[deritis]

#9909

Hi Dr. Then I can only conclude that I have reherniated. Pain has been back for a week and is ever present. Symptoms are not the same as pre-surgery, but pain is increasing. Ibuprofen helps a lot. My surgeon has started me on prednisone. If this is a reherniation, then what options do I have? Is another surgery the only answer? I am very fearful of that as it seems it would take me down the path to fusion at some point.

[Donald Corenman, MD, DC]

#9912

First, maybe your surgeon would consider giving you an oral steroid. Sometimes, this can short circuit an inflammatory reaction and get you onto a healing course again.

If the pain continues, a new MRI might be considered. If you do have a recurrent herniation, this can still be treated conservatively. Epidural injections can be very helpful. Continuation of a physical therapy rehab program can also be effective.

You might have a hematoma (pooling collection of blood) in the canal that mimics a recurrent herniation. This can be aspirated or if the symptoms are not too bad, will eventually resorb away.

Finally, if you do have a recurrent herniation and do undergo repeat surgery, this does not mean you will eventually need a fusion. That only is necessary about 10% of the time in a case of a second herniation (where a third herniation could occur and require a fusion).

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.

[deritis]

#9919

Thank you Doctor. I’m 3 days into a 6-day steroid pack. It helps, but truthfully 2-4 advil help much more (2 reduces pain for a day, 4 just about eliminates it). I regarded that as a positive sign because prior to the surgery I had to take huge doses of advil (12/day) to deal with the pain, and it barely helped.

I’m starting my 6th week post Micro-D (L5/S1)today. Pain has been back for 11 days. I was hoping I was being overly aggressive at stretching or doing cardio 11 days back and that the nerve was just badly inflamed. That seems unlikely at this point. I’ve seen others ask about Dips here. I did some of those as well the day before the pain came back and am thinking that might have been the cause of this possible reherniation. I wonder if the action of the spine being stretched by supporting myself by my arms btw two bars and then lowering myself back to standing on the floor may have had an accordion-like effect.

I’ve also had two buldging disks a few levels higher for a decade. Three rounds of epidurals back then solved that problem, at least until now.

Right now I have no back back, only pain in my right buttocks, back of my right thigh, and then sometimes over the front of my knee and sometimes lighter pain in the back of my calf. It seems to shift frequently. More severe in the mornings, which you noted is common due to nerve swelling overnight. By midday, it recedes some and mainly seems to rotate between locations.

I can walk and function normally. No loss of muscle weakness that I can detect. The down side of course is that I am still in recovery from the MicroD and the pain has returned. The pre-op pain level was a 10 at worst (sitting was very difficult, but it could recede to a 3 if I curtailed certain movements). The pain now is maximum in the morning at about a 7. It’s also not the same kind of pain as pre-op. Pre-op the standout sympton was explosive pain when rising (10/10). Now it’s a continuous ache that can be relieved if I change positions.

I realize only an MRI can confirm what’s going on. But assuming this is reherniation and I do not get a second surgery, what is the likelihood that I can feel good again? Go back to the gym regularly and that sort of thing? Thank you.

[Donald Corenman, MD, DC]

#9923

Dips will not generally stretch a nerve root but can cause a recurrent herniation in rare cases, especially with rotation.

Your pain in the buttocks and leg is radiculopathic pain. Pain that has reduced from a 10 to a 7 is not a sign that the nerve is recovering well. The loss of “explosive pain” when rising from a chair generally means the root is not “getting caught” by a disc herniation that is narrowing the lateral recess. Nonetheless, a recurrent herniation could still be in the differential.

Do not take Advil with a steroid pack as this can cause gastric irritation. Finish the pack and then you can start Advil (if you can tolerate a NSAID).

If you do have a reherniation, this does not automatically lead to surgery. As long as there is no motor weakness, the general rules of radiculopathy caused by a herniation hold. That is, 2-3 months of PT along with an epidural or two, home exercises and medications. Also, activity restriction so there is no pain generated is part of this algorithm.

If the pain is too significant or activity restriction is too limiting, surgery needs to be considered if a recurrent herniation is noted.

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.

[deritis]

#9924

Dr., your answer below actually gives me some hope. First 2-3 weeks after surgery my pain was present, but low compared to pre-op (about a 3 vs. 10). Week 4 was excellent. Only at the start of week 5 — one day after an intense gym day — did I get the symptoms I now have. During that session I stretched a lot more than I had up to that point. I had also been stretching daily for a while to that point. I realize this could be a reherniation, but is it at all possible that I stretched way too much and damaged my healing nerve? It’s been 11 days and the pain isn’t getting worse. Just not getting much better without meds. Or should the pain have subsided in a few days, as you mentioned earlier. Thank you so much for the service you do here. It is very helpful and helps bring peace of mind.

[Donald Corenman, MD, DC]

#9925

Stretching “a lot” can certainly cause the nerve to become re-inflamed. The nerve is a membrane that has some damage to it due to the initial herniation. Healing takes some “quiet time” for the nerve. The nerve can be “moved” in a normal day to day fashion during this healing but significant stretch of the legs will stretch the nerve.

This does not mean that activity will inflame the nerve but heavier stretching and cardiovascular activity can.

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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