Still in pain after surgery

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Abbeygirl
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July 1, 2011 at 10:19 pm

Post count: 40

#4679

Hi Doctor I had back surgery 14 years ago it was a lectomey l5/s1 and have been pretty good up until 3months ago when I reinjured my back again had bad pain in left buttock and the back of left leg and numbness in left foot as well had ct scan and went back to the neurosurgeon who did my first operation I had MRI scans and he operatored on the s1 nerve after the operation I still had the same pain after a week I still had pain the nerosurgeon had me get a nerve block injection and then I went home still no improvement but I started getting pain in the right buttock as well and leg seemed to be getting pain in all different areas if not worse then before surgery went back to the surgeon he put me on nerentin and said I should feel better in about 10 days and still sore went back again last week and he got me to go for another MRI just received a phone call from his secretary today and she said there was no underlieing problem and that it was just inflammation and that he was going to organize another nerve block injecti

Donald Corenman, MD, DC
Moderator

July 2, 2011 at 12:41 am

Post count: 8660

#4680

According to your history, you had a laminotomy/ microdiscectomy at left L5-S1 14 years previously most likely for a herniated disc. You then re-herniated the same disc presumably on the same side 3 months ago. This is not uncommon as the recurrent herniation rate is about 10% in an active population.

You underwent a redo microdiscetomy at L5-S1 left and had no improvement after surgery and even developed symptoms in the opposite leg. A new MRI reportedly demonstrated no further nerve compression but inflammation only.

Some questions. Did you have any relief in the intensity of the left leg pain after surgery or did the pain change in quality or location? Does the pain increase when you sit and bend to tie your shoes or does it improve with those positions? Does the pain become worse with standing and walking or does it improve? Is the pain constant and does not change with any position and does it have a burning quality?

The reasons for those questions is that there are three potential sources of pain. One is that the pain source might have been not fully diagnosed. If you have foraminal stenosis (see website), you will have pain with standing that improves with sitting (the opposite of herniated disc nerve pain). The MRI will reveal foraminal stenosis if closely observed. This can be diagnosed with a selective nerve root block.

If there is a residual fragment of disc material that is still compressing the nerve, the MRI may also reveal it. Ask to review the MRI report from the radiologist. This report may be complicated, but it still can be interpreted.

Finally, you may have chronic radiculopathy. If the nerve has been injured by these recurrent herniations, after surgical decompression, the nerve needs time to heal. This occurs 90% of the time and heals by Mother Nature. Full healing is not always guaranteed and residual pain can continue. It may take 6 months to know if the nerve will heal. Epidural steroid injections are a good treatment as nerve inflammation is significantly reduced with these. Membrane stabilizers like Neurontin are also beneficial medications if there are minimal side effects.

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.

Abbeygirl
Member

July 2, 2011 at 2:30 pm

Post count: 40

#4681

Hi doctor thanks for your quick reply when I am standing it does hurt a lot more and when I try to bend back just a little it really hurts I just can not do it brings tears to the eyes also get pain in the left leg and also the bottom of my left foot goes numb got a appointment with orthapedic doctor on Monday hope I can get some help I need to get back to work thanks again for your reply I am starting to understand what might be wrong do you think that I should had a fusion at the l5/s1leval when I was doing pt the man said when he look at the ct scan that there was narrowing at that level and the disc that was there was black and very small which he said meant there was no fluid there he said that he could not help with pt and that I needed to see Nero and that he would put a cage in then when o went to see the Nero he said that he would do a nerve decompression of the s1 nerve I said that’s sounds better the what the pt said the said that because I had got 14 years out of the last op that he was going to go the same way so that I did not loose any movement just don’t know if I have did the right thing sorry for the long story

Donald Corenman, MD, DC
Moderator

July 2, 2011 at 9:52 pm

Post count: 8660

#4682

By your symptoms of pain with standing that becomes worse with bending back, you may have foraminal stenosis. Again- this problem is discussed at length in the website. The way to accurately diagnose this is with a highly selective nerve root block (see SNRB on website).

If the disc has collapsed and the foramen is narrowed, you could try to have a foramenotomy procedure as one of your surgeons suggests but the success rate for that procedure with a discal collapse is not as high as some others.

The TLIF procedure involving a fusion of this level uses the “cage” that some other physician has recommended. This procedure increase the height of the collapsed disc space to make more room for the nerve and is the best procedure for opening the foramen and increasing the space for the nerve.

If you did have a foramenotomy and the procedure was unsuccessful, you could always then have a TLIF procedure but that does possibly increase the chances of chronic radiculopathy (see website for this) from multiple surgeries and continuing compression of the nerve root.

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.

Abbeygirl
Member

July 3, 2011 at 1:19 am

Post count: 40

#4683

Thanks again doctor you explain things a lot clearer than anybody else has I just want to get better but I must admit I am getting a bit scared because I am still very sore and the symptoms are all over the place I have done everything that I have been told to do I have been taking nerotin and still have pain also I have been taking a fair amount of endone as well anyway thanks again for your information

Abbeygirl
Member

July 3, 2011 at 12:48 pm

Post count: 40

#4684

Hi doctor I sorry for keep on writing stuff but really I do not know what is going on I just brought the newspaper as I do not seem to be able to get comfortable I decided to lye on the floor on my stomach to read the paper which was a struggle on it own straight away had pain in my lower back but I persisted with it then my big toe on my right foot went numb so I got my daughter to take off my slipper then she rub it and after a few minutes got feeling back then my left big toe went numb but not as numb as the right more like a pins and needle numbness I then got up which was a struggle I don’t think I will be doing that in a hurry again I just do not know what is going on with me if you could you explain things so well is this normal to have these sort of problems thanks doctor for your help I just wish I was able to get to your practice thanks again for your information just one more thing I know it is hard without seeing films of my back but what are some of the reasons that I am getting numbness in my big toes for thanks again for your information
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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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