Post Surgery Pain Issues related to Thoracolumbar Laminectomy, disectomy and fus

Tagged: PAIN, spine, thoracic

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Donald Corenman, MD, DC
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December 13, 2015 at 5:18 pm

Post count: 8660

#21026

Multiple questions-I will try to answer as many as I can.

Yes-you can have the instrumentation out as long as you have a solid fusion. This fusion is proven by a CT scan. There generally is no reason to take the instrumentation out unless it is prominent or you have barometric change (weather related) symptoms.

Remaining spurs should over time “melt away” but there is no guarantee these will disappear. If your post-op MRI notes an open canal in spite of these bone spurs, they probably do not need to be taken out surgically. The solid fusion along with a reasonably open canal in the lower thoracic spine should not be a symptom generator.

You noted a TLIF or cage in the disc space with your fusion. By definition, there was at least some discectomy as you have to remove some disc to get a cage in the disc space.

Again, the current symptoms could be from cord injury as there is no significant change in symptoms with spine position (flexion, extension, bending, rotating).

The early surgeries that neurosurgeons have written papers are long laminectomies without fusion that have collapsed into kyphosis. This is an old technique that is generally no longer used. These neurosurgeons also retracted the cord just as all surgeons now retract nerve roots for disc hernations in the lumbar spine (no cord present-only nerve roots). The cord does not tolerate retraction.

Again, I like fusion along with thoracic decompression to prevent this kyphosis and prevent further motion which can lead to degeneration and spur formation.

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.

Jtal19305
Participant

December 13, 2015 at 7:04 pm

Post count: 43

#21036

Thanks for the concise answers, they are very helpful.

A few other questions.

Since I have instrumentation at T12/L1, would an MRI with contrast or a CT Myelogram be better to visualize the canal space, cord and nerves?

One of my main complaints is the burning pain in the sole (especially heel) of my left foot which I detected right after the surgery. If it is due to spinal cord irritation (injury) during the course of surgery, is there anything that can be done to heal it (eg stem cells, physical therapy, massage, etc) or is it only a matter of time? Do I stand a good chance that this will improve over time? I understand the cord has limited ability to self heal but how much damage could have been to my cord with this relatively straight-forward posterior decompression procedure? The surgery to both the T12/L1 decompression with fusion/instruments and the L2/3 hemi (left) laminectomy was a little longer than 2 hours. I only had reported 100 ml of blood loss during surgery.

I was told most spine surgery patients are markedly better at the three month point. I am closing in on 6 months, so I am getting a little anxious. Yes, the left foot pain was very bad at the start (it felt like someone had a blow torch on my foot after beating it a sledge hammer, a classic 10 on the pain scale). Now it is a nagging burning pain, 4-6 on a pain, which waxes and wanes without any noticeable triggers.

I still have other nerve pains in my left leg which are my calf, outer side just left of my knee, and outer left thigh. I just don’t understand why I had decompression surgery and still feel this way after 6 months. I was told my surgeon is good maybe he had a bad day on my surgery. It is quite frustrating. I was pretty healthy before all this, and now this constant pain.

Thanks again for your time and help. It is greatly appreciated.

Donald Corenman, MD, DC
Moderator

December 14, 2015 at 5:11 am

Post count: 8660

#21037

If you have had a cord irritation/injury, only time and medications can help to reduce symptoms. There are unfortunately no stem cells or injections that can heal the cord at this time. You can try epidural steroid injections as inflammation is one of the components of irritation and steroids are a great treatment for this.

Cord and nerve roots heal depressingly slowly but do heal. You have noticed this in the last 6 months. It takes a year to 18 months to recover as best as can be expected. I cannot comment on the injury itself. Could it have been the original compression that caused the symptoms or the surgery? Careful perusal of post-op films might be helpful but might not be definitive.

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.

Jtal19305
Participant

December 15, 2015 at 7:01 pm

Post count: 43

#21039

Hello
Thanks for the very helpful answers.

I can say that I did not have any burning pain in my calves or sole of my left foot prior to the surgery. I had started to get fasiculations in my calves in the month prior to surgery and I experienced sudden leg weakness in the week leading up to my decompression surgery. I had left anterior thigh pain and numbness for a few years which was misdiagnosed as meralgia paresthetica. I awoken from surgery with a severe burning pain in my left foot.

That pain has diminished somewhat since my surgery six months ago.

So a couple of questions. If bone spurs do melt away over time, how much time approximately? I think it would help me greatly if these spurs were to dissappear as they are encroaching on my spinal canal. Note the spurs are on the the edges of the vertabral body near the annulus. Also my disc (or annulus) Is bulging there too (between t12 and L1). So although I had a posterior decompression, if the space opens up on the other side, my cord would be more freed up.

I am having a hard time finding a doctor who is detailed and serious about helping me since I already had surgery. The ones I have seen don’t seem interested in going into the details necessary to understand this.

I still have pain in my left thigh as well as my foot. Walking distances makes my hips hurt. My back gets a little sore if I stand too long. Are some of these things normal six months after spinal fusion? I read some many bad stories about spinal fusion. I imagine there must be people who had success with spinal fusion. I’m am told that it can be two years to feel normal again after this kind of surgery. Is this true? What other limitations can I expect to face with spinal fusion like I have had?

Thanks
Jerry

Donald Corenman, MD, DC
Moderator

December 16, 2015 at 5:46 am

Post count: 8660

#21040

Your cord was dysfunctioning for a long while prior to your decompression and fusion. Your symptoms of “fasiculations in my calves in the month prior to surgery and I experienced sudden leg weakness in the week leading up to my decompression surgery” were quite serious. You needed this decompression and fusion. Unfortunately, you developed allodynia after surgery that was quite impairing for some time but has now quieted down and should continue to improve of the next year.

I think the fusion was important as I stated before. A decompression at this level without a fusion can lead to more significant problems down the road.

Your continued symptoms, “I still have pain in my left thigh as well as my foot. Walking distances makes my hips hurt. My back gets a little sore if I stand too long” could be from the residuals of your cord compression. Give yourself some time to recover as it takes 12-18 months to recover from a cord compression.

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.

Jtal19305
Participant

December 16, 2015 at 2:37 pm

Post count: 43

#21042

I appreciate your synthesis explanation for my symptoms and I must be patient. However should I still be experiencing these calf fasiculations? I still get them but they are off and on. Does this happen?

I’m waiting for approval of mri with contrast my doctor ordered. After my surgery and looking at a one month post op MRI with contrast he felt the decompression was sufficient. If I can get that new MRI I would like to know for sure I am adequately decompressed. Or us it going to be a while until the inflammation and nerves settle down.

I did have an emg ncs one month after surgery that came back normal
Thanks again your help
Jerry from Detroit
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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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