Worsening symptoms 6 weeks post lumbar microdiscectomy.

Tagged: Continued symptoms after a lumbar microdiscectomy

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January 22, 2020 at 6:58 pm

Post count: 10

#31963

Dr.Corenman, I’ve been reading your posts for some time now and it has been very reassuring and supportive throughout my recovery time. I cannot thank you enough for “giving back” (as you’ve put it) as much as you have. You are clearly an expert in your field and your expertise and input is greatly valued. Thank you.
I will try my best below to get straight to the point.

Complaint: worsening radiculopathy in left glute/leg/foot 6 weeks post lumbar microdiscectomy.

symptoms:
“Soreness” radiating down left leg from glute.
Tingling in left foot not present pre-surgery.

straight leg raise from sitting position: I can do it, it just feels like im “over stretching” if that makes any sense.

Original surgery: microdiscectomy: L4-L5

MRI findings:
L4-L5: 6mm broad-based disc extrusion contribute to several central canal stenosis and severely narrows both lateral recesses with mass effect on the cauda equina. Mild bilateral facet arthrosis. Patent neural foramen.

L5-S1: The disc height is preserved. 2-3mm right paracentral disc protrusion moderately narrows the left lateral recess and may contact the descending S1 nerve root. Patent central canal noting the thecal sac relatively tapered at this point. The facet joints are maintained. The neural foramen are patent.

From the MRI to the operating room was about 7 months with pain in left leg becoming more pronounced over time.

Workers comp case.

My orthopedic surgeon is one of those “don’t want to know you” after surgery types. Can’t blame him.

I’m in my late 20’s and work a high impact and physically exhausting job on unever and unforgiving terrain.
I am not used to “taking it easy” for 3 months.

It is possible I may have over extended myself bending down to reach something in the refridgerator, putting on socks, walking up or down stairs or tossing and turning in my sleep. I do occasionally hear and feel “pops” and “cracks” not only in my spine but in my arms and legs as well. It is nothing out of the ordinary to adjust my upper back and here about four or five “cracks”. They are not painful.

Resting on my back with my legs slightly bent above a pillow does not help anymore.
Lying down with my legs straight does not help. Standing up for a matter of seconds can bring on symptoms.
Pacing around does, however, help.

I never asked but I am suspicious that my surgeon may have only addressed The L4-L5 situation and may have left the L5-S1 alone.

As far as possible inflammation, I have consulted my private insurance HMO and they have given me prednisone and scheduled me for physical therapy and another MRI. I am now on day three of taking 4 prednisone tablets at a time.

So far the prednisone is doing nothing.

So given the information, what do you think?

Donald Corenman, MD, DC
Moderator

January 30, 2020 at 7:42 am

Post count: 8660

#32020

Your MRI report; “L4-L5: 6mm broad-based disc extrusion contribute to several central canal stenosis and severely narrows both lateral recesses with mass effect on the cauda equina…L5-S1:… 2-3mm right paracentral disc protrusion moderately narrows the left lateral recess and may contact the descending S1 nerve root”. Based on this report, it is unlikely that the L5-S1 level is causing pain as the L4-5 level was much more severe. The statement “may contact the descending S1 nerve root” means that the root is not compressed.

You note “I never asked but I am suspicious that my surgeon may have only addressed The L4-L5 situation and may have left the L5-S1 alone”. Of course, I was not there but I assume your symptoms and examination pointed to the L5 root at the L4-5 level. The hypothetical proper surgery was an L4-5 decompression.

You note “My orthopedic surgeon is one of those “don’t want to know you” after surgery types. Can’t blame him”. I can. This behavior is inappropriate. He should be taking care of you until these symptoms resolve or there is a good explanation of why there are current symptoms. Is there a seroma, recurrent herniation, discal collapse with foraminal stenosis or ??????

“As far as possible inflammation, I have consulted my private insurance HMO and they have given me prednisone and scheduled me for physical therapy and another MRI”. Good. You need a new MRI with gadolinium.

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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