taschenParticipantAugust 11, 2022 at 10:35 amPost count: 3
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, DCModeratorAugust 11, 2022 at 11:03 amPost count: 8459
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. CorenmantaschenParticipantAugust 11, 2022 at 4:58 pmPost count: 3
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, DCModeratorAugust 13, 2022 at 10:55 amPost count: 8459
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. CorenmantaschenParticipantAugust 13, 2022 at 7:03 pmPost count: 3
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.
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