SLRT POSITIVE AFTER 4 days post op of L4L5 microdiscectomy and laminectomy

Tagged: Symptoms on opposite side after a microdisectomy

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Abhishar20
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December 25, 2018 at 1:27 am

Post count: 9

#29906

Hi Dr. Corenman,

I have been reading your forums regarding the recovery and things to expect after microdiscectomy and really appreciate you spend your valuable time for the patients over a blog.

I would like to provide a little history of my disc herniation, I had been suffering from sciatica in the left leg from buttocks to calf which was relieved while sitting and increased after standing or walking for more than 7 – 8 mins, and progressed to be in right leg as well with numbness and later on pain with same course. MRI revealed disc herniation last year september and i tried everything to get some relief with no benefits ever seen with any medicine or by physical therapy or ayurveda and then i consulted with another doc who progressively started the treatment with medrol as it showed a bit of a relief but but increased to be double the day i stopped the oral steroids. He asked for other MRI and c confirmed it cannot be relieved with ESI and be relieved from microdiscectomy. The surgery was performed on 18th dec 2018 and i had instant relief from all symptoms in right leg but the sciatica pain got increased in the left leg the problem originally started from 1 and a half years ago, my surgeon said its an edema pain and the nerve is irritated and it will improve with time and given me pregabalin, zinase D, and deflazocort 30, nothing works for me, the staple are yet to be removed most likely be removed by 31st dec 2018. I have SLRT positive at 20 degrees which was negative for 80 degrees 2 days after surgery, I can not walk for more than 2 minutes, I feel amaze when read people are in pain and can walk 2 miles. Please help me understand is it something else missed by the my surgeon, I feel pain all the time, on GCS, the pain is 3 -5 while sitt ing or lying and more on standing and walking. I have to join office from 2nd next year and i have a sitting job, I am curious to know what is happening or would I need to go for another surgery.

Thanks a lot for all your forums Dr. Corenman, you are a great hope for a people like me who are awaiting long enough to live the life Again the way they want.

Thanks a again.
Awaiting your reply

Donald Corenman, MD, DC
Moderator

December 25, 2018 at 2:06 pm

Post count: 8660

#29911

Your initial symptom comment; “I had been suffering from sciatica in the left leg from buttocks to calf which was relieved while sitting and increased after standing or walking for more than 7 – 8 mins” fits with lateral recess stenosis, central stenosis or foraminal stenosis. See:

https://neckandback.com/conditions/lumbar-spinal-stenosis-central-stenosis/
https://neckandback.com/conditions/lumbar-foraminal-stenosis-collapse/
https://neckandback.com/conditions/lateral-recess-stenosis/

Your symptoms on the opposite leg could be from inflammation due to surgery, a seroma that has pushed to the other side, a fragment of herniation that lodged on the other side during surgery, a missed fragment or discal collapse which occurs occasionally after a microdisectomy leading to any of the above conditions excluding central stenosis.

A new MRI would be warranted.

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.

Abhishar20
Participant

December 25, 2018 at 9:19 pm

Post count: 9

#29922

Thanks a lot for a quick reply Dr. Corenman

The symptoms which are aggravated after the surgery are in the same left leg.
Before surgery I could stand and walk for sometime and it didn’t pain while sitting or lying, now it pains all the time.
My surgeon says he has completely decompressed the nerve and only the calcified disc part is left inside and rest is removed.

Please let me know your thoughts on this.

Thank you Dr. Corenman

Donald Corenman, MD, DC
Moderator

December 26, 2018 at 9:39 am

Post count: 8660

#29925

If the symptoms are in the same leg as before the surgery but now worse, I would recommend a new MRI.

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.

Abhishar20
Participant

December 28, 2018 at 8:15 pm

Post count: 9

#29931

Thanks Dr. Corenman,

The staples will be removed on this 31st, and my surgeon said if the pain still persists he will get me the epidural block as he has also prescribed me medrol saying its only inflamed nerve.

I will anyway have the MRI done in a week time and will share the results with you.

Thanks a lot for your kind advice.

Thank again!

Donald Corenman, MD, DC
Moderator

December 29, 2018 at 10:04 am

Post count: 8660

#29932

Wait for the MRI before the epidural injection. If you have a seroma then the injections will know to aspirate the fluid before the injection. If you have a recurrent herniation, you will know that too.

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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