[Rustable]

#23276

56 y/o male here, 9 weeks post discectomy. I went for 10 weeks with sciatica which came on very suddenly while I was getting ready for work. Out of work for that period of time as I could not get into any posture to get away from the pain and accordingly could not sleep a wink for the duration of that time. Went through 8 chiro visits and 3 epidural shots with no lessening of symptoms. Neurologist said after looking at MRI (herniated disk at L4/L5) that he thought only surgery was going to get me relief and referred me to NS. The week before I saw the NS, I had been doing inversion on a Teeter table at 60 degrees for 5 min. at a time morning and night and was able to sleep several hours and returned to work. Don’t know if the Teeter was responsible for improvement or just the passage of time. The symptoms were better at time of NS consult but still there. He noticed that my right calf had atrophied and said that he thought I needed the surgery (I have never had any muscular weakness). Had the surgery and woke up without pain whatsoever. Walked every day (1/2 mile day of surgery) and was doing great. I am an avid cyclist (race geometry bike)…rode about 8 miles in town at 5 weeks with some fast intervals as I was feeling so good. I stood up on the pedals at regular intervals to stretch out and on the hills too. No problem as a result and I only rode one time At the 6th week, I started feeling some pain when I moved laterally left or right in the morning out of bed, but that burned off quickly and no problems for the rest of the day. By the 7th week, I was having trouble turning over in bed and getting out of bed and I was hitting that nerve more often. It is a very sharp pain like something is hitting the nerve root. Still no sciatica though the sharp pain will send a brief message on down the leg but nothing major. I called NS and he put me on a 12 day pack of prednisone which had little effect if any. I’m at 9 weeks now and saw NS yesterday for follow up. He said he didn’t know for sure but that he didn’t think I re-herniated. His best guess was that the vertebrae now since being altered are settling some. Said to take two Alleve, 2 times per day to address to stay on top of inflammation. He said MRI so soon after surgery would not give a clear picture to see what is or may be going on. Again, it is a very sharp pain when I happen to move a certain way that is a real eye opener. Otherwise during the day, I have very little pain or mostly a generalized pain in my low back, say a 3 on a scale of 1-10.

Couple of questions….Is this perhaps a case where the nerve simply doesn’t have enough room to avoid my hitting it in certain postures and will it perhaps go away with time? I really enjoyed getting into the Teeter inversion table but afraid to get into it now…what are your thoughts on inversion and would I ever be able to get into it again? I really want to get into cycling and love a good steep climb (foothills of the Appalachians here)….is the pressure of grinding up a climb going to be bad for my disk?

Thanks so much, I have really enjoyed looking over this forum and all of the information your site provides.

[Donald Corenman, MD, DC]

#23279

It takes about 6 weeks to form a scar over the disc space (the annular tear) and that scar is only about 20-30% as strong as the torn annulus. You certainly might have suffered a recurrent disc herniation. Symptoms might be different than the original herniation due to the position of the new herniation and any scarring that has occurred.

The pressure of the climb will increase intradiscal pressure and possibly cause a recurrent herniation but after the 8-12 week period post-operatively, you really cannot worry if that will happen as you have no control over that situation. I tell my patients that it is like worrying that you could be hit by a meteor when you walk to your car. Could it happen-yes but there is nothing you can do to prevent it. That is, other than making sure you don’t “BLT” (bend/load/twist) all at the same time. See the section https://neckandback.com/treatments/conservative-treatment-mechanical-lower-back-disorders/ to understand the biomechanics of the lower back.

Your symptoms also could be instability as your neurosurgeon states and the vertebra is “settling” but those symptoms are typically central (in the middle of the lower back) and not unilateral (only on one side). Do you have a tension sign (pain in one side of the lower back or buttocks) when you perform a hamstring stretch?

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.

[Rustable]

#23286

Thank you Dr Corenman for you kind response. Whereas when I had follow up with my NS on 11/24 and I was having some pain in my lower back and brief messages to my ankle area, today, my pain is worse today, a 5 to 6 which is constant, whether sitting or standing. The locus of pain is perhaps half inch to right of the incision and half inch down from that which is running into my right buttock. Now having constant sciatica, chiefly the right side of my calf and towards the back of my right ankle. No sciatica in the thigh or feet. No muscle weakness, no tingling. I did the hamstring stretch you referenced. Both legs were quite naturally tight as all I have been doing is walking and no stretching out of fear of triggering that nerve root which is quite an eye opener when I do. So…tightness but the stretch did not cause any pain on either side

As I mentioned in my OP, the pains from the original herniation came on quite suddenly. My current state has been a slow progression up to this point from 6 weeks post op and I am now 9 1/2 weeks out which is really odd to me but I suppose herniations can come out gradually just as well as suddenly.

If this is chiefly due to scarring and not herniation, is there anything that can be done? Would an epidural shot possible be of any help (I’ve already had 3 pre surgery)? If re-herniated, would there be any merit in getting another epidural before considering another discectomy? Finally, I have read your responses elsewhere here where you have indicated that MRIs can be done fairly soon after surgery. My N/S had said at my meeting with him on 11/24 that it is too soon and would not show anything conclusive. Any specific method of MRI I could mention to him that would be the best…with or without galadnium? I really want to rule in or rule out the re-herniation quickly especially since my insurance calendar year starts again in January. Thanks again. Best

[Donald Corenman, MD, DC]

#23300

It certainly could be a recurrent herniation but one fact against that is the lack of pain when you hamstring stretch (stretch your nerve root). You could have a seroma or hematoma (collection of serous fluid or blood causing local compression). The nerve could simply be swollen. This is where an MRI comes in handy. This imaging study can be very revealing even at this early date. Gadolinium is very helpful to understand the imaging at an early time after surgery.

The technique to try and prevent scar from attaching to the nerve root called “nerve flossing”. Hamstring stretches (carefully) after surgery should move the root and prevent the scar from adhering the root down to the disc space.

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.

[Rustable]

#23302

Thanks once again for your altruistic service to those of in back pain. Yesterday, I actually had a pretty good day, virtually no pain in my butt and lessening in my lower leg. Pretty good bit of pain in both butt and leg this morning for a while after getting out of bed but better now after two Alleves and heat pad. The day before that, I was 95% convinced I had re-herniated. Your response as above keeps me optimistic. I don’t see my NS until 12/5 but I am fairly sure I can call my neurologist and get him to order the MRI with Gadolinium as you recommended. If re-herniated, there should be no problem in getting into see the NS for earlier consult.

At time of surgery, he had indicated that he was not a fan of PT as he had had pts. that had gotten into trouble by doing it. Walking was about all he recommended. He’s a good patient guy but you have to really pull info out of him which is why I do so much research on my own. I don’t have doubt that his surgery was as good as anyone could have done so that’s good. I do wish to goodness that he had mentioned that doing the “nerve flossing” would keep the scar tissue at bay as I would have been doing it religiously.

So…couple of additional questions. If the MRI shows scar tissue, is there anything that can done about it and will flossing at this point help? What can be done if there is seroma or hematoma or do those conditions just simply reabsorb on their own.

[Donald Corenman, MD, DC]

#23303

Your surgeon can be correct if the PT does not understand spine rehabilitation but most of the long distance patients that have surgery here in Vail and rehabilitate at their location far from me seem to do well. I start PT 7-10 days after surgery. Flossing is always a technique that can be done at any time but is more effective if performed in the first six weeks.

Scar tissue always forms after surgery. If it is extensive, surgery can occasionally help but the success rate is under 60% generally. Sometimes, if there is a small recurrent herniation in the face of scar tissue, the effect of nerve compression is magnified as the nerve has less excursion due to the tethering of the nerve. Seroma/hematomas can be aspirated with an injection technique and then steroid placed after aspiration. This is generally very effective.

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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