Residual pain or possible reherniation?

Tagged: Microdiscectomy post-op recovery

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Battista85
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April 15, 2021 at 6:19 pm

Post count: 15

#33944

Hello Dr. Corenman,

Forgive me cause I’m not too good with all the medical jargon. I’m now roughly 11 days post microdiscectomy on the L5-S1 lumbar. I had extreme sciatica pain for roughly 2 months before the procedure and then roughly 2 weeks before the procedure the pain dissipated but I had a lot of numbness, especially in the foot and buttocks, and I was unable to do a single calf raise on the effected leg. Since the surgery, I still have the same numbness and weakness but now I seem to have some pain along the nerve again as well.

I was nervous that I possibly reherniated again so I went back to my surgeon, who did the straight leg test with me (negative) and figured it was just residual pain from the irritated nerve. He put me on steroids for 6 days (now 2 days in) to see if that helps calm the nerve. In my infinite boredom between walks and laying around doing nothing I read about the slump test, something he did not do. I attempted to do it myself with the help with my wife and sure enough I got pain along the nerve. I haven’t spoken to my surgeon about it yet but I’ve been reading your forums for awhile and wanted to see your thoughts. Main question I have, is a slump test post surgery an accurate way to determine if there’s still compression of the nerve/possible reherniation or am I causing myself undue anxiety for no reason?

Thanks in advance

Donald Corenman, MD, DC
Moderator

April 17, 2021 at 9:31 pm

Post count: 8660

#33956

Numbness after a root decompression is very typical and might take as long as 6 months to fade away. Motor weakness may slowly improve but there is a process for recovery. See: https://neckandback.com/conditions/peripheral-nerve-anatomy/

The slump test is really an offshoot of an old meningitis test (Kernig’s) associated with the straight leg raise test (SLR). If the root is irritated (which is still should be in your case at 11 days out), the test will be positive but this is of minimal concern. The root still is swollen which will generate positive tension signs (positive SLR and Slump)

If your initial leg pain is 50% better than before surgery and improving, you should give it more 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.

Battista85
Participant

April 18, 2021 at 5:20 am

Post count: 15

#33959

Thank you Doctor. You have put my mind somewhat at ease. I was just nervous because for about two weeks before the procedure all my pain seemed to have vanished and I was just dealing with numbness. Since the procedure, I seem to get pain especially after my walks and it seems a bit more “consistent” when I’m laying flat on my back. Though I will say it’s fairly mild compared to what I dealt with before (if a month before surgery was a 10, this is a more of a 3 or 4). I guess I just freaked out a bit because of not having any more pain in the days leading up to the surgery.

One other question if you dont mind me asking. I’ve also noticed since my surgery that when I clean my anus I seem to get a slight tingling in my left foot (the sciatica side) Also when I pee (standing up) sometimes I also get that tingling. I have no other issues with bladder or bowel control nor any saddle numbness of any kind but I’m curious why this is as it was not something I had prior to the surgery. Thanks again!

Donald Corenman, MD, DC
Moderator

April 18, 2021 at 7:25 am

Post count: 8660

#33964

I am not worried about peri-anal tingling if there is no numbness in these regions and you have normal control of your bowel and bladder functions.

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.

Battista85
Participant

April 18, 2021 at 10:37 am

Post count: 15

#33968

Thanks again Doctor.

One last question (until I think of more I guess). I occasionally get very sharp foot pain (despite the numbness) if I clench my buttocks or move a certain way (doing all I can to not bend, twist and so on). And normally the firmer the mattress or seat I’m in the more I feel a bit of that old sciatica pain (though again comparably mild to what it was before). I haven’t noticed any improvement in the pain since the steroids started (2 days left). I know these things take time but I get so anxious about any pain as I don’t want to think for a second the nerve is still compressed as I know the longer it is the harder it is to come back from. Anyway, thanks again for alleviating most of my concern. I’ve had a lot of surgeries in my time (only 35) but this one has scared me the most because of how much uncertainty there seems to be in the healing process. Your forums have been very helpful

Donald Corenman, MD, DC
Moderator

April 18, 2021 at 1:06 pm

Post count: 8660

#33969

You are very concerned about your symptoms even though you have significant improvement of your symptoms (in spite of the disappearance of pain immediately preop). Give yourself 6 weeks and as long as the symptoms don’t escalate, the root needs time to calm down.

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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