Post surgery pain after 6 months

Tagged: increased pain after lumbar fusion

Viewing 6 posts - 1 through 6 (of 11 total)

1 2 Next

Author

Posts
KW Lee
Participant

November 22, 2015 at 7:16 am

Post count: 7

#20768

Dear Dr.

My dad has undergone a 5 level spine fusion surgery . He is still suffering pain on his leg 6 months after the surgery . The pain is at his tibialis anterior.

We have met 18 doctors. He had done CT scan and nerve conductivity test . The CT scan report shows the hardware are intact and various doctors have confirmed the screws are in perfect position . There are plenty of free space for the nerve and no compression is observed . However the nerve conductivity report mentioned there is a delay in the L5 & S1 nerve .

Based on your experience what could be wrong with my dad ? Do we need a MRI scan ? We are helpless as he is still unable to walk 6 months after surgery and pain is remain .

Hope you could give us some advise .

Thank you .
KW Lee

Donald Corenman, MD, DC
Moderator

November 22, 2015 at 9:37 am

Post count: 8660

#20769

There are a number of potential causes of remaining leg pain after a fusion.

First question is what was the diagnosis to lead to the surgery? What were the symptoms prior to surgery?

Second question is if the pain changed in intensity or quality after the surgery.If so-how?

Third is whether the fusion is solid or not?

Fourth is what the EMG found-radiculopathy vs peripheral neuropathy? (See website for differences).

If your father has not had a postoperative MRI, he needs one now with and without gadolinium.

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.

KW Lee
Participant

November 23, 2015 at 7:16 am

Post count: 7

#20771

Dear Dr. Corenman

Appreciate your quick reply . Here are my answer to your question :
1. He has spinal stenosis in multiple level . His first pain that caused him unable to walk was back in 2010. He had an injection and was OK since then until May this year . The doctor asked for surgery and that was how he ended up with spinal fusion surgery
2. He suffered pain on his right leg 2 weeks before surgery . The pain radiated from upper thigh to ankle . He was still able to walk prior to surgery despite of intense pain . 1 month after surgery his pain developed in his tibialis anterior side and we noticed the muscles has some swelling and stiff ! His mood wasn’t as bad as before but he couldn’t walk steadily and smoothly after the surgery and not able to climb up and down staircase because of pain . For your information he has no foot drop .
3. The nerve conductivity report written with “suspect nerve root insult from spinal cord ”

Hope to hear further from you .

Thank you in advance .
KW Lee

KW Lee
Participant

November 23, 2015 at 7:19 am

Post count: 7

#20772

Dear Dr Corenman

For your information my father has had the nerve root block injection but there is no sign of relief .

Thank you .
KW Lee

Donald Corenman, MD, DC
Moderator

November 24, 2015 at 6:31 am

Post count: 8660

#20833

I will assume that with the presence of spinal stenosis and the need for fusion, you father had a degenerative spondylolisthesis (see website). WIth continuing leg pain that is worse after surgery, I would also assume that there might be an existing lumbar foraminal stenosis or lumbar foraminal collapse that was not addressed or fully corrected after surgery.

A nerve root injection that gained no relief is suspicious. For diagnosis, the relief needs to occur for only the first three hours. Most individuals who are injected are not given this information (see pain diary). Long term disappointing results are not important for diagnosis.

New imaging is important to understand the pathology. These would include an MRI with gadolinium and a CT scan.

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.

KW Lee
Participant

November 27, 2015 at 5:50 am

Post count: 7

#20851

Dear Dr. Corenman,

My father had the MRI ( with contrast ) yesterday and below are the report contents from Radiologist :

– Posterior lumbar interbody fusion has been performed from L1 to S1
– Alignment and curvature are normal
– There are central disc bulges at all levels
– At L4 L5 the disc bulges in the right paracentral direction and there is hypertrophy of the facet joints, especially the right side
– The right lateral recess is narrowed and this may impinge upon the right L5 root
– The foremina are not significantly encroaches at any level
– The cenral canal is capacious
– The conus appears normal
– There is no abnormal enhancement
– The paravertebral soft tissues are unremarkable
Comment from Radiologist : Posssibly narrowed right lateral recess at L4 L5 due to a right paracentral disc bulge and hypertrophic facet joints.

While below are the CT Scann radiological report :
– Mild scoliosis of lumbar spine with convexity to the right
– Alignment appears maintained
– There is reduction of L3 L4 disc space
– Air seen within disc at L2L3, L3L4, and L4L5 suggestive of vacuum phenomena
– The rest of vertebral body height and disc spaces are maintained
– The spinal canal appears preserved. No significant spinal stenosis
Comments : Posterial surgical instrumentation seen from L5 to S1 with lumbar spondylosis changes and lumbar
scoliosis

Dr. Corenman, hope you could help us to advice what could be wrong.

Thank you so much.

Regards,
KW Lee
Author

Posts

Viewing 6 posts - 1 through 6 (of 11 total)

1 2 Next

You must be logged in to reply to this topic.

Donald Corenman, MD, DC

Average rating:

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel