Twitching/opposite side pain post microdiscectomy

Tagged: EDS, Ehlers Danlos

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Daniellemc
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January 8, 2020 at 10:32 pm

Post count: 4

#31881

Dr. Corenman, I had an l5-s1 microdiscectomy exactly 3 weeks ago today. The nerve root being pinched was on my left side. However, the original MRI showed I also had a herniation at l4-l5 but this disc was giving me no troubles at the time and so it was essentially ignored. That herniation was on the right side. After my l5-s1 microdiscectomy, my symptoms have been up and down. Every day has been completely different but I would definitely say it’s doing better than day 1 of the surgery. A couple things are sticking out to me though and I’m not sure if they should be looked at further. One, is that a lot of my trouble now is on the right side (where the l4-l5 herniation is located). As I mentioned before, this herniation never bothered me before surgery. It was not operated on nor was it even discussed. I have experienced tingling like I did in the left leg, sciatica type pain in my buttocks, and muscle twitching around my calf. These are all new. The twitching is usually when I am lying down but I have noticed I twitch quite a bit. I also twitch in the left side some, as well as in my back. It’s very prevalent at night. My second concern, is that the left leg has gained some sciatica pain back that had diminished completely after surgery. I tried to perform the straight leg test which I could not do before the surgery and was able to do it post op just fine. However, as of a couple days ago, that pain has returned and I’m unable to straighten all the way. My lower buttocks has also had a sharp pain in it. Nothing is radiating to the foot and the numbness is gone but the occasional tingling is there and the sciatica is definitely worse since I first woke up from surgery. I am so worried of reherniation. I also have Ehlers Danlos syndrome. I’m not sure if this would effect my symptoms or recovery in any way. I hope you are able to assist me in some way. Thank you!

Donald Corenman, MD, DC
Moderator

January 11, 2020 at 7:38 am

Post count: 8660

#31894

You underwent a left “l5-s1 microdiscectomy exactly 3 weeks ago today”. You then note “original MRI showed I also had a herniation at l4-l5 (right) but this disc was giving me no troubles at the time and so it was essentially ignored”.

This is not unusual to leave an asymptomatic herniated disc on the opposite side at a different level (depending upon the size of the disc herniation) as long as you had a conversation with potential risks.

“I have experienced tingling (on the right) like I did in the left leg, sciatica type pain in my buttocks, and muscle twitching around my calf. These are all new”.

It is not unheard of to have some symptoms occur on the opposite side with a preexisting but non-symptomatic disc herniation. Post-operative swelling can temporarily aggravate this HNP. As long as the symptoms are tolerable and no weakness associated with this nerve root is noted, this can be watched.

“My second concern, is that the left leg has gained some sciatica pain back that had diminished completely after surgery. I tried to perform the straight leg test which I could not do before the surgery and was able to do it post op just fine. However, as of a couple days ago, that pain has returned and I’m unable to straighten all the way. My lower buttocks has also had a sharp pain in it. Nothing is radiating to the foot and the numbness is gone but the occasional tingling is there and the sciatica is definitely worse since I first woke up from surgery”.

Post-operative recurrent disc herniations are not uncommon but other common post-operative disorders can occur which can increase nerve symptoms like post-operative swelling and a seroma (a collection of fluid). Give it some time and consider asking your surgeon for a short course of oral steroids. If symptoms continue to progress (get worse) or you have increased weakness, a new MRI should be considered.

“I also have Ehlers Danlos syndrome. I’m not sure if this would effect my symptoms or recovery in any way”. Generally Ehlers Danlos syndrome can increase the chances of herniation but does not get in the way of healing.

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.

Daniellemc
Participant

January 11, 2020 at 7:12 pm

Post count: 4

#31900

I’m not sure I was given any potential risks from my surgeon about the other asymptomatic herniation before surgery. He honestly never really discussed it with me. He only talked about the one we operated on but was aware of the other at the time. I also wanted to mention to you something else that just started today…I’ve had some popping in the back where the incision is that doesn’t really feel like the kind of pop when you crack your joints. It feels more like when things are sliding around over top of one another. It’s been doing this quite a bit tonight and if I stand in one position for even 1 minute, as soon as move it pops. It feels better when it does that though. It almost seems as if something is not positioned right? And it’s a little discomforting until I move and it does that little “pop”. I’m still only concerned about reherniation due to my ehlers and the symptoms that have come since surgery that I previously mentioned. I go back in 3 weeks but if you think I should call before then and update them about these symptoms I will definitely do so. Thank you for your time, Dr.

Donald Corenman, MD, DC
Moderator

January 12, 2020 at 9:39 am

Post count: 8660

#31905

With Ehlers Danlos syndrome, you are more mobile so some “popping” would not be unexpected due to your hypermobility. This can be a fact joint or even some small tendon or ligament sliding over a bony surface not unlike a guitar string being plucked. That I would not worry about at this time and it should settle down.

Your upper level opposite sided non-symptomatic herniation you should have had a discussion that it was not causing pain or numbness at the time but could in the future. If it was not large enough (a value judgement), it could be left alone as it was not symptomatic.

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.

Pashta
Participant

April 28, 2021 at 10:49 pm

Post count: 4

#34015

I’m new, I hope it’s ok to reply to another’s question here? I know hEDS is rare or at least rarely diagnosed, so I think I might be helpful here since I have been diagnosed with it as well. I have done a LOT of research on the subject and must say that yes, our type of EDS absolutely interferes with healing. I have personal experience with this from before I knew I had EDS. I had surgery and the healing was longer and left terrible scarring. I believe my main back problem is the lack of proper healing from an injury years ago, it seems to be how many people find out they have EDS is that they get injured and never heal or not properly. I was told to always tell a surgeon about EDS because it makes a big difference, for example I bled profusely during my surgery according to the doctor (EDS causes that). Hope that helps!
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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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