Returning back/ leg pain 10 weeks after microdiscectomy

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Sean22
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February 7, 2020 at 12:18 pm

Post count: 8

#32047

Hi Dr. Corenman, November 15th I had a microdiscectomy on my L-5 S-1 due to a large protrusion. I’ve dealt with this for about 2 years until I decided to have surgery. Surgery went fine and recovery was going smoothly until about 10 weeks in (3 weeks ago) I woke up with acute back pain. I decided to do some stretching to try relieve it but it didn’t help. As the day continue, I gradually started to develop pain in both legs, buttocks, hips, and on my back near the flank on both sides, pain is more on the right side. Also, I began to lose strength in both legs with extreme pins and needles all around my legs and numbness in my right foot.

Due to this new alarming and gradual pain, I got a MRI a few days later. Here’s what the report said.
“ L5-S1: There is loss of the normal intervertebral disc height. A small disc bulge is present with a posterior annular tear. No displaced disc fragment. No evidence of neuroforaminal or spinal canal stenosis.. The patient had a right hemilaminectomy with a microdiscectomy. No hematoma. No fluid collection. No evidence of a leak or infection.

IMPRESSION: Postoperative changes after a right L5-S1 microdiscectomy. There is a small disc bulge with internal disc desiccation at L5-S1 but no neuroforaminal or spinal canal stenosis. No acute displaced disc fragment. Overall the alignment of the lumbar spine is straightened suggesting paraspinal muscle spasm.

Good news is that everything looks fine, bad news, what’s causing this pain? More so, what confused me was the flank pain, it never went away. Also, why would I have flank pain to begin with? That’s not a common symptom, at least one I never dealt with. So I suspected perhaps there was something wrong with my kidneys.

2 days ago I went to my primary provider, they ran a urine sample and found blood in my urine. Went to the ER right after and suspected perhaps this could explain my flank pain. They did a CT scan and what they found was severe constipation. The doctor said my kidneys were fine and it was this constipation that was most likely causing my unexplained flank pain.

Since then I used a laxative to help with the constipation, and I gotten most of it out. I noticed every time I have a bowel movement, I have pain in my flanks and legs, feel a slight moment of relief in regards to pain, but then the pain would come right back.

Today, I’m still in pain. Flank pain, leg pain all over with pins and needles, loss of strength in both legs, and numbness in right foot. I used an oral steroid pack 3 weeks ago which help but the pain came right back. My doctor said no to an epicdural steroid shot because he sees no alarming concerns on my MRI.

Entirely, I’m at a lost on what to do. Where’s this pain coming from and how to manage/ suppress it? I’m starting PT next week to see if that could help. Really hoping you can help figure this one out. This is a complete mystery to me. Thanks for your time.

Sean22
Participant

February 25, 2020 at 3:34 pm

Post count: 8

#32142

Hello sir, I hope I didn’t break any rules and hope you can give me some insight in my current situation. Symptoms are about the same, I’ve gotten steroid injections in my lower back which helped but bilateral leg pain is still present.

Donald Corenman, MD, DC
Moderator

March 2, 2020 at 12:46 pm

Post count: 8660

#32186

You had no significant symptoms after your L5-S1 microdiscectomy for 2 1/2 months until you awoke with lower back pain for no apparent reason. You then had an MRI which noted “No displaced disc fragment. No evidence of neuroforaminal or spinal canal stenosis… No hematoma. No fluid collection. No evidence of a leak or infection”.

I should note that on rare occasions, a P. Acnes infection can look somewhat benign on MRI but still be present. I would have infection labs drawn just to make sure but I’ll continue assuming you don’t have infection.

Flank pain (lateral pain a distance away from the spine) is very unusual to be generated by the spine. You note current “leg pain all over with pins and needles, loss of strength in both legs, and numbness in right foot”. I assume you have been ruled out for CRPS (https://neckandback.com/conditions/complex-regional-pain-syndrome-crps-reflex-sympathetic-dystrophy-rsd-causalgia/).

An examination needs to be performed to make sure there are no long tract signs indicating a neck problem along with a chronic radiculopathy of the S1 nerve root (from the prolonged compression of the S1 root) See https://neckandback.com/conditions/chronic-radiculopathy/ and https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/

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.

Sean22
Participant

March 3, 2020 at 12:57 am

Post count: 8

#32207

Well good news is that the flank pain is mostly gone now. I also had an MRI of my Cervical area recently that showed no issues.

It is just the bilateral leg pain/ that travels to the toes.

My main symptoms are

Constant pain in legs
Pain or weakness when standing of sitting for too long
Intense episodes of Heating/ Sweating
Burning Feet
Headaches
Lacerating or stabbing pain in legs

Also

Cannot do straight leg raise
Weakness in legs
Hyporeflexia in Legs
Abnormal gait

I don’t meet with my Surgeon until April. I’m worried because perhaps this might be Epidural Fibrosis or Arachnoiditis. Wouldn’t the MRI ruled out these possibilities or can these still be origin of my problem?

Im schedule for an Epidural Steriod Injection Thursday, would that be advisable?

Donald Corenman, MD, DC
Moderator

March 3, 2020 at 6:38 am

Post count: 8660

#32211

Your symptoms could be from an unrelated neuropathy or just residual root compression recovery symptoms. An epidural steroid injection is a good idea. Make sure you get those lobs and if normal, give it some time for recovery.

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.

Sean22
Participant

March 3, 2020 at 9:49 am

Post count: 8

#32214

Okay, will do, thank you.
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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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