Sciatica in opposite leg post surgery

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Alex
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August 3, 2021 at 9:00 pm

Post count: 4

#34243

Thank for answering questions on your forum. The information has been very valuable and wanted to express my gratitude in advance.

I recently had a hemilaminectomy and microdiscectomy on my l4-l5 area. This injury had been around for awhile but recently got worse this year. I was diagnosed with a disc bulge which was slightly worse on the right side vs left.

From what I understand, the surgeon told me he did the rift side and also removed thickened ligamentum. I asked about the left side and he said it was not bulged as much and the microdiscectomy procedure it would be difficult to decompress both sides. The good right side didn’t have as much sciatica so I just trusted that judgement.

Post surgery my bad side (right) has been pain free but I have been experiencing tingling and sciatica now often on the left (good side). It has been about a week post OP and I mentioned it to the surgeon and he said it wasn’t anything to worry about. No issues with incision site.

No motor weakness at all. Is this anything to be worried about right now or is it common? Admittedly if I had the same results on both legs I’d be happy but now the opposite leg is having issues and the treated one is completely fine.

Thanks again.

Donald Corenman, MD, DC
Moderator

August 5, 2021 at 9:04 am

Post count: 8660

#34244

I would have disagreed with your surgeon about the opposite side. It is certainly much more work to do both sides than a simple one-sided decompression. It is great that the operated side is now symptom-free and it well may be that the opposite side is “adjusting” to the surgery. It eventually also might well be symptom-free soon. Give it six weeks for the post-operative period and then assess your symptoms.

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.

Alex
Participant

August 5, 2021 at 4:41 pm

Post count: 4

#34245

Thanks for the response. Given that it is still early I am going to let it run its course for healing first.

I also had a question regarding fusion vs artificial discs. Does the same risk of adjacent segment disease run the same risk as a fusion? It seems on the surface the artificial disc is a obvious solution to replacing a damaged disc with mobility.

The surgeon did initially say that the disc was damaged and long term if it continues to be an issue a fusion or artificial disc replacement could be an option.

The main concern I have esp with a fusion is that it will eventually damage the rest of the discs and become a cascade of future surgeries

Donald Corenman, MD, DC
Moderator

August 6, 2021 at 1:01 pm

Post count: 8660

#34246

Artificial discs (ADRs) in the lumbar spine can be effective but not as well as you might think. In addition, if the ADR fails, there is no safe ability to revise it. See: https://neckandback.com/treatments/artificial-disc-replacement-adr-for-lumbar-spine/
Adjacent segment disease can occur at about a 2.5% rate per year which means in 10 years, there is a 25% chance of a breakdown above or below.

If your pain is strictly buttocks and leg pain and lower back pain is not an issue, I would stick with the simple decompression surgery.

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.

Alex
Participant

August 9, 2021 at 2:21 am

Post count: 4

#34253

Wow that’s quite interesting to learn about. I didn’t realize also they are under more stress in the lumbar level. I equated a disc replacement to a hip or knee replacement which have been used for quite some time. I can see now the desire for a fusion since it has been utilized for quite some time.

I will be patient with the process in the meantime. I suppose I will see where things are when I see the surgeon again in 6 weeks. I did call the office and he called me back relatively quick and stated again that it was probably fluid build up and it may take time to resolve. I had another surgery a long time ago and the doctor wouldn’t respond after the surgery unless I had an appointment. He always had an assistant relay his message.

There was something else I was curious about. I had a surgeon put in this request initially and it was denied by the insurance. His office was impossible to get ahold of anyone and I could never get a call back which is why I just left and went to the second one who did my surgery.

It was listed as a code CPT 62287

Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization, with discography and/or epidural injection(s) at the treated level(s), when performed, single or multiple levels, lumbar.

Is this not generally acceptable for a procedure? The letter said it was considered experimental.

Donald Corenman, MD, DC
Moderator

August 9, 2021 at 9:00 am

Post count: 8660

#34254

A percutaneous discal procedure is “deflating the tire” when the problem is the “jelly” (Use jelly instead of air) in the tire already has come out and is causing compression of the nerve. Taking more “jelly” (air) out of the tire simply deflates the tire even more without taking the mass compressing the nerve root off of the nerve. I would not endorse this procedure.

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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