Struggling a bit 6months post l5s1 discectomy

Tagged: prior microdecompression surgery with continued symptoms

Viewing 6 posts - 1 through 6 (of 9 total)

1 2 Next

Author

Posts
Discodan
Participant

November 22, 2019 at 1:27 pm

Post count: 5

#31517

Hi there. Was hoping someone could throw some light on my back situ and maybe give some advice.

Background- I’m a 35 yr old male. I had been dealing with a back issue for 7+yrs before I had surgery. It started back when i was around 27/28 and had returned to running in an attempt to get fitter to get back playing football. I was in fairly good shape at the time but I noticed some discomfort/tightness in lower back after every run. I got physio a few times and rested up while doing core exercises in the gym but after a couple more attempts it had gotten worse. An mri a short time later showed a small bulge but the advice was to do core exercise which I did. I just got on with things and forgot about running.I cycled and walked to keep fit. The flare ups became more regular and couple of years later I ended up leaving my job as I felt spending 3+hrs a day in a car was making things worse. A flare up would be when my left buttock would tighten up really tight and I would get a dull pain down the left leg which left it hard to walk more than 200m. The physio would dry needle my glute and I would be back ok again until the next time.It was gradually getting worse and I noticed by late 2018 that doing a 7km walk was causing some discomfort and i found myself taking a pain killer before a walk to stay ahead of the pain. I was reducing my walking and I felt that it was now really getting worse almost by the month and I had to do something.

So I went to see a consultant and had an mri. He showed me where there was a small herniation at l5s1.I also noticed the disc was very thin. He booked me in for an injection which had no effect, infact I thought I was slightly worse after.

Surgery was the next option and I decided to go with it. He informed me after surgery that it was worse than he was expecting. He performed a posterior decompression of spinal cord/nerve root, by laminectomy, foraminotomy, facetectomy and/or discectomy, unilateral, 1. He said that had I not elected to go for it that it would have only been a matter of time before I was going to need it.

So now almost 7months out and I’m not progressing the way I hoped. Surgery was easy, I had no pain whatsoever although i was drugged up with targin amd lyrica. I just had to be careful for the first few days while I was getting stronger, and I was improving every day until around the 3 wk mark when I was starting to feel a little discomfort but more annoying was the numb tingling feeling I had on the left side of my lower back wrapping around my side. This only became noticeable after about 800m of walking. I reduced my walks to about 4x 600m walks a day. I found walking any more and the pain would increase.

At the 1month follow up the surgeon was happy enough and said it was normal for some pain to return and to have unusual sensations aswell. He gave me a script for more lyrica should I need it and said to walk as much as I can and come back at 3month mark. Over the next 2 months I had started to improve and I was increasing my walks and reducing lyrica and pain was subsiding. A wk before my 3month follow up I was off lyrica and only using panadol if needed, I was also up to walking a 5km walk once a day aswell as 2 or 3 5-6min walks. I was growing in confidence aswell and probably walking a bit faster. Then 1 wk before my 3month follow up i started to feel some pain again and I had to cut the walking right back down to a few very short walks again. I’ve noticed also that any day I do too much walking, along with feeling extra sore the next couple of days I would also have a really tight left calf muscle.?

So I informed consultant at 3month follow up and he asked how bad the pain was and could i walk through it. I said i only start to feel some pain now at 800m and it isnt bad but gets worse and the problem with walking through it is trying to sleep that night aswell as feeling worse the next day. I said also that I had been using the onset of pain as a guide to my limits and that was how I was building up my walking distance trying to go a little further every other day if I felt up to it. He said to go back on lyrica until you feel you can come off it while also trying to build the walking back up and see if you improve and come back at 6month mark.
I did that and after a month I started to improve again but like before when I had built up to about one 5km walk along with 2 or 3 5-6min walks the same thing happened. So I rested up for a week just doing very short walks and I decided to come off the lyrica over a 2 wk period which I did and I’m now taking nothing. While taking no meds I can walk about the house and sit down pretty much pain free but I start to feel some discomfort after walking 1km. My 6mth follow up was supposed to be 3wks ago but for some reason had to be put back until early December. I have since rang them to get me another mri before I see him.

The past 10days has been great though. I had a flu and had to go to my GP and he put me on a steroid aswell as anti biotic.
The steroid not only gave me a boost of energy but it has relieved my back symptoms a lot. Yesterday I did 2x 2.5km walks and i was active most of the day aswell without hardly any pain. I’m off the steroid 4days now and it’s still working seemingly. I know it will prob wear off soon though.

Any advice?

Donald Corenman, MD, DC
Moderator

November 23, 2019 at 9:25 am

Post count: 8660

#31518

I’ve summarized your history and symptoms here. “A flare up would be when my left buttock would tighten up really tight and I would get a dull pain down the left leg which left it hard to walk more than 200m….He booked me in for an injection which had no effect, infact I thought I was slightly worse after….small herniation at l5s1.I also noticed the disc was very thin….performed a posterior decompression of …nerve root…3 wk mark when I was starting to feel a little discomfort but more annoying was the numb tingling feeling I had on the left side of my lower back ….. This only became noticeable after about 800m of walking”.

By the interpretation of your complaints, you might have both isolated disc resorption (IDR) and foraminal stenosis. Doing the previous decompression surgery can remove compression from the nerve root but may eventually aggravate lower back pain due to IDR and aggravate foraminal stenosis. All-in-all, however, it sounds like you are functioning reasonably well so I don’t think you have to jump into further back surgery.

See
https://neckandback.com/conditions/isolated-disc-resorption-lumbar-spine-idr/ and
https://neckandback.com/conditions/lumbar-foraminal-stenosis-collapse/

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.

Discodan
Participant

November 23, 2019 at 11:51 am

Post count: 5

#31530

Thank you for your quick response and after reading both the IDR and Stenosis links you sent it’s seems to tie in with my symptoms and the mri imaging I saw of my l5s1 disc.

I suppose I’m also wondering what your thoughts are regarding the chances of my current symptoms improving given I’m now at 7months post op?? I’ve read that in some cases where a nerve has been compressed a long time (7yrs in my case) it can take much longer for the nerve to settle down. But I have interpreted that if I have IDR as a result of my surgery then the root cause of my symptoms now may not be from my decompressed nerve..

If my symptoms do not improve over the next few months, is there any other treatment other than surgery that can help my situation? I’ve noticed the oral steroid I took for my flu helped, does this mean a steroid injection may help? I suppose my end goal here is to get back working at maybe 75% capacity and being able to walk/cycle a good distance.

When you say not to jump into another surgery, are you saying that maybe I should be happy with where I am and settle for that? Maybe that is the way to go and I may have to get my head around that. I suppose I just love being active but I am aware that there are people in much worse situations than me.
I won’t be jumping into another surgery and if it’s suggested as an option to me Id definitely be getting a second opinion.

Thank you again for your response, it’s hard to get a response let alone and informed opinion on any other forum.

Donald Corenman, MD, DC
Moderator

November 28, 2019 at 3:12 pm

Post count: 8660

#31560

You can try an epidural steroid injection to calm down the nerve root and patiently see if you can slowly increase your capacity for exercise. When it’s time for further surgery is not easily definable. I like William Potter Stuart’s comment when he was asked to define pornography. He said “I can’t define it but I know it when I see it”.

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.

Discodan
Participant

December 2, 2019 at 4:12 am

Post count: 5

#31607

Seems pretty sound advice. I’ve been able to build up my exercise twice already before the flare up/setbacks so I’m still hopeful that I can do it again more patiently and steadily.
Im booked in for MRI and follow up on 9th/Dec so I will know more then.

Thank you again for getting back to me.

Donald Corenman, MD, DC
Moderator

December 4, 2019 at 11:04 am

Post count: 8660

#31618

Please keep in touch with the Forum for further developments.

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.
Author

Posts

Viewing 6 posts - 1 through 6 (of 9 total)

1 2 Next

You must be logged in to reply to this topic.

Donald Corenman, MD, DC

Average rating:

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel