Microdiscetomy | Lumbar Decompression Recovery

The first six weeks is the immediate recovery phase. Your incision heals within the first two weeks. You are also recovering from the affects of surgery. You will be fatigued. It is like the fatigue felt the day after running a marathon and may last from one day to 2 weeks. Pain medication is used and can be fatiguing by itself. Constipation occurs from these medications and use of tricks for regular bowel movements is important. You learn how to handle yourself in small maneuvers such as getting into and out of bed and how to take a shower comfortably.
Driving can be started as soon as the 3 point test is passed (see section on when to start driving).

Walking is the cornerstone exercise during the first six to promote healing and is encouraged. Walking short distances and repeating laps in the beginning is a preferable. If you walk away from your home soon after surgery let’s say ½ mile and then are too fatigued to walk the ½ mile return, this creates a dilemma. I use to encourage walking as much as tolerated but when one patient walked 8 miles the day upon discharge from the hospital; I had to revise my advice to use more common sense and moderation

Self-regulated exercise during the first 6 weeks is helpful to speed recovery. You can get on a stationary bike as long as it is mostly upright (you don’t want to be on a trainer bent too forward so move the handlebar to the upright position). You can get on a treadmill to walk or even an elliptical as long as your arms are stationary

After having a microdiscectomy or decompression lumbar surgery, understanding of the symptoms that may be residual after the surgery is important. The three main symptoms that can remain are numbness, weakness and pain.

The nerve or nerves have been decompressed and recovery starts immediately. Pain should be reduced significantly. An interesting phenomena that some patients complain about is “new” reported onset of “numbness” in the area where the pain is now gone.

Numbness as reported by patients is not really numbness by definition. Numbness is a decreased sensation of the skin. A check of skin sensation is typically intact and normal in the area of reported numbness. What this complaint most likely stems from is really altered proprioception. Proprioception is the important sensation of position sense of your body in space. When you close your eyes, you automatically know where your right leg is. This is not magic but a series of sensors in your bone, tendon, muscle and ligament that respond to stretch and weight that tell your brain where your body is positioned.

If the nerve that conveys this sensation is not compressed and functioning properly, bizarre altered sensations occur such as “pins and needles” or a hot or cold sensation on the skin occur. Before surgery, the pain covers up these feelings and only after surgery when the pain is resolved do these sensations come to the attention of the patient.

If there was weakness of any muscle group, this weakness may take time to recover. Most of the time, within 6 months, the weakness will significantly improve but there are instances when the weakness can be permanent.

Recovery is based upon allowing the nerve to heal, the surgical incision to recover and the disc to accommodate to the biomechanics of the new situation. Motion of the back or the leg actually stretches the nerve which is both a positive and a negative. Motion prevents scar formation which can bind the nerve down. Motion however also stretches a healing nerve which is swollen which can contribute to further swelling. There is a happy medium or balance where nerve recovery is helped by motion but too much motion can inflame the nerve.

This is where a good physical therapist comes into play. Although occasionally even a great therapist can cause a freshly decompressed nerve root to become irritated. The physical therapist will advance your activities with each visit and council you as to activities that can be added and those that need to be curtailed. In addition, ergonomics (body position and techniques of lifting) will be drilled into your head (I hope). You hopefully will repeat the mantra “no BLT- no BLT- no BLT (no bending, twisting and lifting at the same time)!

For incision care, please see that specific section in this web site.

For being capable of driving, see that specific section in this web site.

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.

Microdiscectomy and Lumbar Decompression Recovery

About the Author: Donald Corenman, MD, DC

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