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

Tagged: PAIN, spine, thoracic

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Jtal19305
Participant

December 29, 2015 at 11:33 am

Post count: 43

#21098

What I notice a lot of these days is stinging pain in my calves and “bubbling” ticks in the lower calves. I know I had the decompression surgery, but why am I still having these muscle ticks in my calves? This is a big concern of mine, and I understand an MRI is the first place to start. I am still trying to get my insurance to approve it through my doctor. Due to the holidays, the doctor is out and nothing gets down without him from what I gather. So I continue to wait.

As far as instrumentation removal, I will wait until fusion is confirmed by Cat scan. Once the fusion is complete, are the vertabrae strongly attached? I get concerned about stability and other issues developing. I am trying to avoid any unnecessary bending, lifting and twisting. Are there other things I should avoid?

Jtal19305
Participant

December 30, 2015 at 9:09 pm

Post count: 43

#21101

Is it possible that an mri image can provide a distorted view of canal space or bone spurs? In that the mri will make the spurs look larger than they are and the canal may look more narrow than it is?

Donald Corenman, MD, DC
Moderator

December 31, 2015 at 4:16 am

Post count: 8660

#21102

Right before surgery, you developed weakness of the legs. This indicates significant compression of the cord. You could have had a cord injury from that compression and you are experiencing residuals from the original compression.

The MRI generally does not over-exaggerate compression but with metal in the spine, could “blur” the pathology. You could consider a CT myelogram as this will both give information on compression as well as fusion mass.

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 31, 2015 at 7:05 am

Post count: 43

#21103

Yes. I had an issue with my back leading up to surgery. I did however have a chiropractic adjustment done about 3 to 4 days before my legs got weak. This was my first appointment with this particular doctor and I made the visit in hopes it could help my left outer thigh pain. The doctor did several adjustments and my back did “Crack”. He did some leg stretches too. I did not have pain directly after this adjustment. I realize in hindsight it was probably not a good idea to see a chiropractic doctor but I didn’t know the extent of my spine issues until after that appointment. So I wonder if this triggered the weakness in my legs? The ortho doctor I was seeing in Pennsylvania and the mri done prior to the chiropractic appointment seemed to suggest issues with compression and disc bulge. I realize given my back issues, a chiropractic treatment may not have been such a good idea although I have had these in the past on an irregular basis without issues. This is what bothers me because maybe I could have avoided surgery had I not had this adjustment. Or I could have put off the surgery. Maybe the adjustments accelerated the inevitable. In either case if my surgery was done correctly I don’t think I would be in such pain for so long afterwards. I read that pain after three months is described as failed back surgery or post laminectomy syndrome. My back was probably bad for many years but I never had leg weakness until this one time prior to surgery. I don’t think my surgeon really factored any of this prior chiropractic when I mentioned it. He seemed fixed on the mri Images. This is why I asked if mri can show things as worse than they are. I realize I can’t undo my choice for surgery or the surgery itself. I think has the pain resolved by now I would better with all this. Because I have all this pain still, I’m filled with questions and doubt. I would consider the ct myelogram but this is another invasive procedure. I read that it is safe but others have indicated it could cause permanent nerve issues too. So I want to be careful from this point forward. I think if the mri and a new very good doctors opinion suggest I need a ct myelogram, I would get one to get definitive information on my post operative spine condition. I don’t want additional surgery but if concensus shows I could benefit I would consider it. I know going back into that area is fraught with risk but maybe under the right hands it could be done. All this confuses me because I had this disc bulge and bone spurs at T12-L1 most likely for years as these issues don’t develop overnight or in days. So if the decompression surgery was sufficient as prooved by a mri or ct myelogram, it is back to your idea that the cord was irritated. Thanks so much and happy new year. I hope I can find a new doctor do I can get the peace of mind and body I really need.

Jtal19305
Participant

January 1, 2016 at 10:14 am

Post count: 43

#21152

Hello doctor.

I was taking a closer look at my cat scan images (post surgery) and I noticed that the top left side pedicle screw (at T12) is slightly lower and outward (into the foreman) when compared to the other pedicle screw on the right side. I don’t know what this could mean but could this explain somethings or is this an indication of a misplaced pedicle screw. My symptoms are predominantly on my left side and as I stated earlier, I awoke from surgery with a burning pain in the sole of my left foot.

Thanks Jerry

Jtal19305
Participant

January 10, 2016 at 4:29 pm

Post count: 43

#21157

Hello doctor
Does the S1 nerve root connect to the spinal cord between T12 and L1? I’m thinking that my laminectomy disectomy and interbody fusion at that level,T12 and L1, could of damaged the S1 root because my pain has been in my left heel area, left calf and occasionally the right calf. I get a diffuse burning pain in these areas that has been fairly constant. I’ve taken Lyrica, percocet and clonazepam for pain management with little relief. I also developed loud ringing in my ears that have been going on for about 3week now. I’m not sure if those medications are having ototoxic symptoms or if it something else. It’s the burning pain I have in my lower legs and feet that have me concerned. I’m having a new MRI soon and wonder if that should show nerve root damage? I also still have the calf fasiculations which come and go for no apparent reason. I am trying to be patient but I need something to give me hope that these symptoms will improve over time. Also could the csf be restricted in its flow or cushioning effect? Will that be seen in a MRI? And could cause my pain symptoms? I don’t have headaches. I see my doctor on Tuesday with the new MRI that I plan to have tomorrow. Are there any specific question I should ask?

Thanks Jerry
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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.

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