Residual Sciatica or Reherniation?

Viewing 6 posts - 19 through 24 (of 25 total)

Previous 1 2 3 4 5 Next

Author

Posts
Donald Corenman, MD, DC
Moderator

December 21, 2013 at 9:52 pm

Post count: 8660

#9980

The MRI report notes radiculitis (“A single enhancing nerve root is seen in the cauda equina without clumping”). This is different than radiculopathy in that radiculopathy is a compressive painful nerve condition that normally is relieved by decompression (a microdisectomy).

Radiculitis is inflammation of the entire nerve from the dorsal root ganglion (the mass of cell bodies at the nerve exit hole down low in the spine) all the way up to the origin of the nerve at about T10 (up in the thoracic spine). This is a different animal than nerve root compression as the entire nerve has developed inflammation. The normal cause of radiculitis is nerve compression from a herniated disc. Why only a small fraction of patients develops radiculitis is not known.

This condition requires time and steroids to help reduce the inflammation of the nerve. It can take as little as a couple months to obtain relief but can take as long as a year 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.

deritis
Member

December 21, 2013 at 11:43 pm

Post count: 18

#9981

That’s very interesting and explains why advil works so well in relieving symptoms most of the time. I see my surgeon in a week to figure out how to treat this. Meantime, is radiculitis a permanent condition? Or is this a case of what I had originally thought — I was over zealous in my stretching at about the 4 week point after surgery and really irritated or injured a healing nerve? Also, given that I otherwise feel normal (other than the pain shooting down my leg), would light to moderate cardio exercise at the gym be ok to restart or not? Currently, I am doing PT exercises 2-3 times a day and walking 2-3 miles a day. Thank you again doctor!

Donald Corenman, MD, DC
Moderator

December 22, 2013 at 1:52 am

Post count: 8660

#9983

Normally radiculitis is not permanent but a portion of patients can have long standing symptoms. You do not want to stretch this nerve too much now so as to allow the inflammatory condition to subside, One of the problems is that pain may be delayed in onset after an activity. Therefore, you have to experiment with slight increases of activity and then wait for the outcome (increased nerve pain).

If you have great relief with NSAIDs (Advil), this is a great treatment. The typical side effects of NSAID chronic use have to be respected but most people do not suffer the side effects. You just need to keep up with your primary care doctor for this.

No one has indicated why certain nerves develop radiculitis and other do not. I don’t think that stretching is the reason for this disorder.

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
Member

December 27, 2013 at 11:18 am

Post count: 18

#10003

I’m curious if the problem is just that single enhancing nerve root. What does the phrase, ” Extensive epidural enhancement is seen on the right surrounding the L5 and S1 nerve roots” mean? If also says the epidural enhancement is consistent with scarring. Does this mean the problem is scar tissue or just general inflamation? Also is inflamation like this possible 7-8 weeks post-op?

Donald Corenman, MD, DC
Moderator

December 27, 2013 at 11:57 am

Post count: 8660

#10004

Inflammation around the nerve root is common after surgery for about three months. Significant inflammation (that displaces the nerve root) is more inflammation than is to be expected. In either case with continued symptoms, an epidural steroid injection will be helpful.

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
Member

January 1, 2014 at 6:36 am

Post count: 18

#10022

Hi Dr.,
Well it turns out according to my surgeon I did reherniate the disk after all. He does not agree with the radiologist conclusion totally. He agrees that scar tissue inflammation is part of the problem, but he also says one of the images shows some disc material displacing the nerve and pressing it against the scar tissue. The image he showed me seems pretty clear. It’s not as large a herniation as pre-op. The symptoms are not pleasant, but they are also not has bad. He said two months after surgery would be too soon for an epidural because the scar tissue would make it difficult to bathe the nerve properly. He said most doctors who do epidurals would prefer to wait three months after surgery. He will put me back on the medrol pack again in the hopes it will get the situation under control. He also said a second surgery would fix the existing pain and the likelihood of a third reherniation is lower as there would be very little disc material left to herniate.

So it seems I’m somewhat back to where I started from. A herniated disc, with the complicating factor being a surgery two months ago on the same disc. I’m choosing to take the conservative route this time in the hopes the disc herniation AND inflammation will eventually shrink and give the nerve room to breathe again. Any other advice would be greatly appreciated. Thank you for all of your kind help.
Author

Posts

Viewing 6 posts - 19 through 24 (of 25 total)

Previous 1 2 3 4 5 Next

You must be logged in to reply to this topic.

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel