar-nerve-injuries/

The lateral femoral cutaneous nerve is a specific distribution and with a careful physical examination, con be easily diagnosed. Hip disorder can be elicited by physical examination as well as imaging (x-rays and MRI). Spinal origin of hip and anterior thigh pain can be diagnosed by history, physical examination and imaging.

Finally, two of the three (hip and spine) can definitively diagnosed by diagnostic injection (numbing the structure and getting temporary relief).

Hips can become irritated spontaneously after surgery as your gait can change and irritate a preexisting but non-symptomatic hip disorder.

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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