Thoracic Microdiscectomy Recovery/Reherniation Possibility?

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zlwalker
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December 12, 2020 at 5:41 pm

Post count: 31

#33471

Dr. Corenman,

I recently had a microdiscectomy, and I am really struggling with my recovery; I was hoping that I could gain some answers from a source outside of my own surgeon.

For some background: I am 28 years old (M), and I am in great shape for my age. However, I had been having massive flare-ups, and I was getting these stabbing pains in my ribs and hips/butt. I went to a doctor, and I discovered that I had a massive herniation at my T11/T12 that was compressing my spine. Two different surgeons noted that surgery would be my best option, and I agreed.

Six weeks ago, I had a successful thoracic microdiscectomy on my T11/T12. My surgeon actually noted that my disc was in two huge pieces, and he could see the compression ease up when he removed the pieces. However, my recovery has not gone according to plan. After coming out of the hospital, I felt really good: I was walking around, but I still had stabbing pains in my ribs and hips. On Day Two, I fainted when I was in the restroom. I don’t remember what happened afterwards, but apparently, I hit my head on the bathroom counter. Long story short, I suffered a concussion.

Since then, my recovery has not gone well. I am noticed that I get my nerve pains in my ribs, hips, and especially my lower back. Sometimes, I have no pain, and sometimes, I get the same pains as my original flare-ups such as the stabbing pains. In the hospital, they did a CT on my back, and it showed no damage. My wife called my doctors, and they both noted that it was unlikely that I reherniated my disc. They also noted that I would probably know if I reherniated, and they encouraged me to be patient. They told me that it is not uncommon for people to have the same types of pains that they did prior to surgery for days or weeks after surgery. Also, my incision site still hurts terribly, and if I am being honest, my mental state has diminished rapidly. I have severe anxiety and depression, and I think the concussion is not helping my case. I have given up, and I believe that I have reherniated my disc–even though there’s no proof that I have.

Overall, I am at a loss and looking for some guidance. I know I am only six weeks out out, but I think that my surgery might not have worked because I still have these pains. Every post I read talks about the “instant relief,” but no one talks about the after-effects.

I will say that most days, my pain levels are better. I used to have whole body pain from my ribs down: Everything from my ribs to my spine to my legs would hurt. At this point, I get “floating” pain that goes to different body parts, but it is never all at the same time like before. Additionally, I’m getting a lot of pins and needles feelings, which my doctors believe is a sign that the nerves are coming back. However, I still get flare-ups that knock out me out for an hour or so every couple of days.

I am just trying to find hope or light at the end of the tunnel, but I honestly feel as if my fall messed everything up/that the surgery failed. I have an MRI next week and a follow-up in two weeks, but I am so scared that I have reherniated/am not healing properly. Is this all typical for a thoracic discectomy, or does anything here look off in your opinion?

Thanks for any help or guidance. It is appreciated. Also, thanks for providing such a wonderful service to internet strangers. I am so thankful for you!

zlwalker
Participant

December 16, 2020 at 12:58 pm

Post count: 31

#33474

Dr. Corenman,

I appreciate your timely response in regards to my surgery and the possibility of a reherniation. I do not have the actual imaging itself, but I have the results of my MRI, and I do not know if they are good or bad. I was wondering if you could look at them to see if the results seem positive or negative! Thanks!

TECHNIQUE: Multiplanar, multisequence MR imaging of the thoracic spine was
obtained without contrast. Image quality is adequate

FINDINGS:
Alignment: Unremarkable. No vertebral body anomalies.

Bone marrow: Unremarkable. No fractures. No nonfat containing geographic marrow
signal abnormalities.

Thoracic cord: The cord is intrinsically unremarkable without intrinsic signal change or
syrinx. There is flattening of the thoracic cord at the T11-T12 level as described below.

Disc spaces: There is a persistent asymmetric broad-based disc bulge, right greater
than left, at the T11-T12 level. This produces mass effect on the ventral portion of the
thoracic cord and moderately narrows the central canal. Previously noted epidural disc
material is improved when compared to the prior exam particularly in the right lateral
recess when compared between the prior study (axial image 61) and the current exam
(axial image 24). There is post surgical change at this level from a right laminotomy. The
remainder of the disc spaces are preserved.

Soft tissues: Axial imaging redemonstrates a round lobulated T2 hyperintensity in the
medial aspect of the right hepatic lobe. Differential is as before.

IMPRESSION:
PERSISTENT MASS EFFECT ON THE THORACIC CORD AT THE T11-T12 LEVEL
THOUGH SLIGHTLY IMPROVED FROM THE PRIOR EXAM.

Donald Corenman, MD, DC
Moderator

December 19, 2020 at 11:58 am

Post count: 8660

#33479

You send me another new link breaking this chain. The answer is on the new link. Please don’t use a new link again.

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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