Post Op complication - Microdiscectomy L5-S1

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painfreeplease
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July 17, 2012 at 10:50 am

Post count: 1

#6541

Dear Sir,

Thank you so much for providing all the valuable information, especially the videos. They have been very very useful to me.

I just had a microdiscectomy L5-S1 6 weeks ago. My pre-op MRI conclusion notes are as below:

There is a central disc protrusion at L5/S1 narrowing the spinal canal and both lateral recession at the level of L5/S1, worse on the left side with impingement on the left S1 descending nerve root. There is also slight impingement on the right S1 discending nerve root.The exit foramina are clear.

I had chronic sciatica pain for 2 years. Worse on the left side, and then after a year the right side was suffering similar pain. Around Nov 2011,the pain was no longer tolerable, and there were very sharp shooting pain going along my back and leg. The frequency of the shooting pain increased rapidly. Ultimately, a surgery was decided to be necessary.

Immediately after surgery,I could feel relief in my right leg. But my left leg was in great numbness. I couldn’t move my toes or push my feet forward. It is assumed to be nerve irratation due to manipulation during surgery.

1st week of post operation, numbness in general. General post op recovery discomfort.

2nd week, pain of the left leg had increased significantly. Unable to stand on the left leg much. The pain is worse than pre-op condition. I am mainly in bed, I can’t stand or walk for long.Severe pain radiating from back to feet when I on my feet. It was not the case before surgery.

3rd week, severe pain, was excruciating, it felt paralysing my back to my leg. Very sensitive with any movement and even touch. In great pain and an emergency doctor was called for house visit. I was prescribed pregabilin/lyrica as co-codamol & diclofernac did not work for me anymore. The main excruciating pain subsided. I am able to get up of bed to stand and walk around the house. But am still in pain – which is worse than before the surgery as the pain is constantly there. Standing and lying down give me more pain than sitting. Which was opposite before my operation, where sitting and walking too long were mainly aggravating my sciatica pain.

This is the post-op note from my neurosurgeon:

On examination she does have clear root tension at 30 degrees on the left side, a clear L5 radiculapathy.

During Surgery, it was very difficult to remove the disc because the disc had hardened significantly and basically was almost like cortical bone at the site of the spinal canal. Once I got into the disc I removed soft material but it did not cause a good decompression more medially. I then created a trench by nibbling away a lot of that bone material. Surgery took longer than anticipated but still within 50 mins. I think that because of the significant root retraction that was required, she has developed swelling of the nerve root that has caused her problems. The retraction certainly explains the numbness that she experienced.

A MRI is arranged to review her current condition.

I have just done my post-op MRI. I have the images but still awaiting for the radiologist report. From what I can see from the second MRI, it looks like the herniation still exists, and if not larger than before. I’m not sure.

Could you please explain, what can possibly be the reason that my pain is much more worse than before the operation? I fear that I might be referred to pain management clinic and no other permanent solution are offered by my consultant.

Please advise as I’m desperately in need to be pain free. It’s debilitating. Thank you.

Donald Corenman, MD, DC
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July 19, 2012 at 1:35 pm

Post count: 8660

#6550

It appears that you have a recurrent herniation at the same level as your surgery. This can happen even when you are lifted off the operating room table immediately after surgery. WIth the motor weakness that you report, in my opinion you need a repeat microdiscectomy.

If the surgeon is reluctant, you need a second opinion soon.

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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Post Op complication – Microdiscectomy L5-S1