Persistent back pain after microdiscectomy

Tagged: lower back pain after microdiscectomy

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taschen
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August 11, 2022 at 10:35 am

Post count: 3

#35229

Hi Dr. Corenman. Thanks for your very helpful website. I underwent an L5-S1 microdicectomy for a herniated disc causing severe right leg pain around 3.5 months ago. The relief from right leg pain was immediate following surgery and my first 5 weeks post-op went very smoothly (only minimal right leg symptoms), granted I wasn’t doing anything more strenuous then walking during that time. Around 5 weeks post-op I began to develop severe low back pain (without significant recurrent leg pain). I found this unusual as even before surgery my back pain had been minimal (my symptoms were largely in the right leg). The back pain became increasingly more severe, with increasing stiffness (particularly in the mornings) and with great difficulty bending. I had an MRI to look into this back pain at around 8 weeks post-op. The MRI showed no evidence of reherniation and the R L5-S1 nerve root did not appear to be compressed. The MRI did show “high STIR signal within the lower half of the L5 vertebral body new compared to prior study, may be postprocedural or due to mechanical strain/stress”. I was told that this finding may be consistent with “Modic changes” although I have only a vague idea of what that means. After the MRI I was instructed to take a break from physical therapy and dial back my activity level, and to take a course of anitinflammatories. The pain did improve in the weeks following this intervention, it is now less severe, bending has become much easier, and I have recently titrated off the antiinflammatories. However, although improved, the low back pain does persist and remains significant and troubling. I currently have a fairly constant dull ache in the low back around the L5/S1 level which is both on the right side and the left side (my surgery was on the right side). Any “high impact” movements (such as running, jumping, catching my step after tripping, or event walking with a fast/forceful pace) causes an acute/immediate sharpening of this pain (and so I’m unable to run or do any other high impact activities). Additionally, any movements where I push my legs into the ground while lying down (such as when trying to do a bridge exercise during PT, or even just shift positions in bed) causes sharp low back pain.. As things stand moving around or shifting positions in bed is quite painful. Otherwise, sitting for long periods sometimes aggravates the ache, and I periodically get what feels like low back spasms a few times per day. Although the symptoms are better then they were 5 weeks ago (when I got the above MRI) I feel like they’ve plateaued and I haven’t seen much further improvement the past couple of weeks. Leg symptoms remain minimal and my leg does not bother me much. What do you think is the underlying cause of these symptoms? Do you think I should expect continued improvement with time or is this likely to be an ongoing/chronic problem for me? I was very active prior to my injury and surgery and am concerned that these persistent symptoms are keeping me from resuming anywhere near my prior activity level. Thank you again!

Donald Corenman, MD, DC
Moderator

August 11, 2022 at 11:03 am

Post count: 8660

#35230

Unfortunately, about 10% of patients will develop new onset lower back pain (LBP) after a herniation or microdiscectomy. This might be due to the annulus (the outside wall of the disc) tearing or the loss of “cushion” (nucleus) shielding against impact. Make sure you don’t have a low-grade infection by P. Acnes (lab tests will help rule that out).

If it is mechanical LBP (no infection or fracture of the facet-which can be diagnosed by the MRI), then rehab, core strengthening and Pilates can be quite helpful. You will have to give it time.

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.

taschen
Participant

August 11, 2022 at 4:58 pm

Post count: 3

#35233

Much thanks for your reply. I had a blood count, esr, and crp sent which were all normal and I was told this makes infection unlikely. There was no mention of facet fracture in the mri report (so I assume that wasn’t present). Assuming this is mechanical LBP, do most patients see this resolve (or at least substantially improve) with time (and core strengthening, rehab, etc), or does this often lead to chronic ongoing pain? Thanks again for your insight.

Donald Corenman, MD, DC
Moderator

August 13, 2022 at 10:55 am

Post count: 8660

#35237

Most people eventually see lower back pain after microdiscectomy resolve. A good core strengthening program is important and I am a supporter of Pilates as therapy. It does take time.

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.

taschen
Participant

August 13, 2022 at 7:03 pm

Post count: 3

#35238

Thanks Dr. Corenman. This is certainly reassuring and much appreciated. I’ll be sure to continue with my core strengthening program and look more into pilates specifically.

James991
Participant

August 17, 2022 at 4:50 am

Post count: 1

#35239

I got Spine Injury in car accident in Los Angeles. I contacted DR , A well reputed and well known Spine surgeon, I’m highly satisfied with him.
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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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