Reherniation 6 months after l4/l5 microdiscectomy

Tagged: recurrent HNP lumbar

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KB32
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October 5, 2021 at 4:10 pm

Post count: 15

#34473

Hi Dr. Corenman,

Back in April I had an emergency microdiscectomy on my L4/L5. The emergency was due to the L5 nerve root being severely displaced and my left foot was experiencing paralysis. Could hardly walk and stand. Couldn’t move my toes in the left foot and was experiencing severe sciatica pain. Anyways, my recovery was going great after surgery up until a few weeks ago. Received a ct scan at the ER and it shows the l4/l5 reherniated and the protrusion is pressing on the l5 nerve root again.
What are your suggestions for conservative treatment? And at what point would you suggest another surgery? Would you suggest another microdiscectomy or would you suggest a fusion? I’m a young mid-30s athletic female and really want to get back to doing the things i love to be doing.

Donald Corenman, MD, DC
Moderator

October 7, 2021 at 12:31 pm

Post count: 8660

#34514

Generally if symptoms are of similar intensity to your prior herniation with a new herniation, a redo microdiscectomy is in order. If symptoms are less and there is no progressive motor weakness, an epidural steroid injection can be considered. Fusion would not be necessary unless there was even another HNP (3rd HNP) as the reherniation rate after a second microdiscectomy is only from 10-20%.

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.

KB32
Participant

October 15, 2021 at 1:36 pm

Post count: 15

#34528

Thanks for the quick reply!

After a week of rest, massage therapy, and acupuncture my sciatica pain went away and so did my lower back pain. The only symptom I am currently feeling is pins and needles in both of my legs. The last time I had a herniated disc only one of my legs was affected. Is it possible to have pins and needles all over both legs with a L4/L5 herniated disc?

KB32
Participant

October 15, 2021 at 1:49 pm

Post count: 15

#34529

I should clarify that the majority of my lower back went away. Still get some pain in lower back when I sit for too long.

Donald Corenman, MD, DC
Moderator

October 16, 2021 at 1:30 pm

Post count: 8660

#34530

You have progressed well. Normally, paresthesias bilaterally in the lower extremities is due to root irritation but it is unusual to have bilateral presentation with a unilateral HNP. Nonetheless, pain is mostly gone and function sounds acceptable so give this some time to improve. Paresthesias typically will fade away over 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.

KB32
Participant

November 3, 2021 at 8:06 am

Post count: 15

#34580

Hi Dr. Corenman,

It’s been 6 weeks now since my symptoms started due to reherniation of the L4/L5 disc. Over these past 6 weeks I tend to get better, then have a severe flare up, then I tend to get a little better, then experience another severe flare up. Flare ups would include extreme lower back pain and nerve pain in my calf. I also notice a hint of nerve pain in my other leg as well. I do not have any motor weakness. I recently started experiencing severe butt pain and tightness again.

I find that sitting really upsets the nerve and causes extreme lower back pain which then leads to nerve pain in my leg. I talked with my surgeon and he is willing to do another microdiscectomy. We both agreed to continue conservative treatment for a little while as I’m not in too much pain at the moment. We also discussed an l5 nerve root block or epidural. I did find out my most recent ct scan showed that my herniation was larger than my first herniation. My first herniation before surgery was 2 cm.

I have a couple of questions:

1. How long should i give the conservative treatment? Another 6 weeks? If I have another severe flare up within these next 6 weeks, I was thinking that I would move forward with surgery. If i continue to feel better, then obviously no surgery would be necessary.

2. With a huge herniation that is greater than 2 cm, does that mean that conservative treatment will take longer than say a 5-7 mm herniation? Do larger herniations suggest that surgery is more likely necessary in the future?

3. What are your thoughts on nerve root block or epidural? I feel like the nerve root block will mask the symptoms too much and I will then become more active. Which could result in not healing. Currently, I am not in too much pain. But that is because I have been laying down a lot and not moving much these past 6 weeks. The more active I become, the more aggravated my nerve gets. So Ive kept everything to a minimum. But I worry inactivity will start to lead to other problems.

Look forward to hearing your thoughts
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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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