Post-OP pain

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Travis.m
Participant

September 1, 2020 at 7:13 pm

Post count: 4

#32930

Good Evening Dr,

I know it’s earlier in my recovery but like most people I’m worried and can’t keep my mind off of it. Was wondering what your thoughts would be.

My history 34yr old male 215lbs first microdiscetomy/Laminectomy Dec 9th 2019 @ L4/l5. Symptoms: severe leg pain to knee, was super tilted, couldn’t walk from couch to kitchen never saw any improvements from March 19’ till surgery. After surgery leg pain was completely took 6-ish weeks and all pain was gone.

Around April 15th 2020 was on a walk and felt some nerve pain decided to head home from walk woke up next day back at square one pain wise. Went through the PT/MRI/Shots I had reherniated the L4/L5 again and had corrective microdiscectomy/Laminectomy on August 27th. Going into the last 2-3weeks I was seeing improvement I was able to sit for long periods of time with no pain and had no issues sleeping. The problem i had was standing or walking for more than a couple minutes I would start to get the stabbing nerve pain down the left leg. After surgery first couple days were much harder on the 2nd surgery than first. I can stand or walk for 40-60 seconds pain free but than the nerve pain starts coming back stronger and stronger till I’m at a 8-9. Couple things regarding this 2nd surgery I don’t know if they could be contributing factors per the doctors there was a lot of scar tissue and manipulation of the nerve to get the disc bulge out. They prescribed a 7 day taper prednisone pack that I have 2 days (3 pills left). Here is where my question lies should I be worried that I’m still only feeling nerve pain after standing or walking for a few minutes or could this still be caused by swelling? My thought was if it was swelling it wouldn’t come and go along with if the nerve is decompressed when first standing it should stay decompressed but I’m also only 5 days post op

Donald Corenman, MD, DC
Moderator

September 1, 2020 at 8:00 pm

Post count: 8660

#32932

Your time line is inaccurate. You note a redo “microdiscectomy/Laminectomy on August 27th”. You then note “Going into the last 2-3weeks I was seeing improvement” but there are only 5 days from surgery to today (Sept 1st). When was the redo surgery performed?

Redo discectomies do have to deal with scar and manipulation of the root which can cause delayed inflammation and increased pain. It really is an unknown how the root was manipulated during surgery and that has some bearing on the post-operative symptoms. You have to be patient with the recovery but if symptoms don’t calm down over the next 3 weeks or significantly increase when you stop the steroid, you might have some cause to consider a new MRI. Fresh post-operative MRIs in redos are sometimes difficult to interpret.

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.

Travis.m
Participant

September 2, 2020 at 6:08 pm

Post count: 4

#32938

Sorry for the confusion I was seeing improvement pre surgery just was having issues walking for more than a couple minutes than the pain would flair up but sitting and laying down had gotten better and I had corrective surgery on August 27th (6 days post-op). I do appreciate the response and know it takes time. I’m hoping it’s just swelling since i only have the pain a minute or so after I stand or start walking now but didn’t know if swelling could give a delayed pain like that or if it would’ve been consistent

Donald Corenman, MD, DC
Moderator

September 3, 2020 at 7:26 am

Post count: 8660

#32939

Please keep us informed of your progress in the next couple of weeks.

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.

Travis.m
Participant

September 21, 2020 at 7:21 pm

Post count: 4

#33021

Good evening Dr,

Just an update things have been going extremely well in my recovery from surgery i am currently 25 days post op and it’s amazing how different my recovery has been from the first surgery to the second both were relieved the symptoms but just the timeframe they did. I had one more question. Prior to surgery to relieve the pain in my left leg I didn’t have any lower back pain. Over the last day or two I’ve started to have pain (almost like it gets super tight) just on the right side at the same l/4 l/5 level down to the top/front top of my hip. It’s not sharp nerve pain but it’s definitely a pain that can only be relieved by laying down, crouching, or sitting. Could this be that I had some disc bulging on the right side but didn’t notice since the pain on the left was so much stronger or could it be (pre-surgery I had a severe tilt to the right that’s now going away as I’m straightening out) that my muscles are just being stretched back out and causing the pain on the one side only.

Donald Corenman, MD, DC
Moderator

September 23, 2020 at 2:53 pm

Post count: 8660

#33031

This is probably “disc settling” pain. When you have a herniation, the annulus tears and a portion of the “jelly” comes out of the “donut”. This decreases the pressure in the disc and just like letting air out of a car tire, the disc settles. It takes some time for the side walls to adapt and there is discomfort in the back during this 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.
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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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